Emerging Diseases:

MERS CoV dan Ebola Virus

Agung Dwi Wahyu Widodo

Prodi Mikrobiologi Klinik FK Unair/
RSUD Dr Soetomo Surabaya
 Subject
• Emerging Diseases
• MERS CoV
• Ebola Virus
Talaro and Chess, 2015
Ebola Hemorrhagic Fever-2014
SARS CoV-2003
Avian Influenza 2005
H1N1 Swine Flu-2009
H7N9 Influenza-2013
MERS-CoV 2012-2014
 Korea Selatan
20 Mei – 29 Juni

Kasus 182
Karantina 2562
Mati 33
Mortalitas 18,2%
 Spreading MERS Cases
Countries in the Countries with Travel-
Arabian Peninsula associated Cases
with Cases • United Kingdom (UK)
• Saudi Arabia • France
• United Arab Emirates • Tunisia
(UAE) • Italy
• Qatar • Malaysia
• Oman • United States of
• Jordan America (USA)
• Kuwait
MERS-CoV First Case in Human
 Abnormalities on Chest Imaging

The Day on Admission 2 day later

Identification of MERS-CoV
Merah: Infeksi pada Human
Abu-Abu: Cluster MERS-CoV
SARS CoV-2003
MERS-CoV 2012
Sign and Symptoms MERS-CoV
Gunakan Masker
Gunakan masker
 Standard, Contact, and Airborne
Precautions Recommended for Prevention
of MERS-CoV Transmission in Hospitals
 Case Definitions
• Patient Under Investigation (PUI)
• A patient under investigation (PUI) is a person with the following
characteristics:
• fever (≥38°C, 100.4°F) and pneumonia or acute respiratory distress
syndrome (based on clinical or radiological evidence);
AND EITHER
• history of travel from countries in or near the Arabian Peninsula within 14
days before symptom onset;
OR
• close contact with a symptomatic traveler who developed fever and acute
respiratory illness (not necessarily pneumonia) within 14 days after traveling
from countries in or near the Arabian Peninsula;
OR
• is a member of a cluster of patients with severe acute respiratory illness
(e.g. fever and pneumonia requiring hospitalization) of unknown etiology in
which MERS-CoV is being evaluated, in consultation with state and local
health departments.
 Case Definitions
• Confirmed Case
• A confirmed case is a person with
laboratory confirmation of MERS-CoV
infection.
• Probable Case
• A probable case is a PUI with absent or
inconclusive laboratory results for MERS-
CoV infection who is a close contact of a
laboratory-confirmed MERS-CoV case.
 Case Definitions
• Countries considered in or near the Arabian Peninsula: Bahrain,
Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian
territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates
(UAE), and Yemen.
• Close contact is defined as a) any person who provided care for
the patient, including a healthcare worker or family member, or
had similarly close physical contact; or b) any person who stayed
at the same place (e.g. lived with, visited) as the patient while the
patient was ill.
• Confirmatory laboratory testing requires a positive PCR on at
least two specific genomic targets or a single positive target with
sequencing on a second.
• Examples of laboratory results that may be considered
inconclusive include a positive test on a single PCR target, a
positive test with an assay that has limited performance data
available, or a negative test on an inadequate specimen.
 CDC Guideline for MERS CoV Infection
Komponen Rekomendasi
Patient placement Airborne Infection Isolation Room
(AIIR)
Personal Protective Equipment Gloves
(PPE) for Healthcare personnel Gowns
(HCP) Eye protection (goggles or face shield)
Respiratory protection that is at least
as protective as a fit-tested NIOSH-
certified disposable N95 filtering
facepiece respirator.
Environmental Infection Control Follow standard procedures, per
hospital policy and manufacturers’
instructions, for cleaning and/or
disinfection of:
Environmental surfaces and equipment
Textiles and laundry
Food utensils and dishware
Ebola Virus Disease
 Ebola Virus Disease (EVD)
• Ebola virus disease (EVD), formerly known as Ebola haemorrhagic
fever, is a severe, often fatal illness in humans.
• The virus is transmitted to people from wild animals and spreads in
the human population through human-to-human transmission.
• The average EVD case fatality rate is around 50%. Case fatality rates
have varied from 25% to 90% in past outbreaks.
• The first EVD outbreaks occurred in remote villages in Central
Africa, near tropical rainforests, but the most recent outbreak in
West Africa has involved major urban as well as rural areas.
