[net-gold] MEDICAL: DISEASES: MIDDLE EAST RESPIRATORY SYNDROME CORONAVIRUS : COUNTRIES: SAUDI ARABIA: Middle East Respiratory Syndrome Coronavirus (MERS-CoV): The Bottom Line for Clinicians
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- Date: Sun, 4 May 2014 22:47:03 -0400 (EDT)
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MEDICAL: DISEASES: MIDDLE EAST RESPIRATORY SYNDROME CORONAVIRUS :
COUNTRIES: SAUDI ARABIA:
Middle East Respiratory Syndrome Coronavirus (MERS-CoV):
The Bottom Line for Clinicians
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Middle East Respiratory Syndrome Coronavirus (MERS-CoV):
The Bottom Line for Clinicians
Susan Yox, RN, EdD
May 04, 2014
Medscape Multispeciality
http://www.medscape.com/viewarticle/824588
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Middle East respiratory syndrome (MERS) is a respiratory illness caused by
a coronavirus, usually referred to as the Middle East Respiratory Syndrome
Coronavirus, or MERS-CoV. A coronavirus also caused the outbreak of severe
acute respiratory syndrome (SARS), which led to almost 800 deaths in 2003.
.
MERS-CoV was first reported in Saudi Arabia in September 2012. In a press
release issued May 2, 2014, the US Centers for Disease Control and
Prevention (CDC) identified 401 confirmed cases of MERS-CoV infection in
12 countries, with all reported cases originating in the Arabian
Peninsula. Most patients developed severe acute respiratory illness, with
fever, cough, and shortness of breath, and 93 patients have died. The
overall mortality rate is 30%.
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On April 24, 2014, the World Health Organization (WHO) issued a statement
indicating, "although camels are suspected to be the primary source of
infection for humans, the exact routes of direct or indirect exposure
remain unknown. Investigations to identify the source of infection and
routes of exposure are still ongoing." (See also a recent article from
Emerging Infectious Diseases, "Human Infection With MERS Coronavirus After
Exposure to Infected Camels.")
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On May 2, 2014, the first confirmed case of MERS-CoV was reported in the
United States: A healthcare worker who was working in Saudi Arabia and who
traveled back to the United States on April 24 fell ill on April 27, went
to an unidentified hospital emergency department in Indiana on April 28,
and was admitted to the hospital that same day. On May 2, CDC testing
confirmed that the patient had MERS-CoV, and he/she remains in the
hospital, in isolation and in stable condition.
.
snip
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Topics Covered in this Article:
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What are the characteristics of patients diagnosed with MERS-CoV and how
communicable is the disease?
Which patients in the United States should be evaluated for MERS?
What lab specimens should I collect if I suspect MERS-CoV?
If I suspect a patient may have MERS-CoV, what infection control
precautions should be put into place?
Are antiviral drugs or other specific therapies recommended for the
treatment of MERS-CoV?
What should I tell patients who ask whether they may safely travel to
countries in the Arabian Peninsula?
.
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CDC announces first case of Middle East Respiratory Syndrome Coronavirus
infection (MERS) in the United States
MERS case in traveler from Saudi Arabia hospitalized in Indiana
Centers for Disease Control and Prevention
http://www.cdc.gov/media/releases/2014/p0502-US-MERS.html
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Press Release
Embargoed Until: Friday, May 2, 2014, 3:30 PM ET
Contact: CDC Media Relations
(404) 639-3286
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CDC announces first case of Middle East Respiratory Syndrome Coronavirus
infection (MERS) in the United States
.
MERS case in traveler from Saudi Arabia hospitalized in Indiana
.
Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was confirmed
today in a traveler to the United States. This virus is relatively new to
humans and was first reported in Saudi Arabia in 2012.
.
Weve anticipated MERS reaching the US, and weve prepared for and are
taking swift action, said CDC Director Tom Frieden, M.D., M.P.H. Were
doing everything possible with hospital, local, and state health officials
to find people who may have had contact with this person so they can be
evaluated as appropriate. This case reminds us that we are all connected
by the air we breathe, the food we eat, and the water we drink. We can
break the chain of transmission in this case through focused efforts here
and abroad.
