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| {{CMG}} | | {{MERS}} |
| | {{About1|Middle East respiratory syndrome coronavirus}} |
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| ==Overview==
| | {{CMG}}; {{AE}} {{YD}}; {{Rim}}, {{JS}}, {{AL}} |
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| ==Epidemiology and Demographics==
| | {{SK}} MERS, MERS-CoV infection, ''Middle East'' respiratory syndrome |
| * The Middle East respiratory syndrome coronavirus (MERS-CoV) was first reported to cause human infection in September 2012. In July 2013, the World Health Organization (WHO) International Health Regulations Emergency Committee determined that MERS-CoV did not meet criteria for a "public health emergency of international concern," but was nevertheless of "serious and great concern".
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| * As of September 20, 2013, a total of 130 cases from eight countries have been reported to WHO; 58 (45%) of these cases have been fatal. All cases have been directly or indirectly linked through travel to or residence in four countries: Saudi Arabia, Qatar, Jordan, and the United Arab Emirates (UAE).
| | ==[[Middle East respiratory syndrome coronavirus infection overview|Overview]]== |
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| * The median age of persons with confirmed MERS-CoV infection is 50 years (range: 2–94 years).
| | ==[[Middle East respiratory syndrome coronavirus infection historical perspective|Historical Perspective]]== |
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| * The male-to-female ratio is 1.6 to 1.0.
| | ==[[Middle East respiratory syndrome coronavirus infection pathophysiology|Pathophysiology]]== |
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| * Twenty-three (18%) of the cases occurred in persons who were identified as health-care workers.
| | ==[[Middle East respiratory syndrome coronavirus infection causes|Causes]]== |
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| * Although most reported cases involved severe respiratory illness requiring hospitalization, at least 27 (21%) involved mild or no symptoms.
| | ==[[Middle East respiratory syndrome coronavirus infection differential diagnosis|Differentiating Middle East Respiratory Syndrome Coronavirus Infection from Other Diseases]]== |
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| *Despite evidence of person-to-person transmission, the number of contacts infected by persons with confirmed infections appears to be limited. No cases have been reported in the United States, although 82 persons from 29 states have been tested for MERS-CoV infection.
| | ==[[Middle East respiratory syndrome coronavirus infection epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==Pathophysiology== | | ==[[Middle East respiratory syndrome coronavirus infection risk factors|Risk Factors]]== |
| Potential animal reservoirs and mechanism(s) of transmission of MERS-CoV to humans remain unclear. A zoonotic origin for MERS-CoV was initially suggested by high genetic similarity to bat coronaviruses , and some recent reports have described serologic data from camels and the identification of related viruses in bats. However, more epidemiologic data linking cases to infected animals are needed to determine if a particular species is a host, a source of human infection, or both.
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| ==History and Symptoms== | | ==[[Middle East respiratory syndrome coronavirus infection natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| ===History===
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| Suspect MERS-CoV infection in case of:<br>
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| * Fever (≥38°C, 100.4°F) and pneumonia or acute respiratory distress syndrome (based on clinical or radiological evidence);<br>
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| ''AND EITHER'' <br>
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| * History of travel from countries in or near the Arabian Peninsula1 within 14 days before symptom onset;<br>
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| ''OR''<br>
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| * Close contact2 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;<br>
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| ''OR''<br>
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| * Is 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 state and local health departments.
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| ===Symptoms===
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| * [[Fever]] (98%)
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| * [[Cough]] (83%)
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| * [[Shortness of breath]] (72%)
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| * Gastrointestinal symptoms
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| ** [[Diarrhea]] (26%)
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| ** Vomiting (21%)
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| All but two patients (96%) had one or more chronic medical conditions, including [[diabetes]] (68%), [[hypertension]] (34%), [[heart disease]] (28%), and [[kidney disease]] (49%). Thirty-four (72%) had more than one chronic condition.
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| ==Diagnosis== | | ==Diagnosis== |
| CDC has changed its guidance to indicate that testing for MERS-CoV and other respiratory pathogens can be conducted simultaneously and that positive results for another respiratory pathogen should not necessarily preclude testing for MERS-CoV. Health-care providers in the United States should continue to evaluate patients for MERS-CoV infection if they develop fever and pneumonia or acute respiratory distress syndrome (ARDS) within 14 days after traveling from countries in or near the Arabian Peninsula. Providers also should evaluate patients for MERS-CoV infection if they have ARDS or fever and pneumonia, and have had close contact§ with a recent traveler from this area who has fever and acute respiratory illness.
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| CDC continues to recommend that clusters¶ of patients with severe acute respiratory illness (e.g., fever and pneumonia requiring hospitalization) be evaluated for common respiratory pathogens and reported to local and state public health departments. If the illnesses remain unexplained, particularly if the cluster includes health-care providers, testing for MERS-CoV should be considered, in consultation with state and local health departments. In this situation, testing should be considered even for patients without travel-related exposure.
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| ===Confirmed Case===
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| A confirmed case is a person with laboratory confirmation of MERS-CoV infection.
