MERS-CoV -Middle East Respiratory Syndrome Coronavirus

Middle East Respiratory Syndrome Coronavirus, MERS-CoV, MERS cases in the United States, MERS in Orlando, MERS in Indiana, Signs and symptoms of MERS, How MERS is transmitted, what do I do if I'm think I have MERS,

UPDATE:

The first two cases of MERS has been reported within the U.S. both MERS cases came from outside the United State.  The first case was identified in Indiana and confirmed on May 2, 2014.  This patient is a resident of Saudi Arabia who traveled to the U.S.

On Monday May 12 the first MERS case was confirmed in an Orlando hospital.  The patient is a healthcare worker from Saudi Arabia and is visiting the U.S.  The patient flew from London to Boston then Atlanta, and arriving in Orlando on May 1st.  This patient was hospitalized on May 9 and was placed in isolation as soon as MERS-CoV was suspected.  As of the date of this posting there is no evidence of transmission to anyone within the U.S.

FACTS:

  • These cases of MERS represents a very low risk to the general public throughout the United States.
  • There have been no further cases of MERS identified with the United States.
  • CDC recommends that people protect themselves from all respiratory illnesses whether or not they know they are being exposed to MERS by frequent handwashing, using tissues when coughing or sneezing, voiding touching their face with unwashed hands, staying away from ill people, and disinfecting frequently touched surfaces.
  • CDC recommends that healthcare providers evaluate patients for MERS-CoV infection using CDC guidance (see the section of this post entitled, “What healthcare professionals should do”.  They should contact their stat or local health department if they have questions.

WHAT IS MERS and MERS-CoV

  • Middle East Respiratory Syndrome (MERS) is the illness caused by Middle East Respiratory Syndrome Coronavirus (MERS-CoV).
  • MERS-CoV is different from other coronaviruses that have been found to infect people.  MERS-CoV is not the same coronavirus that caused SARS in 2003.  However MERS-CoV has caused severe acute respiratory illness and pneumonia in many reported cases.
  •  Scientists are investigating clusters of MERS in countries in and near the Arabian Peninsula to learn how the initially infected people were exposed to the virus.  (the Arabian Peninsula include: Bahrain, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen.)
  • MERS-CoV has spread among family members and to care takers in hospital settings, where there was close contact but there is no evidence of continued sustained transmission within a community.
  • Studies have been done on animals including camels with the hope to identify where the virus came from.  Recent studies show evidence of MERS-CoV in three out of 14 camels on a farm, linked to two confirmed human infections from Qatar.
  • The gene sequences have also been identified in dromedary camels in Saudi Arabia and Egypt, which has been linked to human cases.
  • Other studies show that camels from several countries, including Egypt, Oman, and Spain, had antibodies to MERS-CoV.  This indicates that the animals had previous exposure to MERS-CoV or another virus which is closely related to MERS-CoV.
  • More studies have to be done to identify the role that camels, bats, and other animals play in possible transmission of MERS-CoV.

