Distributed via the CDC Health Alert Network
August 12, 2013, (12:00 PM ET)
CDCHAN-00352
Notice to Healthcare Providers and
Public Health Officials: Updated Guidance for the Evaluation of Severe
Respiratory Illness Associated with Middle East Respiratory Syndrome
Coronavirus (MERS-CoV)
Summary: The Centers for Disease Control and
Prevention (CDC) continues to work closely with the World Health
Organization (WHO) and other partners to better understand the public
health risks posed by Middle East Respiratory Syndrome Coronavirus
(MERS-CoV). To date, no cases have been reported in the United States.
The purpose of this health update is 1) to provide updated guidance to
healthcare providers and state and local health departments regarding
who should be tested for MERS-CoV infection, 2) to make them aware of
changes to CDC’s “probable case” definition, and 3) to clarify what
specimens should be obtained when testing for MERS-CoV. 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
MERS-CoV, formerly called novel coronavirus, is a beta coronavirus
that was first described in September 2012. As of August 12, 2013, 94
laboratory-confirmed cases have been reported to WHO. Of those cases,
49% (46) were fatal. All diagnosed cases were among people who resided
in or traveled from four countries (Kingdom of Saudi Arabia, United
Arab Emirates, Qatar, or Jordan) within 14 days of their symptom onset,
or who had close contact with people who resided in or traveled from
those countries. Cases with a history of travel from these countries or
contact with travelers from these countries have been identified in
residents of France, the United Kingdom, Tunisia, and Italy.
To date, no cases have been reported in the United States. The most up-to-date details about the number of MERS-CoV cases and deaths by country of residence are on CDC’s MERS website (
http://www.cdc.gov/coronavirus/mers/index.html).
Updates to Interim Guidance and Case Definitions
Interim Guidance for Health Professionals: Patients in the U.S. Who Should Be Evaluated
CDC has changed its criteria for who should be evaluated for MERS-CoV. In the previous guidance (
HAN 348,
dated June 7, 2013), CDC did not recommend MERS-CoV testing for people
whose illness could be explained by another etiology. The new guidance
states that, in patients who meet certain clinical and epidemiologic
criteria, testing for MERS-CoV and other respiratory pathogens can be
done simultaneously and that positive results for another respiratory
pathogen should not necessarily preclude testing for MERS-CoV.
The new guidance also clarifies recommendations for investigating
clusters of severe acute respiratory illness when there is not an
apparent link to a MERS-CoV case. Clusters* of patients with severe
acute respiratory illness (e.g., fever and pneumonia requiring
hospitalization) should be evaluated for common respiratory pathogens
and reported to local and state health departments. If the illnesses
remain unexplained, testing for MERS-CoV should be considered, in
consultation with state and local health departments.
For CDC’s updated interim guidance for healthcare professionals, see (
http://www.cdc.gov/coronavirus/mers/interim-guidance.html).
Case Definitions
CDC has not changed the case definition of a confirmed case, but the
criteria for laboratory confirmation have been clarified. CDC has
changed its definition of a probable case so that identification of
another etiology does not exclude someone from being classified as a
“probable case.”
For CDC’s updated case definitions, see (
http://www.cdc.gov/coronavirus/mers/case-def.html).
CDC may change its guidance about who should be evaluated and
considered a case as we learn more about the epidemiology of MERS-CoV
infection and risk of transmission.
Interim Guidance about Testing of Clinical Specimens
CDC recommends collecting multiple specimens from different sites
at different times after symptom onset. Lower respiratory specimens are
preferred, but collecting nasopharyngeal and oropharyngeal (NP/OP)
specimens, as well as stool and serum, are strongly recommended. This
will increase the likelihood of detecting MERS-CoV infection. For more
information, see CDC’s Interim Guidelines for Collecting, Handling, and
Testing Clinical Specimens (
http://www.cdc.gov/coronavirus/mers/guidelines-clinical-specimens.html).
Many state health department laboratories are approved for MERS-CoV
testing using the CDC rRT-PCR assay. Contact your state health
department to notify them of people who should be evaluated for
MERS-CoV and to request MERS-CoV testing. If your state health
department is not able to test, contact CDC’s EOC at 770-488-7100.
*In accordance with the WHO’s guidance for MERS-CoV, a cluster is
defined as two or more persons with onset of symptoms within the same
14-day period, and who are associated with a specific setting such as a
classroom, workplace, household, extended family, hospital, other
residential institution, military barracks, or recreational camp. See
WHO’s Interim Surveillance Recommendations for Human Infection with
Middle East Respiratory Syndrome Coronavirus (
http://www.who.int/csr/disease/coronavirus_infections/InterimRevisedSurveillanceRecommendations_nCoVinfection_27Jun13.pdf 
).
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
HAN Message Types
- Health Alert: Conveys the highest level of importance; warrants immediate action or attention. Example: HAN00001
- Health Advisory: Provides important information for a specific incident or situation; may not require immediate action. Example: HAN00346
- Health Update: Provides updated information regarding an incident or situation; unlikely to require immediate action. Example: HAN00342
- Info Service: Provides general information that is not necessarily considered to be of an emergent nature. Example: HAN00345
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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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