Middle East respiratory syndrome coronavirus infection

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Prevention

• 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.
• 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 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.
• 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.
• 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.