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Late this week the World Health Organization released revised MERS-CoV Surveillance recommendations that emphasize the need for taking lower respiratory specimens for diagnostic testing, and extend the supposed incubation period of the virus up to 2 weeks.
These changes come about as a result of studies (see The NEJM Saudi MERS-CoV Cluster Report & The Lancet: Virological Analysis Of A MERS-CoV Patient) recently published on cases in Saudi Arabia and France.
This document reiterates the WHO’s request that all `probable and confirmed cases be reported within 24 hours of classification, through the Regional Contact Point for International Health Regulations at the appropriate WHO Regional Office’.
First a link and some excerpts from the document, then a link to last night’s CIDRAP overview of MERS-News.
As of 27 June 2013Update
WHO is updating its guidance for surveillance for Middle East respiratory syndrome coronavirus (MERS-
CoV) that were first published in late 2012. WHO will continue to update these recommendations as
new information becomes available.
This document summarizes WHO recommendations, and is not a comprehensive summary of current
case reports, which are found on WHO’s novel coronavirus page
(http://www.who.int/csr/disease/coronavirus_infections/en/).It is important to note that these WHO recommendations need to be implemented in different countries with varying resources and
epidemiological patterns.
Two key changes in this 27 June 2013 update
- Stronger recommendations for lower respiratory specimens, rather than nasopharyngeal swabs, to be used to diagnose MERS-CoV infection.
- A longer period of observation for contacts of cases; this is based on accumulating information about the incubation period.
<SNIP>
Recommendations for specimen collection
It is strongly advised that lower respiratory specimens such as sputum, endotracheal aspirate, or
bronchoalveolar lavage should be used when possible until more information is available. If patients do not have signs or symptoms of lower respiratory tract infection and lower tract specimens are not possible or clinically indicated, both nasopharyngeal and oropharyngeal specimens should be collected.
The two can be combined in a single collection container and tested together. If initial testing of a nasopharyngeal swab is negative in a patient who is strongly suspected to have MERS-CoV infection, patients should be retested using a lower respiratory specimen or a repeat nasopharyngeal specimen with additional oropharyngeal specimen if lower respiratory specimens are not possible. For patients in whom adequate lower respiratory samples are not possible, investigators may also want to consider other types of auxiliary testing such as nasopharyngeal wash and paired acute and convalescent sera.
Virus has also been demonstrated in other body fluids such as blood, urine, and stool but the usefulness of those body fluids in diagnosing MERS-CoV infection is uncertain.
For more on this, and a round up of additional MERS-CoV news, I’d invite you to visit CIDRAP NEWS and read Robert Roos & Lisa Schnirring’s report from last night.
WHO revises MERS-CoV surveillance advice
Filed Under:
Robert Roos and Lisa Schnirring | Staff Writers | CIDRAP News
The World Health Organization (WHO) yesterday updated its surveillance recommendations for MERS-CoV (Middle East respiratory syndrome coronavirus) to make them consistent with recent findings about diagnostic samples and the disease's potentially long incubation period.
