Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Oman: Current Situation and Going Forward

Al Awaidy, Salah T.; Khamis, Faryal

Between January and March, the season of dromedary camels breeding, races take place in these governorates. It is possible that during these months there is increased MERS-CoV circulation in the animal reservoir. The index cases were in contact with or resided on a farm where camels were kept. Individuals in close contact with dromedary camels are at an increased risk of acquiring the infection compared with the general population. 12 The transmission from camels to humans can be via direct contact with camels through respiratory droplets or saliva, or the use of camel products. 12 In the current outbreaks, we observed non-linked clusters and sporadic cases, in addition to nosocomial transmission in healthcare facilities with no evidence of sustained human-to-human transmission. 13 Although most MERS-CoV infected healthcare workers are asymptomatic, 13 serious infections can occur, and healthcare workers might play a critical role in spreading the virus within their area of practice in healthcare facilities. 14 Several factors could have contributed to the current transmission within healthcare facilities, including delays in suspicion and case detection, and providing close patient care without adherence to infection prevention and control (IPC) measures. Hospital transmission of MERS-CoV has been attributed to suboptimal infection control practices such as lack of personal protective equipment use, poor hand hygiene, delay in timely index case isolation, lack of negative pressure rooms, and performing aerosolizing procedures without appropriate personal protective equipment. Thus, there is an urgent need to reinforce the execution of basic IPC measures at all times in all healthcare facilities. Other pivotal interventions in reducing nosocomial transmission include prompt triaging, staff cohorting, and excluding non-essential staff and visitors. 6, 15 The current outbreak highlights the need for increased awareness among the public, particularly in individuals with comorbidities, who are at higher risk of complications and death. Awareness among this group should focus on avoiding close contact with camels or camel products, particularly in camel race festivals and breeding areas. 12 Stringent efforts are required to improve IPC to prevent transmission of the virus within healthcare facilities, to reduce mortality rates, and minimize community transmission. Institutional monitoring and training of healthcare workers remain the mainstay of disease prevention in healthcare facilities. 15 Furthermore, urgent adoption of the 'One Health' strategic approach (the collaboration of multiple disciplines and sectors working locally, nationally, and globally to attain optimal health for people, animals, and the environment), including establishing a robust, timely, integrated surveillance system, and strengthening the governorates capabilities for rapid and efficient investigation of the disease is critical in minimizing the risk of disease spread. r efer ences