WHAT HEALTHCARE PROFESSIONALS SHOULD DO

  • Healthcare professionals should immediately report to their local health department any person being evaluated for MERS-CoV infection as a patient under investigation (PUI) data collection forms.  The forms can be found at http://www.cdc.gov/coronavirus/mers/data-collection.html
  • As soon as MERS -CoV infection is suspected, a mask should be placed on the patient and the evaluation should continue after the patient has been placed on airborne and contact precautions to prevent any additional exposures.
  • Healthcare professionals should evaluate patients for MERS-CoV infection who:
    • Have fever and pneumonia or acute respiratory distress syndrome (ARDS), and either
      • a history of travel from countries in or near the Arabian Peninsula within 14 days before symptom onset, or
      • have had 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.  The definition of close contacts is: 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) with the patient while the patient was ill.
      • are part of a cluster of patients with severe acute respiratory illness of unknown etiology in chichi MERS-CoV is being evaluated.
      • evaluate with assistance from your local health department anyone who has had close contact with a confirmed or probable case.
  • Patients with lower respiratory illness should also be evaluated for common causes of community-acquired pneumonia (e.g. influenza A and B, respiratory syncytial virus, Streptococcus pneumoniae, and Legionella pneumophila.   Testing for MERS-CoV and other respiratory pathogens can be done simultaneously.  Positive results for another respiratory pathogen such as influenza should not preclude testing for MERS-CoV because co-infection can occur.
  • Additional information, including criteria for PUI can be obtained at http://www.cdc.gov/coronavirus/mers/interim-guidance.html.
  • People who had close contact with a confirmed or probable case of MERS while the case was ill, if not using recommended infection control precautions (e.g. appropriate use of personal protective equipment), are at increased risk of developing MERS-CoV infection and should be evaluated and monitored by healthcare professionals with a higher index of suspicion.  See Interim Guidance for Health Professionals for more information at: http://www.cdc.gov/coronavirus/mers/infection-prevention-control.html.
  • CDC recommendations and guidance for healthcare providers, and laboratories can be found at www.cdc.gov/coronavirus/mers/interim-guidance.

SPECIMEN COLLECTION AND SHIPPING

Check with your local health department regarding collection and shipping.

  • For suspect cases, healthcare providers should collect the following specimens: nasopharyngeal swab, oropharyngeal swab (which can be placed in the same tube of viral transport medium), sputum, serum, and stool/rectal swab.

Contact your local health department to receive approval for collection and shipping.

INFECTION CONTROL

  • Any patient seeking care for symptoms consistent with MERS-CoV infection should be given a mask to wear and immediately placed in a private room with the door closed until an isolation room is available.
  • Healthcare providers and facilities can take key actions now to enhance preparedness for MERS-CoV infection prevention. See:www.cdc.gov/coronavirus/mers/preparedness.
  • Evaluation and care of the patient should be performed using standard, contact, and airborne precautions while awaiting confirmation of diagnosis.
  • Place a surgical mask on the patient whenever the patient is outside of the isolation room.
  • Healthcare providers should use eye protection in addition to disposable gowns, gloves, and respiratory protection when entering the isolation room.
  • Patient care equipment, such as stethoscopes and blood pressure cuffs, should be dedicated to the isolation room and not removed.
  • Environmental cleaning should be done with an EPA-registered hospital disinfectant following manufacturer recommendations play extra attention to toilets and high touch areas.
  • Persons who have had unprotected contact with the patient who is suspected to have MERS-CoV should be monitored for fever, cough or shortness of breath.

SYMPTOMS

  • Most persons confirmed with MERS-CoV infection have had severe acute respiratory illness.  Other symptoms include:
    • fever, cough, and shortness of breath
    • pneumonia
    • gastrointestinal symptoms, including diarrhea
    • kidney failure
    • More than 30% have died.
    • Some patients did no have any symptoms, or had only mild respiratory illness.

RISKS

  • Current available information show people with pre-existing health conditions or weakened immune systems may be more likely to become infected with, or have a severe case of, MERS.  (health conditions may include diabetes, cancer, chronic lung, health and kidney disease.

TRANSMISSION

MERS-CoV has infected people in other healthcare setting  in Saudi Arabia, France, Jordan, UAE, and Qatar.

  • A large MERS outbreak occurred in April through May 2013 in eastern Saudi Arabia and involved 23 confirmed cases in four healthcare facilities.
  • Additional hospital outbreaks are currently ongoing in Saudi Arabia and the United Arab Emirates.

TREATMENT

  • There is no vaccine to prevent MERS-CoV.
  • There is no antiviral treatment recommended for MERS-CoV infection.  Treatment is to manage symptoms.
    • Watch for symptoms:
      • fever >100 F. Take temperature twice a day.
      • coughing
      • shortness of breath
      • early symptoms may be chills, body aches, sore throat, headache, diarrhea, nausea/vomiting, and runny nose.

FOR MORE INFORMATION IN YOUR STATE VISIT YOUR LOCAL DEPARTMENT OF HEALTH WEBSITE

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