MERS-CoV: CDC Guidance for Clinical Surveillance, Management

Laurie Barclay, MD

September 27, 2013

In preparation for future cases of Middle East respiratory syndrome coronavirus (MERS-CoV) in the United States, the Centers for Disease Control and Prevention (CDC) has released recommendations for patient evaluation, case definitions, home care, travel, and infection control.

The guidance and a summary of worldwide epidemiologic information were published in the September 26 issue of the Morbidity and Mortality Weekly Report.

"[MERS-CoV] was first reported to cause human infection in September 2012 and is associated with high death rates," write Gayle Langley, MD, from the National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, and colleagues. "All cases have been linked through travel to or residence in Saudi Arabia, Qatar, Jordan, and United Arab Emirates. No cases have been reported in the United States."

Specific CDC Recommendations

  • Testing for MERS-CoV and other respiratory pathogens can be conducted simultaneously. Confirmation of another respiratory pathogen should not necessarily preclude testing for MERS-CoV in patients who develop fever and pneumonia or acute respiratory distress syndrome (ARDS) within 14 days after traveling from the Arabian Peninsula or nearby, or after close contact with a recent traveler from this area who has fever and ARDS.

  • Clusters of patients with ARDS should be evaluated for common respiratory pathogens and reported to local and state public health departments. Testing for MERS-CoV, even for patients without travel-related exposure, should be considered if the illnesses remain unexplained, particularly if the cluster includes healthcare providers.

  • Laboratory confirmation now requires a positive polymerase chain reaction of at least 2 specific genomic targets or a single positive target with sequencing of a second. Identifying another etiology does not exclude a person with an illness meeting this definition from being classified as a probable case.

  • Persons aged 65 years or older, children, pregnant women, and persons with chronic diseases, weakened immune systems, or cancer may wish to avoid or postpone travel to Saudi Arabia or consult a healthcare provider before deciding on such travel.

  • US travelers to the region should wash their hands often and avoid contact with ill persons. They should seek medical care if they develop fever with cough or shortness of breath during their trip or within 14 days of returning to the United States.

  • CDC has issued infection control checklists highlighting key actions for healthcare providers and facilities to prepare for patients with MERS-CoV. For hospitalized patients with known or suspected MERS-CoV infection, standard, contact, and airborne precautions are recommended.

  • Federal isolation and quarantine are authorized for MERS-CoV under Executive Order 13295, but the CDC is not currently restricting the movement of travelers from the Arabian Peninsula who have respiratory illness that is not confirmed or probable MERS-CoV infection. Persons with confirmed or probable MERS-CoV infection "should remain in isolation until they are no longer considered to be contagious according to current guidance."

"Although most reported cases involved severe respiratory illness requiring hospitalization, at least 27 (21%) involved mild or no symptoms," the report authors write.

"Despite evidence of person-to-person transmission, the number of contacts infected by persons with confirmed infections appears to be limited. No cases have been reported in the United States, although 82 persons from 29 states have been tested for MERS-CoV infection."

More detailed interim guidance regarding MERS-CoV patient evaluation, case definitions, travel, and infection control is available on the CDC's Web site.

The authors are from the CDC and have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2013;62(38):793-796. Full text

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