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WHO mission on Middle East respiratory syndrome coronavirus (MERS‐CoV) in Saudi Arabia

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WHO mission to Saudi Arabia13 September 2015 - A team of experts from the World Health Organization (WHO) Regional Office for the Eastern Mediterranean concluded a mission to Saudi Arabia to assess the current situation of the Middle East respiratory syndrome (MERS-CoV) following the report of a hospital outbreak in Riyadh city. The main objectives of the mission were to better understand the: 1) scope and basis for the repetitive hospital outbreak in the country; and 2) provide guidance on public health control measures undertaken by the government. The mission was led by the Assistant Director General of Health Security and Environment of WHO. 

Members of the WHO mission held discussions with high-level representatives from the Ministry of Health, visited the Command and Control Centre that has been leading all activities related to the control of the MERS-CoV, and toured the emergency and isolation facilities of the King Abdulaziz Medical City (KAMC), Ministry of National Guard Affairs and also visited the Prince Mohammed bin Abdulaziz Hospital, one of the three national reference hospitals for MERS-CoV in Saudi Arabia to assess the situation. The mission rounded off with a meeting with His Excellency the Minister of Health of Saudi Arabia and briefed him about the objectives and outcome of the WHO mission. 

The WHO mission identified that from the first week of July until 31 August, a total of 112 cases of MERS-CoV including 38 deaths were reported to have been linked to a hospital in Riyadh city which is currently facing this hospital outbreak of MERS-CoV. The mission found out that most of the nosocomial cases, reported from the hospital, where the outbreak is currently ongoing involved patient to patient infection. The mission also identified overcrowding in the emergency room coupled with breaches in compliance with infection control measures by some patients, visitors and healthcare workers triggered this nosocomial outbreak. The WHO mission was also informed that no multiple chains of transmission were detected either in the emergency room of the hospital where the outbreak is currently ongoing or in any other hospitals in Riyadh which also received patients who acquired the infection from the hospital experiencing the nosocomial outbreak.  

At the time of the mission, the MoH of Saudi Arabia was investigating how transmission might have occurred and potential risk factors, including duration of stay at the Emergency Room, movement of patients between Emergency Room and other in-patient departments and breaches in infection control measures.. 

The WHO mission appreciated the government for taking significant measures to contain the outbreak and limit its spread. The WHO Mission concluded that sharing of information, in future, with WHO on such essential control measures, the outbreak status as well as on the findings of investigation of such outbreaks in the form regular situation reports, would be a good practice to avoid unnecessary concern.

The current situation once again highlighted the fact that when confronted by an unforgiving emerging virus such as the MERS-CoV, even small lapses in the implementation of IPC practices at the level of individuals can lead to significantly large and dangerous outbreaks posing a risk not only to Saudi Arabia but to other countries as well. 

The mission, along with the Saudi Arabian health authorities, identified main areas that should be urgently addressed:

(i) Conducting systematic risk assessment of the evolving MERS-CoV situation on a regular basis as well as share such information through media release or in the form of a daily situation report aiming for domestic and international audiences; 

(ii) Document and broadly disseminate key lessons learnt and best practices for effective response to stop the transmission of MERS-CoV in healthcare settings. Such information will be valuable for improving public health preparedness at the global level against the emerging risk associated with this virus.  

(iii) Strengthen infection prevention and control practices in health care systems across the country in all hospital settings through developing a shared commitment and to identify and share practical institutional lessons on how to strengthen IPC standards in the country and also through conducting periodic educational programmes for the Emergency Room specialists on triage and adequate compliance to high standards of IPC practices;  

(iv) Pro-actively engaging the Ministry of Agriculture so that investigations and control measures for community acquired cases are jointly coordinated and conducted as a matter of routine. 

(v) Filling critical knowledge gaps in the science and epidemiology of MERS-CoV by conducting further research studies and by sharing the findings widely and rapidly;