First MERS Case Reported in United States

Disclosures

May 02, 2014

The US Centers for Disease Control and Prevention (CDC) today announced the first confirmed case of deadly Middle East Respiratory Syndrome (MERS) in the United States, a development that a CDC official nevertheless called a "low risk to the broader general public."

The agency confirmed the MERS coronavirus (CoV) this afternoon in an unidentified healthcare provider who traveled from Riyadh, Saudi Arabia, by plane on April 24 to London, United Kingdom, and then to Chicago, Illinois, where the person took a bus to somewhere in Indiana. The traveler began to experience shortness of breath, coughing, fever, and other respiratory symptoms on April 27 and was admitted to an unnamed Indiana hospital the next day.

In a news briefing today, Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, said the patient, who was eventually put in isolation, is in stable condition.

MERS-CoV was first detected in Saudi Arabia in 2012. The World Health Organization (WHO) has received reports of 262 people in 12 countries, including the patient in Indiana, with confirmed infections, and of these, 93 have died, Dr. Schuchat said. There are more than 100 other confirmed cases not in the WHO tally.

There is no evidence of sustained transmission of the virus from person to person in a community setting, said Dr. Schuchat.

"The first US importation of MERs-CoV represents a very low risk to the broader general public," said Dr. Schuchat. At the same time, CDC and other public health authorities are taking "an abundance of caution" to protect the public.

She noted that the virus has spread more easily in hospital settings. "We should not be surprised if additional cases are identified among the healthcare providers who had close contact with this patient before the patient was isolated and special precautions were implemented," said Dr. Schuchat.

The CDC and other authorities are attempting to contact individuals who traveled with the patient by plane and bus, as well as other individuals who have been in close contact with the patient.

So far, "there is no evidence of anyone else with confirmed illness," said Dr. Schuchat.

Animal Reservoir for Virus in United States May Be Lacking

One immediate take-home lesson from the first reported MERS case in the United States is the need for clinicians in hospital settings to be extra cautious in caring for infected patients, said Paul Auwaerter, MD, clinical director of the Division of Infectious Diseases at Johns Hopkins University School of Medicine in Baltimore, Maryland. Among other things, that means donning high-quality masks, gowns, and gloves.

Dr. Auwaerter agreed with Dr. Schuchat's characterization of the Indiana MERS case as a low-risk threat to the general public at this point. Other countries with imported cases, he told Medscape Medical News, have not experienced "additional human-to-human transmission."

He also noted that conditions in the United States may be less conducive to MERS-CoV outbreaks than those where the virus was first detected. The virus probably enjoys a reservoir in camels, and possibly bats, on the Arabian Peninsula, he said.

"It's not clear that the virus has established any kind of reservoir in animals here," said Dr. Auwaerter. "We do not have camels."

The CDC is urging anyone who develops fever, cough, and shortness of breath within 14 days after traveling from countries in or near the Arabian Peninsula to see a clinician and inform him or her about their travels. At the same time, the agency is not recommending that Americans change their travel plans.

More information on the today's CDC announcement is available on the agency's Web site.

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