1. Bashaer Mohammedsaleh

2.  Middle East Respiratory Syndrome Coronavirus.  Causes Respiratory failure  With small number of reported cases, info about transmission, severity, clinical impact.  Extraordinary large RNA virus.  A syndrome means it’s progressive.

3.  Starting June 2012 the 1 st patient (Saudi) was identified with it.  60 cases of deaths globally out of 138, 40 of which are Saudis or in SA.  Mortality 60%

4.  Similar to any respiratory disease e.g. common flu:  Cough and/or sneezing  Fever  Shortness of breath  Headache  Diarrhea and/ or vomiting  Dizziness

5.  Severe Acute Respiratory Syndrome, caused by SARS-CoV.  breakage in 2003, in China- Guangdong  1 st host are civets, then humans.  778 deaths out of 8098 infected patients.  Same symptoms, same incubation period (~12d)  Later respiratory failure (5d later).  Treated with O2 supplement, corticosteroids, and ribavirin.

6.  Less medical personnel infected.  Witnessed of person to person transmission, though with no clear evidence or basis.  Infected person seems with be personally close to patient.  Ribavirin and Interferon aren’t of much benefit.  Host camels (Oman, Canary Islands, and Egypt) and bats (Bisha, SA).  24% of cases and nosocomial --of hospital origin.

7.  Isolate patients, patient-to-medical personnel infection.  Treatment of evident symptoms.  No cure/ vaccine.  Influenza and Pneumococcal vaccinations recommended for ME travelers.

8.  Like all air-transmitted diseases:- the point is to keep sneezed or coughed water droplet min. in breathed air and, min. contact with those contaminated with them.  Washing hands properly with soap often.  Sneezing and coughing on a paper tissue and dispose it.

9.  Hygiene promoting brochures: wash hands, avoid direct sun exposure, don’t share personal items…  Over 337000 medical employee and volunteers in the season, present in pilgrimage site.  Medical care is free of charge.  Recommendations for those with higher risk of infection to post-pone it: pregnant ladies, children, elders >56y.

10.  WHO website: http://www.who.int/csr/disease/coronavirus _infections/en/ http://www.who.int/csr/disease/coronavirus _infections/en/  Saudi Ministry of Health website: http://www.moh.gov.sa/en/Hajj/Pages/defa ult.aspx http://www.moh.gov.sa/en/Hajj/Pages/defa ult.aspx  http://www.thelancet.com/journals/laninf/ article/PIIS1473-3099(13)70193-2/fulltext http://www.thelancet.com/journals/laninf/ article/PIIS1473-3099(13)70193-2/fulltext  http://www.ecdc.europa.eu/en/publications /publications/rra_mers-cov_7th_update.pdf http://www.ecdc.europa.eu/en/publications /publications/rra_mers-cov_7th_update.pdf