ABU DHABI // Pregnant women in the Middle East with flu-like symptoms should be screened for the Mers coronavirus, doctors say.
Experts at Mafraq Hospital in the capital made the call after they led a landmark study into the death of an Abu Dhabi teacher who was believed to be the first pregnant woman confirmed to have contracted the disease.
The 32-year-old died in December 2013, shortly after delivering a daughter by Caesarean section.
For the study, researchers investigated the rapid deterioration of her health and concluded that changes in the immune systems of pregnant women may increase their susceptibility to infectious diseases.
Standard treatment for Mers patients may also not be appropriate for pregnant women, the study said.
Doctors initially diagnosed the teacher as having a bacterial infection. They later suspected pneumonia before further tests showed she had Mers.
She died two weeks after giving birth.
Dr Asim Malik, the study’s lead researcher and Mafraq Hospital’s head of infectious diseases, said routine screening procedures for pregnant women could help to detect Mers earlier than usual.
He added that more studies were needed to examine the effect of Mers on pregnant women.
“Pregnant women who seek medical care for pneumonia, influenza-like illness, or sepsis in the Arabian Peninsula may benefit from screening for Mers-CoV to ensure early diagnosis and management of this sometimes fatal disease,” Dr Malik wrote in the study summary.
“When the pregnant patient in our study sought medical care, she had atypical symptoms (fever and back pain, followed later by cough and shortness of breath).
“It is unclear if the delay in initiating antimicrobial therapy may have contributed to the fatal outcome.”
When the teacher first sought medical care at the hospital on November 19, 2013, after suffering from fever and back pain for four days, she was told that she had a urinary tract infection.
When she returned to the emergency room three days later with a fever, cough, and shortness of breath, she was admitted with suspected pneumonia.
Shortly afterwards, her condition worsened and she was admitted to the intensive care unit. The next day, she developed acute respiratory distress, which required mechanical respiratory and circulatory support. That spurred doctors to deliver her baby by Caesarean section that day.
She later tested positive for Mers before developing septic shock and dying on December 2.
In the study, Dr Malik said “little is known” about how Mers affected pregnant women or how it should be treated. But in the case of the teacher, it was “unlikely that the patient succumbed to a superimposed bacterial infection”.
Her husband and their then eight-year-old son were also admitted to hospital for the respiratory illness. Both of them recovered. Like his wife, the husband received antimicrobial treatment.
The couple’s other two children, including the newborn baby, tested negative for Mers.
The family had no travel history and no contact with people infected with Mers.
However, the husband later said that he and his wife had visited a farm with goats, sheep and camels 10 days before they fell ill.
The World Health Organisation (Who) advises people with chronic diseases (such as diabetes, renal failure, lung disease or those with a weak immune system) to avoid close contact with animals, particularly camels, when visiting farms, markets or barn areas.
To date, the Who has been notified of 1,621 laboratory-confirmed cases of Mers infection, including at least 584 related deaths. The last confirmed cases were reported in Saudi Arabia.
The UAE has not reported a case of Mers since June 21 last year.
The study, Middle East Respiratory Syndrome Coronavirus During Pregnancy, Abu Dhabi, United Arab Emirates, 2013, was published last month in the Emerging Infectious Diseases Journal - Centres for Disease Control and Prevention.
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