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On April 24, the patient traveled by plane from Riyadh, Saudi Arabia to
London, England then from London to Chicago, Illinois. The patient then
took a bus from Chicago to Indiana. On the 27th, the patient began to
experience respiratory symptoms, including shortness of breath, coughing,
and fever. The patient went to an emergency department in an Indiana
hospital on April 28th and was admitted on that same day. The patient is
being well cared for and is isolated; the patient is currently in stable
condition. Because of the patients symptoms and travel history, Indiana
public health officials tested for MERS-CoV. The Indiana state public
health laboratory and CDC confirmed MERS-CoV infection in the patient this
afternoon.
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It is understandable that some may be concerned about this situation, but
this first U.S. case of MERS-CoV infection represents a very low risk to
the general public, said Dr. Anne Schuchat, assistant surgeon general and
director of CDCs National Center for Immunizations and Respiratory
Diseases. In some countries, the virus has spread from person to person
through close contact, such as caring for or living with an infected
person. However, there is currently no evidence of sustained spread of
MERS-CoV in community settings.
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CDC and Indiana health officials are not yet sure how the patient became
infected with the virus. Exposure may have occurred in Saudi Arabia,
where outbreaks of MERS-CoV infection are occurring. Officials also do not
know exactly how many people have had close contact with the patient.
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So far, including this U.S. importation, there have been 401 confirmed
cases of MERS-CoV infection in 12 countries. To date, all reported cases
have originated in six countries in the Arabian Peninsula. Most of these
people developed severe acute respiratory illness, with fever, cough, and
shortness of breath; 93 people died. Officials do not know where the virus
came from or exactly how it spreads. There is no available vaccine or
specific treatment recommended for the virus.
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In this interconnected world we live in, we expected MERS-CoV to make its
way to the United States, said Dr. Tom Frieden, Director, Centers for
Disease Control and Prevention. We have been preparing since 2012 for
this possibility."
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Federal, state, and local health officials are taking action to minimize
the risk of spread of the virus. The Indiana hospital is using full
precautions to avoid exposure within the hospital and among healthcare
professionals and other people interacting with the patient, as
recommended by CDC.
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In July 2013, CDC posted checklists and resource lists for healthcare
facilities and providers to assist with preparing to implement infection
control precautions for MERS-CoV.
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As part of the prevention and control measures, officials are reaching out
to close contacts to provide guidance about monitoring their health.
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While experts do not yet know exactly how this virus is spread, CDC
advises Americans to help protect themselves from respiratory illnesses by
washing hands often, avoiding close contact with people who are sick,
avoid touching their eyes, nose and/or mouth with unwashed hands, and
disinfecting frequently touched surfaces.
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The largest reported outbreak to date occurred April through May 2013 in
eastern Saudi Arabia and involved 23 confirmed cases in four healthcare
facilities. At this time, CDC does not recommend anyone change their
travel plans. The World Health Organization also has not issued Travel
Health Warnings for any country related to MERS-CoV. Anyone who develops
fever and cough or shortness of breath within 14 day after traveling from
countries in or near the Arabian Peninsula should see their doctor and let
them know where they travelled.
For more information about MERS Co-V, please visit:
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Middle East Respiratory Syndrome:
http://www.cdc.gov/coronavirus/mers/index.html
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About Coronavirus:
http://www.cdc.gov/coronavirus/about/index.html
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Frequently Asked MERS Questions and Answers:
http://www.cdc.gov/coronavirus/mers/faq.html
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Indiana Department of Health
http://www.state.in.us/isdh/External Web Site Icon
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WHO RISK ASSESSMENT
Middle East respiratory syndrome coronavirus (MERS - CoV)
24 April 2014
Summary of available information
http://www.who.int/csr/disease/
coronavirus_infections/MERS_CoV_RA_20140424.pdf?ua=1
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A shorter URL for the above link:
.
