Be on the Lookout for MERS-CoV

Susan Gerber, MD


June 23, 2014

Editorial Collaboration

Medscape &

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Hello. I am Dr. Susan Gerber, a medical epidemiologist at the Centers for Disease Control and Prevention (CDC). I'm speaking with you as part of the CDC Expert Commentary series on Medscape.

Today I will provide an update on Middle East Respiratory Syndrome Coronavirus (MERS-CoV), including recent updates to CDC's interim guidance for health professionals on determining when to evaluate patients for MERS-CoV infection, collecting the appropriate specimens, and implementing the appropriate infection-control measures.

MERS is the viral respiratory illness caused by MERS-CoV. It was first reported in Saudi Arabia in 2012, and CDC, along with global health partners, has been closely monitoring it ever since.

In May 2014, the first 2 imported cases of MERS-CoV were confirmed in the United States.[1] These cases were not linked, but both were healthcare workers who traveled to the United States from Saudi Arabia, where they are believed to have been infected.

All reported cases to date have been directly or indirectly linked through residence or travel to countries in and near the Arabian Peninsula. Given the level of international travel, and based on the incidence of MERS-CoV in the Arabian Peninsula, imported cases in this country are not surprising.

It is expected that MERS-CoV will cause more cases globally, including in the United States. That is why healthcare providers should be prepared to detect people at risk for MERS-CoV infection. Be especially alert to patients who have symptoms consistent with MERS and links to places where MERS-CoV has been reported. This requires clinical judgment, because information about modes of transmission and clinical presentation is limited and continues to evolve.

You should evaluate patients for MERS-CoV infection if they have fever and pneumonia or acute respiratory distress syndrome (ARDS), with either 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 from a country in or near the Arabian Peninsula, within 14 days after traveling. You should also evaluate people who have had close contact with a confirmed or probable case of MERS-CoV while the patient was ill.

It is also important to evaluate people who have fever and symptoms of respiratory illness, such as cough or shortness of breath but not necessarily pneumonia, if within 14 days before symptom onset they were a patient, worker, or visitor at a healthcare facility in or near the Arabian Peninsula in which recent healthcare-associated cases of MERS-CoV have been identified.

Healthcare providers should immediately report patients under investigation to their state or local health department, using the case definitions on CDC's MERS-CoV Website. When evaluating patients for MERS-CoV, healthcare providers, including staff collecting specimens for testing, should follow CDC MERS-CoV infection-control recommendations and wear appropriate personal protective equipment including gloves, gowns, eye protection, and a respirator (mask) at least as protective as a NIOSH-certified N95 respirator.

What specimens should be collected? To increase the likelihood of detecting MERS-CoV infection in suspected cases, CDC recommends collecting multiple specimens from different sites at different times after symptom onset. You should prioritize collection of lower respiratory tract specimens including sputum, broncheoalveolar lavage fluid, and tracheal aspirate. It is also important to collect nasopharyngeal and oropharyngeal swabs, serum specimens, and stool and/or rectal swabs. It is important to contact your state or local public health department for help coordinating lab testing at state public health laboratories or CDC. See CDC's MERS-CoV Website for more information.

CDC continues to work closely with the World Health Organization and international partners to better understand the source of MERS-CoV, how it spreads, and the risks to public health. We are constantly updating our guidance and recommendations as the situation evolves and we learn more. You should stay informed about our latest guidance and recommendations by visiting CDC's MERS-CoV Website. If you have further questions on specimen collection or evaluating patients for MERS-CoV infection, you can contact your state or local health department. Thank you.

Web Resources


Information for Healthcare Providers (interim guidance, clinical features of MERS, case definitions, infection prevention & control recommendations, home care guidance, preparedness checklists)

Information for Laboratories (guidelines for clinical specimens, lab biosafety)

CDC Features: MERS Imported to US

World Health Organization: Coronavirus infections.

Dr. Susan Gerber is team lead for the Respiratory Viruses and Picornavirus Team, Division of Viral Diseases, at the Centers for Disease Control and Prevention (CDC). She received her MD from Loyola University and completed a pediatric residency and pediatric infectious disease fellowship at the University of Chicago. Dr. Gerber later joined the University of Chicago faculty in the section of pediatric infectious disease. Dr. Gerber acquired 14.5 years of experience in local public health with work on communicable diseases at the Cook County Department of Public Health and the Chicago Department of Public Health.