Middle East Respiratory Syndrome (MERS) is in the news again, as the first U.S. case was diagnosed in Indiana on May 2 and health authorities in the Middle East reported an escalating number of lab-confirmed new cases. The dramatic spike in overseas cases during the final week of April 2014 is expected to continue through May. The CDC is following up on the Indiana case (reported to be a health care worker who has recently returned from Saudi Arabia), stating there is no cause for alarm. Since this emerging disease was first identified in 2012, it has caused over 100 deaths worldwide.
The latest research, published on April 19, 2014 in the journal mBio, lends support to previous suspicions that camels are a reservoir or a vector for the virus. Researchers recovered the virus that causes MERS from the nasal swabs of camels, and demonstrated that genetic sequences of it are indistinguishable from the virus found in humans.
What you should know about MERS
MERS is a respiratory illness that is caused by a coronavirus known as MERS-Cov. People who become ill develop severe, acute respiratory symptoms that include fever, coughing, and shortness of breath. Yet, others who are screened after contact with a MERS patient have tested positive for the virus but have not become ill at all.
While no cases have been identified in the United States, the ease of global travel today means MERS-Cov could surface here at any time. Based on the current information, the World Health Organization (WHO) is advising public health organizations around the globe to continue surveillance for severe acute respiratory infections (SARI) and to quickly identify any unusual patterns.
To date, confirmed cases of MERS have been reported in the following regions:
Middle East: Jordan, Kuwait, Oman, Qatar, Saudi Arabia.
Europe: France, Germany, Greece, Italy, United Kingdom.
Asia: Malaysia, the Phillipines.
North Africa: Tunisia
From an infection control standpoint, the exact routes of indirect or direct transmission are not known. Most of the cases (up to 75 percent, by one estimate) appear to be secondary cases – meaning these patients apparently acquired the virus from another person, without direct exposure to animals. A large number of these secondary cases have been health care workers who seem to have been infected at work; a smaller number have been inpatients who acquired the virus in the hospital. Human-to-human transmission does not seem to be sustained: there have been very few tertiary cases to date and no large family clusters. This could change if the virus evolves to become more transmissible.
Current recommendations for travelers
While most cases have been in the Middle East, the CDC is not currently recommending that anyone change their travel plans because of MERS. Instead, travelers to the Arabian Peninsula are being advised to wash/sanitize hands frequently; avoid touching the eyes, nose, and mouth; limit contact with animals and animal products; and avoid people who are ill. Travelers should also seek medical care immediately if they develop respiratory symptoms while abroad or within two weeks of returning home (and should tell their physician about any Middle Eastern travel).
Current recommendations for health care providers
Because MERS is an evolving situation, no evidence-based practices have been identified as of yet. However, the CDC has issued interim guidelines and these can be found online.
Again, there have been no cases of MERS in the States, yet the CDC is urging doctors, nurses, and public health workers to remain vigilant and to watch for severe, acute respiratory infections. Contact precautions and testing for MERS-Cov is advised when a patient presents with a SARI, particularly if that person has recently returned from traveling in the Middle East. It’s wise to not only question patients about their own recent travel, but to find out if they’ve had close contact with anyone who has recently returned from travel to the Middle East.
According to the CDC, infection control professionals who find they are dealing with a hospitalized patient with a confirmed case of MERS can follow the same precautions that were used for cases of SARS: an airborne isolation room for the patient, along with standard contact precautions and droplet precautions for staff.
Clinicians should also be aware that it may not be possible to identify MERS patients early, because some present with mild symptoms or unusual symptoms (the CDC does not give details as to what these may be). This is a prime example of why clinicians should always use good hand hygiene and follow standard infection control procedures consistently, with all patients.
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