The CDC has released recommendations for healthcare professionals on patient evaluation, specimen collection, and home care and isolation following the first two cases of MERS-CoV infection in the United States.

The first case of MERS in the U.S. was confirmed by the CDC on May 2, 2014, involving a male U.S. citizen in Indiana, aged ≥60 years who had recently traveled from Saudi Arabia to the U.S. He is considered to be fully recovered and has been discharged from the hospital. The second case was confirmed on May 11, 2014 in a healthcare provider aged ≥40 years in Florida who had recently traveled from Saudi Arabia to the U.S. The patient is currently being treated in a hospital with infection control precautions.

While no specific treatment or vaccine is currently available for MERS-CoV infection, the CDC is advising clinicians to evaluate a suspected a patient who is exhibiting symptoms of fever and pneumonia or acute respiratory distress syndrome (based on clinical or radiologic evidence) for the following scenarios:

  • A history of travel from countries in or near the Arabian Peninsula within 14 days before symptom onset
  • Close contact with a symptomatic traveler who developed fever and acute respiratory illness (not necessarily pneumonia) within 14 days after traveling from countries in or near the Arabian Peninsula
  • Is a member of a cluster of patients with severe acute respiratory illness (e.g., fever and pneumonia requiring hospitalization) of unknown etiology in which MERS is being evaluated in consultation with a state or local health department
  • Close contact with a confirmed or probable case of MERS while the affected person was ill, such as community contacts or contacts on conveyances (e.g., airplane, bus)

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In testing for MERS-CoV, the CDC is also recommending that these patients be evaluated for common causes of community-acquired pneumonia; the test for MERS-CoV and other respiratory pathogens can be conducted simultaneously. Co-infection can occur with MERS-CoV and other respiratory pathogens. The majority of cases have reported severe acute lower respiratory illness but mild and asymptomatic infections have also been reported. Additional early symptoms can include chills, headache, myalgia, nausea, vomiting, and diarrhea. It is advised that testing using nasopharyngeal and oropharygeal swabs by rRT-PCR to detect MERS-CoV be considered on initial evaluation, whether or not the symptoms are present or significant. Patients exhibiting symptoms could be evaluated for additional MERS-CoV testing, including rRT-PCR testing of lower respiratory and serum specimens, and possibly MERS-CoV serology (particularly if symptom onset was >14 days prior). For the most accurate diagnosis, multiple testing specimens from different sites at varying times following symptom onset should be collected. Those collecting specimens should wear personal protective equipment (i.e., gloves, gowns, eye protection, and respiratory protection), and recommended infection control precautions should be used when collecting specimens.

Recommended infection-control measures in healthcare setting include:

  • Airborne Infection Isolation Room (AIIR)
  • Gloves
  • Gowns
  • Eye protection (goggles or face shield)
  • Respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator, or a facemask if unavailable
  • Cleaning and disinfection of environmental surfaces and equipment, textiles and laundry, food utensils and dishware

Any healthcare professional should notify their state or local health department if they suspect MERS-CoV infection in a patient. These health departments can determine if home isolation is suitable for the patient or if hospitalization is required.

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