The Centers for Disease Control and Prevention (CDC) just issued updated information and guidelines for evaluation of patients for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection.
First identified and reported to cause severe acute respiratory illness in September 2012, MERS-CoV has caused infections worldwide, with 25 countries reporting cases to date. As of June 10, 2015, 1,219 laboratory-confirmed2 cases of MERS-CoV infection have been reported to and confirmed by WHO, including at least 449 (37%) deaths. The majority of cases (~85%) have been reported from KSA. All reported cases have been directly or indirectly linked through travel or residence to nine countries: KSA, UAE, Qatar, Jordan, Oman, Kuwait, Yemen, Lebanon, and Iran.
CDC continues to recommend that healthcare providers and health departments throughout the US be prepared to detect and manage cases of MERS. Healthcare providers should continue to routinely ask their patients about their travel history and healthcare facility exposure and to consider a diagnosis of MERS-CoV infection in persons who meet the criteria for patient under investigation (PUI), which has been revised to include considerations of recently being in a Korean healthcare facility and is available at http://www.cdc.gov/coronavirus/mers/case-def.html. Specifically, persons who meet the following updated criteria for PUI should be evaluated for MERS-CoV infection in addition to other common respiratory pathogens3 and reported immediately to state and local health departments:
A. Fever AND pneumonia or acute respiratory distress syndrome (based on clinical or radiologic evidence) AND one of the following:
- A 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
- A history of being in a healthcare facility (as a patient, worker, or visitor) in the Republic of Korea within 14 days before symptom onset, OR
- 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 in the US,
B. Fever AND symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath) AND a history of being in a healthcare facility (as a patient, worker, or visitor) within 14 days before symptom onset in a country or territory in or near the Arabian Peninsula in which recent healthcare-associated cases of MERS have been identified,
C. Fever OR symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath) AND close contact with a confirmed MERS case while the case was ill.
The above criteria serve as guidance for testing; however, patients should be evaluated and discussed with public health departments on a case-by-case basis if their clinical presentation or exposure history is equivocal (e.g., uncertain history of health care exposure).
For more detailed information, please visit http://emergency.cdc.gov/han/han00380.asp