Middle East Respiratory Syndrome (MERS): Global Travel Raises Concerns for Spread of Disease from the Arabian Peninsula

Middle East Respiratory Syndrome-Coronavirus (MERS-CoV), a novel Coronavirus in the same family as the Coronavirus that caused Severe Acute Respiratory Syndrome (SARS), has caused 339 illnesses and 102 deaths in Saudi Arabia .  However, the WHO has only reported 262 laboratory-confirmed cases.  Six Middle Eastern countries have reported MERS (Saudi Arabia, Qatar, United Arab Emirates, Jordan, Oman, Kuwait) and 5 other countries have reported traveler-associated MERS cases (United Kingdom, France, Tunisia, Italy, Malaysia).  On May 2nd, the United States became the 6th county to report a traveler-associated MERS case.  According to the CDC, an American healthcare worker flew back to the US from Saudi Arabia on April 24th, connecting in London and Chicago before taking a bus to Indiana.  He is currently hospitalized and in stable condition.  US Public Health officials are tracing the US MERS patient’s travel itinerary and attempting to contact other travelers who may have been in close contact with the affected individual.  Currently, the US government has not issued any warnings to travelers to avoid the affected countries or to change travel plans.

The WHO reports that nearly 75% of cases have been due to secondary contact (individuals became ill after being in close contact with someone identified with MERS), and most of the secondary MERS cases have been healthcare workers.  The primary source of infection is suspected to be from camels.

For healthcare institutions and providers, the CDC has provided preparedness guidelines:

  • Remain up to date on current Case Definitions (clinical suspicion) for MERS and be alert to these patients who meet these criteria
  • Review Infection Control Policies
    • Assessment & Triage processes for patients with acute respiratory symptoms
    • Patient placement plans
    • Vistor management & exclusion plans
    • Personal Protective Equipment (PPE) available for healthcare personnel
    • Source control measures (masks, etc.) for suspected patients
  • Know how to report a suspected MERS case or exposure to local & state public health officials (CDC Reporting Form)
  • Know whom and when to notify within occupational health for unprotected healthcare personnel exposure to a suspected MERS case

Three levels of classification are being used for individuals who meet the Case Definition for MERS:

  • Patient Under Investigation (PUI)
    • Fever (temperature > 38 degree C) and pneumonia or Acute Respiratory Distress Syndrome AND EITHER
    • History of travel to countries with primary cases of MERS withjin past 14 days
    • OR  close contact with a person with fever, respiratory disease and travel to a country with MERS cases
    • OR member of a cluster of patients with severe unknown respiratory illness who are being evaluated for MERS
  • Probable Case: a PUI who has inconclusive laboratory evidence for MERS but was in close contact with a person with laboratory-confirmed MERS
  • Confirmed Case: a person with laboratory-confirmed MERS

Remain up to date about MERS-CoV with Risk Assessments and Outbreak Updates information from the WHO.


(MERS-CoV courtesy of CDC)





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