Thomas Pringle (Donegal South West, Independent)
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400. To ask the Minister for Health the actions his Department have taken in response to the increasing global health threat presented by emerging zoonotic diseases such as Middle East respiratory syndrome coronavirus, which emerged in Saudi Arabia in 2012 and which, although it is more limited than the previous SARS-CoV, has a much higher mortality rate; and if he will make a statement on the matter. [25908/15]

Leo Varadkar (Dublin West, Fine Gael)
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Middle East respiratory syndrome (MERS) is a viral respiratory disease caused by a novel coronavirus (MERS-CoV) that was first identified in Saudi Arabia in 2012. Coronaviruses are a large family of viruses that can cause diseases ranging from the common cold to Severe Acute Respiratory Syndrome (SARS). Typical MERS symptoms include fever, cough and shortness of breath. Pneumonia is common, but not always present. Gastrointestinal symptoms, including diarrhoea, have also been reported. Severe illness can cause respiratory failure that requires mechanical ventilation and support in an intensive care unit. Approximately 36% of reported patients with MERS-CoV have died. The virus appears to cause more severe disease in older people, people with weakened immune systems, and those with chronic diseases such as cancer, chronic lung disease and diabetes.

Although the majority of human cases of MERS have been attributed to human-to-human infections, camels are likely to be a major reservoir host for MERS-CoV and an animal source of MERS infection in humans. However, the exact role of camels in transmission of the virus and the exact route(s) of transmission are unknown. Between April 2012 and 26 June 2015, globally, 1355 laboratory-confirmed cases of infection with MERS-CoV including 483 related deaths have been reported to WHO.

The is an ongoing outbreak of MERS-CoV in South Korea. Up to 26 June, a total of 180 MERS-CoV cases, including thirty (30) deaths have been reported to WHO from South Korea and one case has been reported in China. Although the MERS-CoV cluster in South Korea is the largest observed outside of the Arabian Peninsula, the cluster remains limited to patients, visitors to patients and healthcare workers in a few healthcare facilities, and close relatives of the cases who were visiting the health facilities where the cases where admitted. The pattern noticed in Korean hospitals corresponds to what had been observed in Saudi Arabian hospitals, when extended transmission in hospital occurred following the admission of one case. This resulted in ‘super-spreader’ situations, amplified by the absence of triage in emergency rooms.

The Health Protection Surveillance Centre (HPSC) of the HSE acts as the focal point in Ireland for receipt of international alerts on communicable disease from the World Health Organisation under the International Health Regulations and also as focal point for early warning on emerging infectious disease threats in Europe as part of the European Early Warning and Response System (EWRS). These systems are monitored 24/7 by HPSC. In addition the European Centre for Disease control provides rapid risk assessments of emerging infectious threats including zoonotic diseases. These risk assessments are analysed and disseminated by HPSC as appropriate.

The HPSC has sent three recent alerts to clinicians in relation to MERS-CoV - on 2 June, 8 June and 17 June. The main points to note for clinicians/public health at this time are:

1. Continued clinical vigilance and awareness of the possibility of MERS Co-V in patients presenting with severe acute respiratory infection who have recently been in contact with healthcare services in South Korea and also those who have returned from the Middle East (the index case in the South Korean outbreak had a history of travel to the Middle East prior to illness onset). Note the possibility of atypical presentations in persons with immunosuppression.

2. The importance of eliciting a travel history from the aforementioned patients with severe respiratory disease cannot be overemphasised.

3. The prompt, systematic and strict implementation of infection prevention and control measures for such patients presenting in healthcare facilities is essential to interrupt transmission and to prevent health care-associated infections from MERS-CoV.See infection prevention and control guidance on HPSC website at .

Additional information and documents are available on the HPSC website.

The Scientific Advisory Committee of HPSC in 2005 established a Vector borne Subcommittee to monitor emerging threats posed by insect vectors. This Subcommittee remains vigilant for vector borne disease and, most recently has published a Ranking of Likelihood of Emergence of Selected Vector borne Diseases in Ireland (available on the HPSC website). This document and the work underpinning it, feeds into the ongoing threat assessment of European Centre for Disease Prevention and Control into vectorborne diseases.

In addition the Department of Foreign Affairs has issued travel advice on its website for those travelling to Middle East and to South Korea.