http://emergency.cdc.gov/han/han00361.asp
Confirmed
Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Case in Indiana, 2014
Distributed via the CDC Health Alert Network
May 3, 2014, 16:30 ET (4:30 PM ET)
May 3, 2014, 16:30 ET (4:30 PM ET)
CDCHAN-00361
Summary
The first case of Middle
East Respiratory Syndrome Coronavirus (MERS-CoV) infection in the United
States, identified in a traveler, was reported to CDC by the Indiana State
Department of Health (ISDH) on May 1, 2014, and confirmed by CDC on May 2. The
patient is in a hospital in Indiana after having flown from Saudi Arabia to
Chicago via London. The purpose of this HAN is to alert clinicians, health
officials, and others to increase their index of suspicion to consider MERS-CoV
infection in travelers from the Arabian Peninsula and neighboring countries.
Please disseminate this information to infectious disease specialists,
intensive care physicians, primary care physicians, and infection preventionists,as
well as to emergency departments and microbiology laboratories.
Background
The first known cases of
MERS-CoV occurred in Jordan in April 2012. The virus is associated with
respiratory illness and high death rates, although mild and asymptomatic
infections have been reported too. All reported cases to date have been linked
to six countries in the Arabian Peninsula: Saudi Arabia, Qatar, Jordan, the
United Arab Emirates (UAE), Oman, and Kuwait. Cases in the United Kingdom,
France, Italy, Greece, Tunisia, Egypt, and Malaysia have also been reported in
persons who traveled from the Arabian Peninsula. In addition, there have been a
small number of cases in persons who were in close contact with those infected
travelers. Since mid-March 2014, there has been an increase in cases reported
from Saudi Arabia and UAE.
Public health
investigations are ongoing to determine the reason for the increased cases.
There is no vaccine yet available and no specific treatment recommended for the
virus. In some cases, the virus has spread from infected people to others
through close contact. However, there is currently no evidence of sustained
spread of MERS-CoV in community settings. Additional information is available
at (http://www.cdc.gov/coronavirus/mers/index.html).
Recommendations
Healthcare providers
should be alert for and evaluate patients for MERS-CoV infection who 1) develop
severe acute lower respiratory illness within 14 days after traveling from
countries in or near the Arabian Peninsula, excluding those who only transited
at airports in the region; or 2) are close contacts of a symptomatic recent
traveler from this area who has fever and acute respiratory illness; or 3) are
close contacts of a confirmed case. For these patients, testing for MERS-CoV
and other respiratory pathogens can be done simultaneously. Positive results
for another respiratory pathogen (e.g H1N1 Influenza) should not necessarily
preclude testing for MERS-CoV because co-infection can occur.
Clusters of patients
with severe acute respiratory illness (e.g., fever and pneumonia requiring
hospitalization) without recognized links to cases of MERS-CoV or to travelers
from countries in or near the Arabian peninsula should be evaluated for common
respiratory pathogens. If the illnesses remain unexplained, providers should
consider testing for MERS-CoV, in consultation with state and local health
departments. Healthcare professionals should immediately report to their state
or local health department any person being evaluated for MERS-CoV infection as
a patient under investigation (PUI).
Additional information,
including criteria for PUI are at http://www.cdc.gov/coronavirus/mers/interim-guidance.html.
Healthcare providers should contact their state or local health department if
they have any questions.
Persons at highest risk
of developing infection are those with close contact to a case, defined as any
person who provided care for a patient, including a healthcare provider or family
member not adhering to recommended infection control precautions (i.e., not
wearing recommended personal protective equipment), or had similarly close
physical contact; or any person who stayed at the same place (e.g. lived with,
visited) as the patient while the patient was ill.
Healthcare professionals
should carefully monitor for the appearance of fever (T> 100F) or
respiratory symptoms in any person who has had close contact with a confirmed
case, probable case, or a PUI while the person was ill. If fever or respiratory
symptoms develop within the first 14 days following the contact, the individual
should be evaluated for MERS-CoV infection. Ill people who are being evaluated
for MERS-CoV infection and do not require hospitalization for medical reasons
may be cared for and isolated in their home. (Isolation is defined as the
separation or restriction of activities of an ill person with a contagious
disease from those who are well.).
Providers should contact
their state or local health department to determine whether home isolation,
home quarantine or additional guidance is indicated since recommendations may
be modified as more data becomes available. Additional information on home care
and isolation guidance is available at http://www.cdc.gov/coronavirus/mers/hcp/home-care.html.
Healthcare providers
should adhere to recommended infection-control measures, including standard,
contact, and airborne precautions, while managing symptomatic contacts and
patients who are persons under investigation or who have probable or confirmed
MERS-CoV infections. For CDC guidance on MERS-CoV infection control in
healthcare settings, see Interim Infection Prevention and Control
Recommendations for Hospitalized Patients with MERS-CoV athttp://www.cdc.gov/coronavirus/mers/infection-prevention-control.html.
For suspected MERS-CoV
cases, healthcare providers should collect the following specimens for
submission to CDC or the appropriate state public health laboratory:
nasopharyngeal swab, oropharyngeal swab (which can be placed in the same tube
of viral transport medium), sputum, serum, and stool/rectal swab. Recommended
infection control precautions should be utilized when collecting specimens.
Specimens can be sent using category B shipping containers. Providers should
notify their state or local health departments if they suspect MERS-CoV
infection in a person. State or local health departments should notify CDC if
MERS-CoV infection in a person is suspected. Additional information is
available athttp://www.cdc.gov/coronavirus/mers/guidelines-clinical-specimens.html.
Additional or modified
recommendations may be forthcoming as the investigation proceeds.
For More Information
For more information,
for consultation, or to report possible cases, please contact the CDC Emergency
Operations Center at (770) 488-7100.
The Centers for Disease Control and Prevention
(CDC) protects people's health and safety by preventing and controlling
diseases and injuries; enhances health decisions by providing credible
information on critical health issues; and promotes healthy living through
strong partnerships with local, national and international organizations.
DEPARTMENT
OF HEALTH AND HUMAN SERVICES
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This message was distributed to state and local health officers, state and local epidemiologists, state and local laboratory directors, public information officers, HAN coordinators, and clinician organizations.
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This message was distributed to state and local health officers, state and local epidemiologists, state and local laboratory directors, public information officers, HAN coordinators, and clinician organizations.
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