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First cases of MERS in the United States are not unexpected

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Middle East Respiratory Syndrome has been in the news since the beginning of May when the first case surfaced in the United States and though it could be a danger, the true question that needs to be asked is how dangerous is it.

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But first to the facts of how the disease first appeared in the United States.

The first case was confirmed by the Centers for Disease Control and Prevention in Atlanta, Ga., on May 2 in a patient in Indiana and on May 11 a second case was confirmed by the agency in an individual in Florida.

Both individuals recently returned from Saudi Arabia where they were health care workers, which put them in an environment where they could be exposed to MERS. It was in Saudi Arabia where MERS was first reported in 2012 and it has since spread to surrounding countries in the region. There has been no connection found between the two patients other than the fact that they were healthcare workers in Saudi Arabia when they contracted the disease.

Then on May 16, an individual who had very casual contact with the Indiana patient tested positive for anti-bodies associated with MERS, meaning he had come in contact with the illness but did not show symptoms. An individual would show antibodies in their blood after having encountered an illness and in this case, his body's own defenses prevented him from becoming ill.

He was located after health officials began screening those who had come in contact with either of the two original patients. He is the only individual so far to show having had the infection after being with either of the people with MERS.

Both of the original individuals with MERS have recovered and have been released from the medical facilities where they were treated. They were only released from care after multiple screenings showed they tested negative for the virus and they had recovered from the original onset of the disease. All testing was done in conjunction with the state health departments where they were being treated and with the CDC.

So now the question is has the United States or for that matter anywhere else "dodged the bullet" when it comes to MERS? Clearly with the ability of pathogens to hitch rides on human hosts who travel around the world, the answer is no, but this does not mean the end of the world has come, as some more sensational news outlets would lead you to think.

In this world of global travel, an illness in one part of the world is only an airlines ticket away from reaching other countries, but the CDC is working to monitor all diseases in the world along with MERS.

“Given the dramatic increase in MERS cases in the Arabian Peninsula, we expected and are prepared for additional imported cases,” said Dr. Anne Schuchat, assistant surgeon general and director of CDC’s National Center for Immunizations and Respiratory Diseases. “The reason for this increase in cases is not yet known, but public health investigations are ongoing, and we are pleased to have a team in Saudi Arabia supporting some of those efforts.”

Now on to the facts of the virus itself.

MERS causes a viral respiratory illness that affects the lungs and bronchial tubes. Most of those who have the illness develop, in the words of the CDC are stricken with, "severe acute respiratory illness". The symptoms include fever, shortness of breath and cough. The fatality rate for those infected hovers around 30 percent.

The virus was first noted in humans in 2012 in Saudi Arabia. Since then it has spread to seven other countries in the Middle East region. When the illness surfaced, the search was on for the probable source of the virus and it settled on animals from the region. Contrary to what has been reported, it is not only found in camels.

Samples have been taken from animals around the globe by the World Health Organization that showed exposure to the virus. From hedgehogs and bats in southern China, Thailand, Europe, Mexico, Ghana and South Africa to camels in the Spanish Canary Islands, Oman and Egypt, the virus has been found.

In the first case of MERS, the animal that was traced to have carried the virus was the Taphozous perforates bat, commonly known as the Egyptian Tomb Bat. In testing, the virus found in bat dropping was a 100 percent match to that in the first individual with MERS in Bisha, Saudi Arabia. So it becomes obvious that not only a single animal can be infected with the virus, but as shown, a wide variety of creatures can.

Where the concern has come in and been expressed by many is the manner and ease at which the virus may be passed and the threat seems to be much less than some may think.

Both individuals who suffered from MERS here in the United States, undoubtedly became infected while on the job as healthcare workers in Saudi Arabia. This has been the case with nearly all other infections in the Middle East region. Those directly caring for MERS patients or living with them and having close contact were at risk. In each case, there was not general spread of the virus to the general public.

Studies by WHO have concluded that the illness is not an overwhelming threat to the general population.

"The relative ease with which outbreaks have been extinguished without resorting to overly aggressive isolation and quarantine measures and the limited secondary transmission around clusters, suggest that transmission of virus may be readily stopped," a WHO report stated.

When it comes to having spread to other nations, the United States seems to be late in having it happen. Cases have been reported in the United Kingdom, France, Tunisia, Italy, Malaysia, Turkey, Greece, Egypt and the Netherlands. In all cases where it has spread outside the country, there have not been outbreaks of the disease.

Until a vaccine is developed, there are steps travelers can take to avoid the disease as suggested by the CDC at the MERS in the Arabian Peninsula webpage.

  • Wash your hands often with soap and water. If soap and water are not available, use an alcohol.
  • Avoid touching your eyes, nose, and mouth. Germs spread this way.
  • Avoid close contact with sick people.
  • Be sure you are up-to-date with all of your shots, and if possible, see your health care provider at least 4–6 weeks before travel to get any additional shots.
  • Visit CDC’s Travelers’ Health website for more information on healthy travel.

For more information on MERS go to the CDC Middle East Respiratory Syndrome (MERS) webpage.

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