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 The male patient traveled via a British Airways flight on April 24
from Riyadh to London, where he changed flights at Heathrow airport
to fly to the United States. He landed in Chicago and took a bus to
an undisclosed city in Indiana.
On April 27, he experienced respiratory symptoms, including fever,
cough and shortness of breath. According to the Indiana State
Department of Health, the man visited the emergency department at
Community Hospital in Munster, Indiana, on April 28 and was admitted
that same day.
Because of his travel history, Indiana health officials tested him
for MERS, and sent the samples to the CDC, which confirmed the
presence of the virus on Friday.
The virus is similar to the one that caused Severe Acute Respiratory
Syndrome (SARS) which emerged in China in 2002-2003 and killed some
800 people. It was first detected in Saudi Arabia in 2012.
Dr. Anne Schuchat, director of the CDC's National Center for
Immunization and Respiratory Diseases, said on a conference call the
first U.S. case of MERS was "of great concern because of its
virulence," proving fatal in about a third of infections.
She said the case represents "a very low risk to the broader general
public," but MERS has been shown to spread to healthcare workers and
there are no known treatments for the virus.
Schuchat said the patient was now in stable condition and there are
no other suspected cases of MERS at the current time.
The CDC declined to identify the patient by name or say where he was
being treated. It also declined to say on which airlines or bus line
the patient traveled. Schuchat said the CDC was working with the
U.S. Department of Homeland Security to contact individuals who may
have been exposed to the patient during his travels.
In Britain, public health officials said they were contacting any
passengers who had been sitting near the patient.
Greg Cunningham, a spokesman for the Chicago Department of Aviation,
said that the department "has been advised that there is no reason
to suspect any risk at O'Hare," Chicago's main international
airport. "There has only been one incident confirmed to have MERS,
and he is hospitalized in Indiana," he said.
Officials at Community Hospital in Munster confirmed that the man
was in good condition, and said the hospital is "maintaining
appropriate isolation protocols for the protection of health care
staff."
The hospital, located in northwest Indiana about 30 miles from
Chicago, said it has been working with the CDC and the state health
department, and will be tracking the health of the patient's family
members and exposed health care workers daily during the next two
weeks to check for MERS symptoms.
"This patient was not out in the local community and, therefore, any
public exposure was minimal," the hospital said in the statement.
The hospital stressed that transmission of MERS requires close
contact, and said the patient's activities in the United States have
been very limited, reducing the risk of widespread transmission of
the virus.
WORKING SURVEILLANCE
Although the vast majority of MERS cases have been in Saudi Arabia
and other countries in the Middle East, the discovery of sporadic
cases in Britain, Greece, France, Italy, Malaysia and elsewhere have
raised concerns about the potential global spread of the disease by
infected airline passengers.
With the addition of the U.S. patient, 262 people in 12 countries
have been confirmed to have MERS infections and have been reported
to the World Health Organization. Of those, 93 have died, Schuchat
said.
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Infectious disease specialists in the United States said that the
fact the newest patient was identified quickly showed that disease
surveillance was working.
"It was only a matter of time before the United States had a case,"
said virologist Dr. W. Ian Lipkin of Columbia University in New
York. "Most of us thought it was not a question of if, but when. Am
I more concerned as a result of this case? No."
"One case does not represent a reason for panic," agreed Dr. Wayne
Marasco, an infectious disease specialist at Dana-Farber Cancer
Institute in Boston.
"But the very fact that we have a virus with documented
person-to-person transmission at a fairly efficient rate and a high
mortality rate suggests we have a potentially serious pathogen.
There are no therapies out there that I'm aware of, but I don't
think we have a very big risk in the United States."
Marasco suggests that immigration agents should nevertheless be on
heightened alert for passengers arriving in the United States after
trips to the Middle East, especially Saudi Arabia.
"They should ask, where did you travel? Have you had contact with
animals, with anyone who was sick, and do you have a fever or
cough?" he said.
Marasco does not believe that thermal scanners such as those China
and other countries deployed during the 2003 SARS epidemic would
make much of a difference. That's because the incubation period for
MERS is two to 14 days, "so an asymptomatic traveler could make it
through a thermal scanner," Marasco said.
MYSTERY OF TRANSMISSION
The greatest reason for concern is that so little is known about
this coronavirus. It has been found in bats and camels, and many
experts say camels are the most likely animal reservoir from which
humans become infected.
In part, that ignorance is a result of the lack of cooperation
between Middle Eastern countries, where MERS has been spreading, and
scientists elsewhere. "One of the biggest problems is that we
haven't had any access to samples from Saudi Arabia, Jordan or Qatar
despite my efforts," Marasco said
Now that the United States has a case of MERS, there might be
political pressure for that to change, suggested Lipkin, who pointed
out that during the SARS epidemic, China was similarly reluctant to
cooperate with western scientists.
"Now the U.S. is going to be more interested. I think it will have
an impact on the number of scientists here who will be encouraged to
work on MERS and congressmen will stand up and rail about the
importance of this," Lipkin said.
(Reporting by Julie Steenhuysen in Chicago and Sharon Begley in New
York; Additional reporting by Kate Kelland in London and Susan
Guyett in Indianapolis; Editing by Michele Gershberg, Tom Brown and
Lisa Shumaker)
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