http://tinyurl.com/m6yj33c
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Emerging Infectious Diseases
Human Infection With MERS Coronavirus After Exposure to Infected Camels
Saudi Arabia, 2013
Medscape Multispecialty
Ziad A. Memish, Matthew Cotten, Benjamin Meyer, Simon J. Watson, Abdullah
J. Alsahafi, Abdullah A. Al Rabeeah, Victor Max Corman, Andrea Sieberg,
Hatem Q. Makhdoom, Abdullah Assiri, Malaki Al Masri, Souhaib Aldabbagh,
Berend-Jan Bosch, Martin Beer, Marcel A. Mler, Paul Kellam, Christian
Drosten
Disclosures
Emerging Infectious Diseases. 2014;20(6)
http://www.medscape.com/viewarticle/823311
We investigated a case of human infection with Middle East respiratory
syndrome coronavirus (MERS-CoV) after exposure to infected camels.
Analysis of the whole human-derived virus and 15% of the camel-derived
virus sequence yielded identical nucleotide polymorphism signatures
suggestive of cross-species transmission. Camels may act as a direct
source of human MERS-CoV infection.
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Introduction
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Middle East respiratory syndrome coronavirus (MERS-CoV) was identified in
2012 in a cell culture taken from a patient who died of pneumonia in Saudi
Arabia.[1] Since 2012, at least 187 laboratory-confirmed human cases of
MERS-CoV infection, most resulting in respiratory tract illness, have been
reported to the World Health Organization; 97 of these cases were fatal.
Known cases have been directly or indirectly linked to countries in the
Arabian Peninsula.[2] Dromedary camels across and beyond the region show
high rates of antibodies against MERS-CoV,[37] and viral RNA has been
detected in camels in different countries.[8,9] In 1 instance, a camel and
2 humans caring for the camel were found to be infected with viruses that
were highly similar but distinct within 4,395 nt of the camel-derived
virus sequence, including several phylogenetically informative nucleotide
changes.[10] To investigate possible camelhuman virus transmission, we
analyzed an infection with MERS-CoV in a man after he had contact with an
infected camel.
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First MERS Case Reported in United States
Robert Lowes
DisclosuresMay 02, 2014
Medscape Multispecialty
http://www.medscape.com/viewarticle/824553
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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.
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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.
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There is no evidence of sustained transmission of the virus from person to
person in a community setting, said Dr. Schuchat.
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"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.
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Middle East Respiratory Syndrome (MERS)
Centers for Disease Control and Prevention
http://www.cdc.gov/coronavirus/mers/guidelines-clinical-specimens.html
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Interim Guidelines for Collecting, Handling, and Testing Clinical
Specimens from Patients Under Investigation (PUIs) for Middle East
Respiratory Syndrome Coronavirus (MERS-CoV) Version 2
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Summary of Changes in Version 2
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This is an updated version of the interim guidance document issued by the
Centers for Disease Control and Prevention (CDC) June 7, 2013. CDC has
revised the interim guidance based on comments received from public health
partners, healthcare providers, professional organizations, and others.
CDC will continue to update the document as necessary to incorporate new
information that increases our understanding of MERS-CoV.
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Updates:
Modified the title of the document to reflect additional testing
guidelines
Expanded the Specimen Type and Priority section to better describe
what specimens are preferred for testing
Expanded the Blood Components Serum section to better describe
available testing options based on time between symptom onset and serum
collection
Revised Summary of MERS-CoV rRT-PCR Testing Guidelines for Respiratory
Specimens that describes reporting MERS-CoV test results and testing for
other respiratory pathogens
.
Before collecting and handling specimens for Middle East Respiratory
Syndrome Coronavirus (MERS-CoV) testing, determine whether the person
meets the current definition for a patient under investigation (PUI) for
MERS-CoV infection prepared by the Centers for Disease Control and
Prevention (CDC). See case definitions.
Specimen Type and Priority
.
To date, little is known about pathogenic potential and transmission
dynamics of MERS-CoV. To increase the likelihood of detecting infection,
CDC recommends collecting multiple specimens from different sites at
different times after symptom onset, if possible.
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Points to consider when determining which specimen types to collect from a
patient under investigation for MERS include:
The number of days between specimen collection and symptom onset
Symptoms at the time of specimen collection
.
