Thursday, June 11, 2015

CDC Releases HAN #380 On MERS

# 10,190

Although there are no known MERS cases in the United States right now (we saw two in 2014), the reality is that MERS - like avian flu, Ebola, and a short list of other highly problematic infectious diseases - are but a plane ride away from any major city in the country.

For that reason the CDC is urging physicians to be aware of the possibility of seeing an imported MERS case, and providing information on how they should be handled to minimize the risk of spreading the virus. 

 Earlier today the CDC held a COCA Call (see Updated Information & Guidelines For Evaluation Of MERS), which ought to be archived and available for download in the next day or so.  Along with this presentation, the CDC has also released the following HAN Advisory.

Distributed via the CDC Health Alert Network
June 11, 2015, 14:00 EST (2:00 PM EST) 
Updated Information and Guidelines for Evaluation of Patients for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection  

Summary: The Centers for Disease Control and Prevention (CDC) continues to work with the World Health Organization (WHO) and other partners to closely monitor Middle East Respiratory Syndrome Coronavirus (MERS-CoV) globally, including the cases of MERS-CoV infection recently reported by China and the Republic of Korea, to better understand the risks to public health. The purpose of this HAN Advisory is to provide updated guidance to state health departments and healthcare providers in the evaluation of patients for MERS-CoV infection, which have been revised in light of the current situation in the Republic of Korea. Healthcare providers and public health officials should maintain awareness of the need to consider MERS-CoV infection in ill persons 
who have recently traveled from countries in or near the Arabian Peninsula1 or in the Republic of Korea as outlined in the guidance below. Please disseminate this information to healthcare providers, especially infectious diseases specialists, intensive care physicians, internists, infection preventionists, and to emergency departments and microbiology laboratories. 

On May 20, 2015, the Republic of Korea (Korea) reported to WHO a case of laboratory-confirmed2 MERS-CoV infection, the first case in what is now the largest outbreak of MERS-CoV outside of the Arabian Peninsula1. The index case is a 68 year-old male who travelled to Bahrain, United Arab Emirates (UAE), Kingdom of Saudi Arabia (KSA), and Qatar, prior to returning to Korea on May 4. 
He subsequently became ill and sought medical care at several healthcare facilities before being diagnosed with MERS-CoV on May 20.  Since then, as of June 10, 107 additional laboratory-confirmed2 cases of MERS-CoV have been identified according to the Republic of Korea Ministry of Health, for a total of 108 cases, including 9 deaths; WHO has confirmed 64 of these cases and 5 deaths. One of these cases is a contact associated with this outbreak who travelled from Korea to China on May 26 while symptomatic, tested positive for MERS-CoV in China on May 29, and is the first reported case from China; no other countries have reported any cases of MERS-CoV infection linked to this outbreak. 
According to available WHO reports, all reported cases are epidemiologically linked to the index case, with transmission limited to other patients, healthcare workers, and visitors in healthcare facilities where case-patients received care.  This outbreak is still under investigation, and active contact tracing and prevention measures are ongoing in Korea and China. CDC is closely monitoring the situation to better understand the public health risks associated with this outbreak.  
First identified and reported to cause severe acute respiratory illness in September 2012, MERS-CoV has caused infections worldwide, with 25 countries reporting cases to date. As of June 10, 2015, 1,219 laboratory-confirmed2 cases of MERS-CoV infection have been reported to and confirmed by WHO, including at least 449 (37%) deaths. The majority of cases (~85%) have been reported from KSA. All reported cases have been directly or indirectly linked through travel or residence to nine countries: KSA, UAE, Qatar, Jordan, Oman, Kuwait, Yemen, Lebanon, and Iran. In the United States (US), nationwide surveillance for MERS-CoV has been ongoing since 2012, and as of June 5, 2015, 45 states have submitted specimens to CDC or conducted their own testing for MERS-CoV based on CDC criteria available in their current form at Of the 584 total persons tested in the US, two patients tested positive for MERS-CoV in May 2014 and were determined to be imported cases from KSA; the remaining 582 patients tested negative. 

Follow the link to read the CDC's case definitions and recommendations for handling suspected and confirmed cases. 

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