HEALTH ADVISORY #315
May 20, 2014
MIDDLE EAST RESPIRATORY SYNDROME CORONAVIRUS (MERS-CoV) CONFIRMED IN THE UNITED STATES
Please distribute to the Healthcare Providers, Infection Control Department, Emergency Department, Employee Health Service, Infectious Disease Department, Director of Nursing, Medical Director, Laboratory Service, and all patient care areas.
SUMMARY
The first two cases of MERS-CoV infection in the United States were recently confirmed in Indiana on May 2 and in Florida on May 12. The two cases are not linked. Both patients had recently traveled to the U.S. from Saudi Arabia, where each lives and works as a healthcare worker. Both patients were hospitalized prior to the diagnosis of MERS-CoV infection and are reportedly recovering.
A third individual has tested positive for MERS antibodies after having casual contact with the initial case in Indiana. This individual is part of the ongoing contact investigation in Indiana and had no associated symptoms or recent travel. No cases have been identified in New York State at this time.
The Erie County Department of Health (ECDOH) is asking clinicians to consider the possibility of MERS-CoV infections in persons exhibiting symptoms of severe respiratory illness who have appropriate travel or exposure history.
TESTING CRITERIA
The Centers for Disease Control (CDC) advises that patients meeting the following criteria be evaluated for MERS-CoV:
Fever (≥38°C, 100.4°F) and pneumonia or acute respiratory distress syndrome (based on clinical or radiological evidence) AND 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 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 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 a state and local health department.
Providers must immediately report suspected cases of MERS-CoV infection to the local health department (LHD) where the patient resides. Erie County residents should be reported to the Erie County Department of Health Epidemiology and Disease Surveillance Program at (716) 858-7697 during normal business hours and (716) 961-7898 after hours.
LABORATORY TESTING
To date, limited information is available on the pathogenic potential and transmission dynamics of MERS-CoV. To increase the likelihood of detecting MERS-CoV infection, CDC and NYSDOH recommend collecting multiple specimens from different sites at different times after symptom onset.
Patients with lower respiratory illness should also be evaluated for common causes of community-acquired pneumonia. For these patients, testing for MERS-CoV and other respiratory pathogens can be done simultaneously. Positive results for another respiratory pathogen (e.g., influenza) should not necessarily preclude testing for MERS-CoV because co-infection can occur.
Testing for MERS-CoV and other respiratory pathogens can be performed at NYSDOH’s Wadsworth Center Laboratories. Providers wishing to access public health testing must obtain pre-approval from the ECDOH.
For more information, see CDC’s Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for MERS-CoV: http://www.cdc.gov/coronavirus/mers/guidelines-clinical-specimens.html
INFECTION CONTROL
Standard, contact, and airborne precautions are recommended for management of patients in a healthcare facility with suspected or known MERS-CoV infection. These recommendations are consistent with those recommended for the coronavirus that caused severe acute respiratory syndrome (SARS). Details are contained in CDC’s Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV), which is available at: http://www.cdc.gov/coronavirus/mers/infection-prevention-control.html
CONTACT PHONE NUMBER:
ECDOH Epidemiology and Disease Surveillance Program: (716)858-7697 during normal business hours and (716)961-7898 after hours.
FOR MORE INFORMATION:
CDC: http://www.cdc.gov/coronavirus/mers/index.html
CDC MMWR Report May 16, 2014 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6319a4.htm?s_cid=mm6319a4_e
Health Category Definitions:
Health Alert FLASH: conveys the highest level of importance due to a large-scale, catastrophic public health emergency; warrants immediate action or attention
Health Alert Priority: conveys the highest level of importance; warrants immediate action or attention to a health problem or situation
Health Advisory: provides important information for a specific incident or situation; may not require immediate action
Health Update: provides updated information regarding an incident or situation; no immediate action necessary
The Erie County Department of Health does not provide medical advice. The information provided on the Erie County Department of Health website is not an attempt to practice medicine and is not intended as a substitute for professional medical advice, diagnosis, or treatment. It is for informational purposes only. Always seek the advice of your personal physician or other qualified health provider with any questions you may have regarding a medical condition or issue. Never disregard professional medical advice or delay in seeking it because of the content found on the Erie County Department of Health website or this correspondence.
The ECDOH Health Alert & Advisory System is an e-mail notification system designed to alert community partners about important health related information. You can sign up to receive alerts & advisories at http://www2.erie.gov/health/index.php?q=node/59.