Additional points to consider:
Maintain proper infection control when collecting specimens
Use approved collection methods and equipment when collecting
specimens
Handle, store, and ship specimens following appropriate protocols
.
Lower respiratory specimens are preferred, but collecting nasopharyngeal
and oropharyngeal (NP/OP) specimens, as well as stool and serum, are
strongly recommended depending upon the length of time between symptom
onset and specimen collection. For example, if symptom onset for a PUI
with ongoing lower respiratory tract infection was 14 or more days ago, a
single serum specimen for serologic testing (see Section II. Blood
Components Serum) in addition to a lower respiratory specimen and an
NP/OP specimen (see Section I. Respiratory Specimens) are recommended.
.
Respiratory specimens should be collected as soon as possible after
symptoms begin ideally within 7 days and before antiviral medications are
administered. However, if more than a week has passed since symptom onset
and the patient is still symptomatic, respiratory samples should still be
collected, especially lower respiratory specimens since respiratory
viruses can still be detected by rRT-PCR.
General Guidelines
.
For short periods (? 72 hours), most specimens should be held at 2-8C
rather than frozen. For delays exceeding 72 hours, freeze specimens at
-70C as soon as possible after collection (with exceptions noted below).
Label each specimen container with the patients ID number, specimen type
and the date the sample was collected.
.
I. Respiratory Specimens
.
A. Lower respiratory tract
.
Broncheoalveolar lavage, tracheal aspirate, pleural fluid
.
Collect 2-3 mL into a sterile, leak-proof, screw-cap sputum collection cup
or sterile dry container. Refrigerate specimen at 2-8C up to 72 hours; if
exceeding 72 hours, freeze at -70C and ship on dry ice.
Sputum
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Have the patient rinse the mouth with water and then expectorate deep
cough sputum directly into a sterile, leak-proof, screw-cap sputum
collection cup or sterile dry container. Refrigerate specimen at 2-8C up
to 72 hours; if exceeding 72 hours, freeze at -70C and ship on dry ice.
.
B. Upper respiratory tract
.
Nasopharyngeal AND oropharyngeal swabs (NP/OP swabs)
.
Use only synthetic fiber swabs with plastic shafts. Do not use calcium
alginate swabs or swabs with wooden shafts, as they may contain substances
that inactivate some viruses and inhibit PCR testing. Place swabs
immediately into sterile tubes containing 2-3 ml of viral transport media.
NP/OP specimens can be combined, placing both swabs in the same vial.
Refrigerate specimen at 2-8C up to 72 hours; if exceeding 72 hours, freeze
at -70C and ship on dry ice.
.
Nasopharyngeal swabs - Insert a swab into the nostril parallel to the
palate. Leave the swab in place for a few seconds to absorb secretions.
Swab both nasopharyngeal areas.
Oropharyngeal swabs - Swab the posterior pharynx, avoiding the tongue.
Nasopharyngeal wash/aspirate or nasal aspirates
.
Collect 2-3 mL into a sterile, leak-proof, screw-cap sputum collection cup
or sterile dry container. Refrigerate specimen at 2-8C up to 72 hours; if
exceeding 72 hours, freeze at -70C and ship on dry ice.
II. Blood Components
.
Serum (for serologic testing)
.
For serum antibody testing: Serum specimens should be collected during
the acute stage of the disease, preferably during the first week after
onset of illness, and again during convalescence, ? 3 weeks after the
acute sample was collected. However, since we do not want to delay
detection at this time, a single serum sample collected 14 or more days
after symptom onset may be beneficial. Serologic testing is currently
available at CDC upon request and approval. Please be aware that the
MERS-CoV serologic test is for research/surveillance purposes and not for
diagnostic purposes - it is a tool developed in response to the MERS-CoV
outbreak. Contact CDCs Emergency Operations Center (EOC) (770-488-7100)
for consultation and approval if serologic testing is being considered.
Serum (for rRT-PCR testing)
.
For rRT-PCR testing (i.e., detection of the virus and not antibodies), a
single serum specimen collected optimally during the first week after
symptom onset, preferably within 3-4 days, after symptom onset, may be
also be beneficial.