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| ===Probable Case===
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| A probable case is a PUI with absent or inconclusive laboratory results for MERS-CoV infection who is a close contact of a laboratory-confirmed MERS-CoV case.
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| ==Laboratory Tests==
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| Confirmatory laboratory testing now requires a positive [[polymerase chain reaction]] of at least two, instead of one, specific genomic targets or a single positive target with sequencing of a second.
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| ==Prevention==
| | [[Middle East respiratory syndrome coronavirus infection diagnostic criteria|Diagnostic Criteria]] | [[Middle East respiratory syndrome coronavirus infection history and symptoms|History and Symptoms]] | [[Middle East respiratory syndrome coronavirus infection physical examination|Physical Examination]] | [[Middle East respiratory syndrome coronavirus infection laboratory findings|Laboratory Findings]] | [[Middle East respiratory syndrome coronavirus infection chest x ray|Chest X Ray]] | [[Middle East respiratory syndrome coronavirus infection CT|CT]] | [[Middle East respiratory syndrome coronavirus infection other diagnostic studies|Other Diagnostic Studies]] |
| * Enhancing infection prevention and control awareness and measures is critical to prevent the possible spread of MERS‐CoV in health care facilities. Health‐care facilities that provide care for patients suspected or confirmed to be infected with MERS‐CoV infection should take appropriate measures to decrease the risk of transmission of the [[virus]] from an infected patient to other patients, health‐care workers and visitors. It is not always possible to identify patients with MERS‐CoV early because some have mild or unusual symptoms. For this reason, it is important that health‐care workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices all the time.
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| * Urgent investigations are required to better understand the transmission pattern of this virus. The most urgent include detailed [[outbreak]] investigations, [[case‐control studies]] to understand risk factors for infection, enhancing community studies and surveillance of [[pneumonia|community‐acquired pneumonia]] to assess whether significant numbers of mild cases resulting from human to human transmission are being missed, and identifying risk factors for infection in the hospital setting. Detailed information on the surveillance strategy and contact tracing would help understand limitations of current data.
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| * Although the immediate focus should be on clarifying the magnitude of the human‐to‐human transmission, no control will be possible until the transmission from the animal/environment source to humans is understood and interrupted. Based on current information, it is prudent for people at high risk of severe disease due to MERS‐CoV, including those with [[diabetes]], chronic [[lung disease]], pre‐existing [[renal failure]], or those who are immunocompromised, to take appropriate precautions when visiting farms, barn areas or market environments where camels are present. These measures might include avoiding contact with camels, good hand hygiene, and avoiding drinking raw milk or eating food that may be contaminated with animal secretions or products unless they are properly washed, peeled, or cooked. For the general public, when visiting a farm or a barn, general hygiene measures, such as regular hand washing before and after touching animals, avoiding contact with sick animals, and following food hygiene practices, should be adhered to.
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| * WHO recommends increasing efforts to raise awareness of MERS among travelers going to and traveling from MERS‐affected countries but otherwise does not advise special screening at points of entry with regard to this event nor does WHO currently recommend the application of any travel or trade restrictions.
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| ===Travel Guidance=== | | ==Treatment== |
| The peak travel season to Saudi Arabia is July through November, coinciding with the religious pilgrimages of Hajj and Umrah. CDC encourages pilgrims to consider recommendations from the Saudi Arabia Ministry of Health regarding persons who should postpone their pilgrimages this year, including persons aged ≥65 years, children, pregnant women, and persons with chronic diseases, weakened immune systems, or cancer. WHO advises that persons with preexisting medical conditions consult a health-care provider before deciding whether to make a pilgrimage.
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| CDC continues to recommend that U.S. travelers to countries in or near the Arabian Peninsula protect themselves from respiratory diseases, including MERS-CoV, by washing their hands often and avoiding contact with persons who are ill. If travelers to the region have onset of fever with cough or shortness of breath during their trip or within 14 days of returning to the United States, they should seek medical care. They should tell their health-care provider about their recent travel.
| | [[Middle East respiratory syndrome coronavirus infection medical therapy|Medical Therapy]] | [[Middle East respiratory syndrome coronavirus infection contact and airborne precautions|Contact and Airborne Precautions]] | [[Middle East respiratory syndrome coronavirus infection primary prevention|Primary Prevention]] | [[Middle East respiratory syndrome coronavirus infection future or investigational therapies|Future or Investigational Therapies]] |
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| ===Infection Control=== | | ==Case Studies== |
| With multiple health-care–associated clusters identified (8,10), infection control remains a primary means of preventing and controlling MERS-CoV transmission. CDC has recently made checklists available that highlight key actions that health-care providers and facilities can take to prepare for MERS-CoV patients. CDC's infection control guidance has not changed. Standard, contact, and airborne precautions are recommended for management of hospitalized patients with known or suspected MERS-CoV infection.
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| ==References==
| | [[Middle East respiratory syndrome coronavirus infection case study one|Case #1]] |
| {{Reflist|2}}
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| | [[Category:Disease]] |
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| [[Category:Viral diseases]] | | [[Category:Up-To-Date]] |
| [[Category:Zoonoses]] | | [[Category:Virology]] |