• Early supportive care with rehydration, symptomatic treatment
improves survival. There is as yet no licensed treatment proven to
neutralise the virus but a range of blood, immunological and drug
therapies are under development.
• There are currently no licensed Ebola vaccines but 2 potential
candidates are undergoing evaluation.
Ebola Virus
 Transmission
• It is thought that fruit bats of the Pteropodidae family are
natural Ebola virus hosts.
• Ebola is introduced into the human population through
close contact with the blood, secretions, organs or other
bodily fluids of infected animals such as chimpanzees,
gorillas, fruit bats, monkeys, forest antelope and
porcupines found ill or dead or in the rainforest.
• Ebola then spreads through human-to-human transmission
via direct contact (through broken skin or mucous
membranes) with the blood, secretions, organs or other
bodily fluids of infected people, and with surfaces and
materials (e.g. bedding, clothing) contaminated with these
fluids.
 Symptoms of Ebola virus disease
• The incubation period, that is, the time interval from
infection with the virus to onset of symptoms is 2 to 21
days.
• Humans are not infectious until they develop symptoms.
• First symptoms are the sudden onset of fever fatigue,
muscle pain, headache and sore throat. This is followed by
vomiting, diarrhoea, rash, symptoms of impaired kidney
and liver function, and in some cases, both internal and
external bleeding (e.g. oozing from the gums, blood in the
stools).
• Laboratory findings include low white blood cell and
platelet counts and elevated liver enzymes
EVD Symptoms
 Diagnosis EVD
• It can be difficult to distinguish EVD from other
infectious diseases such as malaria, typhoid fever and
meningitis.
• Confirmation that symptoms are caused by Ebola virus
infection are made using the following investigations:
– antibody-capture enzyme-linked immunosorbent assay
(ELISA)
– antigen-capture detection tests
– serum neutralization test
– reverse transcriptase polymerase chain reaction (RT-PCR)
assay
– electron microscopy
– virus isolation by cell culture.
Screening criteria for EVD testing in
live patients
 Treatment and vaccines
• Supportive care-rehydration with oral or
intravenous fluids- and treatment of specific
symptoms, improves survival.
• There is as yet no proven treatment available for
EVD. However, a range of potential treatments
including blood products, immune therapies and
drug therapies are currently being evaluated.
• No licensed vaccines are available yet, but 2
potential vaccines are undergoing human safety
testing.
 Controlling infection in health-care
settings
• Health-care workers should always take standard precautions when
caring for patients, regardless of their presumed diagnosis. These include
basic hand hygiene, respiratory hygiene, use of personal protective
equipment (to block splashes or other contact with infected materials),
safe injection practices and safe burial practices.
• Health-care workers caring for patients with suspected or confirmed
Ebola virus should apply extra infection control measures to prevent
contact with the patient’s blood and body fluids and contaminated
surfaces or materials such as clothing and bedding. When in close contact
(within 1 metre) of patients with EBV, health-care workers should wear
face protection (a face shield or a medical mask and goggles), a clean,
non-sterile long-sleeved gown, and gloves (sterile gloves for some
procedures).
• Laboratory workers are also at risk. Samples taken from humans and
animals for investigation of Ebola infection should be handled by trained
staff and processed in suitably equipped laboratories
 WHO Guideline for Ebola Infection
Komponen
Patient placement, staff
allocation and visitors
Hand hygiene, personal
protective equipment and other
precautions
Injection safety and
management of sharps
Environmental cleaning and
management of linen
Waste management
Rekomendasi
Isolation Room
Hand Hygiene
Gloves Double
Gowns
Eye protection (goggles or face shield)
Respiratory protection that is at least
as protective as a fit-tested NIOSH-
certified disposable N95 filtering
facepiece respirator.
exclusively dedicated injection and
parenteral medication equipment
Arigato Gozaimasu