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| novel coronavirus (CDC.gov) |
The Middle East Respiratory Syndrome (MERS) is a viral illness first reported in Saudi Arabia in 2012. It is novel coronavirus (CDC.gov) caused by a coronavirus called MERS-CoV. This virus is similar to the coronovirus that caused SARS. As of 23 May 2014, there have been 635 laboratory confirmed cases of infection with MERS-CoV including 193 deaths (case fatality rate = 30.4%). However, the mortality rate may be inflated by ascertainment bias (i.e., only sicker patients are being tested for MERS-CoV).
To date, all the cases have been linked to countries in the Arabian Peninsula occurring either in people who have recently returned from the Arabian Peninsula or had contact with an ill person who recently returned from the Arabian Peninsula (Table 1).
The median incubation period is approximately 5 days (range, 2-13 days). Most cases have been in men and in adults (median age ~ 50 years of age, range <1 year to 94 years old). Most hospitalized adults have had chronic co-morbidities (e.g., diabetes, chronic renal failure, obesity). The reservoir of MERS-CoV is likely bats, although camels may serve as a course of transmission to humans. Person-to-person transmission has been well documented but appears to be relatively inefficient (i.e., household attack rates ~1-2%). To date, it appears that persons do not transmit infection before they are symptomatic. Clusters have been reported in families and multiple outbreaks have been reported in hospitals.
A wide clinical spectrum of MERS-CoV has been reported ranging from asymptomatic infection to acute upper respiratory illness, and rapidly progressive pneumonitis, respiratory failure, septic shock and multi-organ failure resulting in death. At hospital admission, common signs and symptoms include fever, chills/rigors, headache, non-productive cough, dyspnea and myalgias. Other symptoms can include sore throat, coryza, nausea and vomiting, dizziness, sputum production, diarrhea, vomiting, and abdominal pain. Atypical presentations include mild respiratory illness without fever and diarrheal illness preceding development of pneumonia. Laboratory findings at admission may include leukopenia, lymphopenia, thrombocytopenia, and elevated lactate dehydrogenase levels. Radiographic findings may include unilateral or bilateral patchy densities or opacities, interstitial infiltrates, consolidation, and pleural effusions. No specific treatment for MERS-CoV infection is currently available.
The CDC case definition of MERS-CoV is available at: http://www.cdc.gov/coronavirus/mers/case-def.html. Diagnostic testing for MERS-CoV is available through the North Carolina 24/7 with less than 24 turn around time. See http://slph.ncpublichealth.com/
The CDC has developed recommendations for the prevention of transmission of MERS-CoV (Table 2). UNC Hospitals has developed signage for rooms that house patients with MERS-CoV (airborne precautions plus contact precautions plus eye shields (for all HCP entering the room) or goggles (for cough inducing procedures) and for hospital entrances to alert patients or visitors with possible MERS-CoV to immediately self-identify themselves and don a mask immediately. We plan to use the entrance signs if any MERS cases are identified in North Carolina. These signs are available on the SPICE web page. Persons interested in additional information should visit the public health websites listed in Table 3.
Table 1. Countries With Lab-Confirmed MERS Cases (as of 21 May 2014)
Countries in the Arabian Peninsula with Cases:
Saudi Arabia
United Arab Emirates (UAE)
Qatar
Oman
Jordan
Kuwait
Yemen
Lebanon
Countries with Travel-Associated Cases:
United Kindom (UK)
France
Tunisia
Italy
Malaysia
Phillippines
Greece
Egypt
Netherlands
Germany (2 cases transferred for care)
United States
Table 2. Key Components of Standard, Contact, and Airborne Precautions Recommended for Prevention of MERS-CoV Transmission in U.S. Hospitals http://www.cdc.gov/coronavirus/mers/infection-prevention-control.html#infection-prevention
Table 3. Web Sites for Additional Information
World Health Organization (WHO)
http://www.who.int/csr/disease/coronavirus_infections/en/
Centers for Disease Control and Prevention (CDC)
http://www.cdc.gov/coronavirus/mers/index.html?s_cid=cdc_homepage_whatsnew_003
North Carolina Department of Public Health
http://epi.publichealth.nc.gov/cd/diseases/merscov.html
North Carolina Statewide Program in Infection Control and Epidemiology (SPICE)
http://spice.unc.edu/icresources/middle-east-respiratory-syndrome-mers-guidance/