.
Note: These time frames are based on SARS-CoV studies. The kinetics of
MERS-CoV are not well understood and may differ from SARS-CoV. Once
additional data become available, these recommendations will be updated as
needed.
.
Children and adults. Collect 1 tube (5-10 mL) of whole blood in a serum
separator tube. Allow the blood to clot, centrifuge briefly, and separate
sera into sterile tube container. The minimum amount of serum required for
testing is 200 L. Refrigerate the specimen at 2-8C and ship on ice- pack;
freezing and shipment on dry ice is permissible.
.
Infants. A minimum of 1 mL of whole blood is needed for testing of
pediatric patients. If possible, collect 1 mL in an EDTA tube and in a
serum separator tube. If only 1 mL can be obtained, use a serum separator
tube.
.
EDTA blood (plasma)
.
Collect 1 tube (10 mL) of heparinized (green-top) or EDTA (purple-top)
blood. Refrigerate specimen at 2-8C and ship on ice-pack; do not freeze.
III. Stool
.
Collect 2-5 grams of stool specimen (formed or liquid) in sterile,
leak-proof, screw-cap sputum collection cup or sterile dry container.
Refrigerate specimen at 2-8C up to 72 hours; if exceeding 72 hours, freeze
at -70C and ship on dry ice.
IV. Shipping
.
Specimens from suspected MERS cases must be packaged, shipped, and
transported according to the current edition of the International Air
Transport Association (IATA) Dangerous Goods RegulationsExternal Web Site
Icon. Shipments from outside of the United States may require an
importation permit that can be obtained from CDC.
.
Specimens should be stored and shipped at the temperatures indicated
above. If samples are unable to be shipped within 72 hours of collection,
they should be stored at -70C and shipped on dry ice. When shipping frozen
specimen from long distances or from international locations, it is best
to use a combination of dry ice and frozen gel ice-packs. The gel
ice-packs will remain frozen for a day or two after the dry ice has
dissipated.
.
All specimens must be pre-packed to prevent breakage and spillage.
Specimen containers should be sealed with Parafilm and placed in ziplock
bags. Place enough absorbent material to absorb the entire contents of the
Secondary Container (containing Primary Container) and separate the
Primary Containers (containing specimen) to prevent breakage. Send
specimens with cold packs or other refrigerant blocks that are
self-contained, not actual wet ice. This prevents leaking and the
appearance of a spill. When large numbers of specimens are being shipped,
they should be organized in a sequential manner in boxes with separate
compartments for each specimen.
.
CDC recommends against the following:
.
Do not place any dry ice in the "Primary Container" or "Secondary
Container", foam envelopes, ziplock bags, cryovial boxes, or hermetically
sealed containers.
Do not place Primary Containers sideways or upside down in ziplock
bags.
Do not use red top Secondary Containers for Category A Infectious
Substances.
Do not place any paperwork in the Secondary Containers or ziplock
bags, so as not to damage the paperwork.
Do not use biohazard/autoclave bags to prepack your materials due to
the inadequate seal of these bags.
.
For additional information, consultation, or the CDC shipping address,
contact the CDC Emergency Operations Center (EOC) at 770-488-7100.
Specimens should be shipped for overnight delivery - if Saturday delivery
is planned, special arrangements must be made with the shipping company.
Summary of MERS-CoV rRT-PCR Testing Guidelines for Respiratory Specimens
.
Many state health department laboratories are approved for MERS-CoV
testing using the CDC rRT-PCR assay. Contact your local/state health
department to notify them of the PUI and to request MERS-CoV testing. If
your state health department is unable to test, contact CDCs EOC at
770-488-7100.
.
Testing for MERS-CoV and other respiratory pathogens can be done
simultaneously. Virus isolation in cell culture and initial
characterization of viral agents recovered in cultures of MERS-CoV
specimens are NOT recommended at this time. However, if done, these
activities must be performed in a BSL-3 facility using BSL-3 work
practices.
.
Test for MERS-CoV
.
The laboratory must follow the protocol for the CDC rRT-PCR assay.
NEGATIVE test results should be reported through the CDC Laboratory
Response Network (LRN) within 24 hours. When a PRESUMPTIVE POSITIVE or
EQUIVOCAL test result is obtained, CDC must be contacted immediately as
per the assay protocol, and the result must also be reported to the LRN
within 6 hours. Confirmation of a PRESUMPTIVE POSITIVE result by CDC is
required, however this should not delay the local investigation and
response, including the contact investigation.
Test for Other Respiratory Pathogens
.
Testing for common respiratory pathogens by molecular or antigen detection
methods (not by viral culture) is strongly recommended. Common respiratory
pathogens include 1) influenza A, influenza B, respiratory syncytial
virus, human metapneumovirus, human parainfluenza viruses, adenovirus,
human rhinovirus and other respiratory viruses; 2) Streptococcus
pneumoniae, Chlamydia pneumophila, and other pathogens that cause severe
lower respiratory infections. Clinical presentation, epidemiologic and
surveillance information, and season should be considered when selecting
which pathogens to test for. A few MERS-CoV cases have had other
respiratory pathogens detected, so identification of a respiratory
pathogen prior to MERS-CoV testing should not preclude testing for
MERS-CoV, especially if MERS is strongly suspected. If your laboratory
does not have molecular or antigen testing capability for respiratory
pathogens, contact your state laboratory for assistance.
.
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Interim Infection Prevention and Control Recommendations for Hospitalized
Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
Content source:
National Center for Immunization and Respiratory Diseases,
Division of Viral Diseases
http://www.cdc.gov/coronavirus/mers/infection-prevention-control.html
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MERS in the Arabian Peninsula
Warning - Level 3, Avoid Nonessential Travel
*Alert - Level 2, Practice Enhanced Precautions*
Watch - Level 1, Practice Usual Precautions
.
Updated: May 02, 2014
http://wwwnc.cdc.gov/travel/notices/alert/
coronavirus-arabian-peninsula-uk
.
A shorter URL for the above link:
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http://tinyurl.com/qbhuzl7
.
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What is the Current Situation?
.
Cases of MERS (Middle East Respiratory Syndrome) have been identified in
multiple countries in the Arabian Peninsula. There have also been cases in
several other countries in travelers who have been to the Arabian
Peninsula and, in some instances, their close contacts. One case has been
confirmed in the United States in a traveler who had recently been to
Saudi Arabia. For more information, see CDCs MERS website.
.
If you are traveling to countries in or near the Arabian Peninsula,* CDC
recommends that you pay attention to your health during and after your
trip. You should see a doctor right away if you develop fever and symptoms
of lower respiratory illness, such as cough or shortness of breath, within
14 days after traveling from countries in or near the Arabian Peninsula.
Tell the doctor about your recent travel.
.
CDC does not recommend that travelers change their plans because of MERS.
Most instances of person-to-person spread have occurred in health care
workers and other close contacts (such as family members and caregivers)
of people sick with MERS. If you are concerned about MERS, you should
discuss your travel plans with your doctor.
Special advice for people traveling to the Arabian Peninsula to work in
health care settings
.
If you are traveling to provide health care services in the Arabian
Peninsula, please review CDCs recommendations for infection control of
confirmed or suspected MERS cases. CDC recommends that you practice these
precautions and monitor your health closely.
.
What is MERS?
.
MERS is caused by a coronavirus known as MERS-CoV; coronaviruses cause a
variety of illnesses, from the common cold to SARS (severe acute
respiratory syndrome), which caused a global epidemic in 2003. MERS-CoV is
different from any other coronavirus that has been previously found in
people. Symptoms of MERS have included fever, cough, and shortness of
breath. CDC is working with the World Health Organization and other
partners to understand the public health risks from this virus.
What can travelers do to prevent MERS?
.
People traveling to provide health care services in the Arabian Peninsula
should review CDCs recommendations for infection control of confirmed or
suspected MERS cases.
.
All travelers can take these everyday actions to help prevent the spread
of germs and protect against colds, flu, and other illnesses:
.
Wash your hands often with soap and water. If soap and water are not
available, use an alcohol-based hand sanitizer.
Avoid touching your eyes, nose, and mouth. Germs spread this way.
Avoid close contact with sick people.
Be sure you are up-to-date with all of your shots, and if possible,
see your health care provider at least 46 weeks before travel to get any
additional shots.
Visit CDCs Travelers Health website for more information on healthy
travel.
.
If you are sick:
.
Cover your mouth with a tissue when you cough or sneeze, and throw
the tissue in the trash.
Avoid contact with other people to keep from infecting them.
See a doctor if you develop a fever and symptoms of lower
respiratory illness, such as cough or shortness of breath, within 14 days
after traveling from countries in or near the Arabian Peninsula.* You
should tell the doctor about your recent travel.
.
Clinician Information:
.
Health care providers should be alert to patients who develop severe acute
lower respiratory illness (e.g., requiring hospitalization) within 14 days
after traveling from countries in the Arabian Peninsula* or neighboring
countries, excluding those who transited at airports without entering the
countries.
.
Consider other more common causes of respiratory illness, such as
influenza.
Evaluate patients using CDCs case definitions and guidance.
Immediately report patients with unexplained respiratory illness and
who meet CDCs criteria for patient under investigation (PUI) to CDC
through the state or local health department.
A PUI is a person with the following characteristics:
Fever (?38, 100.4F) and pneumonia or acute respiratory distress
syndrome (based on clinical or radiologic evidence)
.
AND EITHER
.
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
Is a member of a cluster of patients with severe acute respiratory
illness (such as fever and pneumonia requiring hospitalization) of unknown
etiology in which MERS-CoV is being evaluated, in consultation with state
and local health departments
Collect specimens for MERS-CoV testing from all PUIs.
Contact your state or local health department if you have any
questions.
See additional recommendations and guidance on CDCs MERS website.
Health departments with questions should contact CDCs Emergency
Operations Center (770-488-7100).
.
Additional Information:
.
CDC Middle East Respiratory Syndrome (MERS)
Middle East Respiratory Syndrome (MERS) Interim Guidance for Airline
Crew: Report Ill Travelers on Flights Arriving to the United States (CDC
Quarantine site)
WHO Coronavirus InfectionExternal Web Site Icon
Novel Coronavirus, Public Health EnglandExternal Web Site Icon
ECDC: Updates to Rapid Risk Assessment on MERS-CoV (PDF) Adobe PDF
fileExternal Web Site Icon
Update: Recommendations for Middle East Respiratory Syndrome
Coronavirus (MERS-CoV). MMWR July 12, 2013/62 (27); 557.
Update: Severe Respiratory Illness Associated with a Novel
CoronavirusWorldwide, 20122013 MMWR March 7, 2013/62 (Early Release); 12
Severe Respiratory Illness Associated with a Novel Coronavirus Saudi
Arabia and Qatar, 2012 MMWR October 12, 2012/61; 820820.
.
*Countries considered in the Arabian Peninsula and neighboring include:
Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian
territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE),
and Yemen.
.
**Close contact is defined as a) any person who provided care for the
patient, including a health care worker or family member, or had similarly
close physical contact; or b) any person who stayed at the same place
(lived with or visited) as the patient while the patient was ill.
.
.
Middle East Respiratory Syndrome (MERS)
Information for Healthcare Providers
http://www.cdc.gov/coronavirus/mers/hcp.html
.
Important Links
.
Health Alert Network: Confirmed Middle East Respiratory Syndrome
Coronavirus (MERS-CoV) Case in Indiana, 2014 May 3, 2014
http://emergency.cdc.gov/han/han00361.asp
.
Guidelines for Clinical Specimens
http://www.cdc.gov/coronavirus/mers/guidelines-clinical-specimens.html
.
Data Collection
http://www.cdc.gov/coronavirus/mers/data-collection.html
.
.
WEBBIB1314
.
.
Sincerely,
David Dillard
Temple University
(215) 204 - 4584
jwne@xxxxxxxxxx
http://workface.com/e/daviddillard
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