May 7, 2014 Liz Borkowski, MPH 1Comment

Middle East respiratory syndrome (MERS) is a viral respiratory illness characterized by fever, cough, and shortness of breath, and it has been fatal in 30% of the cases identified since the disease was first reported in Saudi Arabia in 2012. It is caused by a coronavirus (MERS-CoV) and has been shown to spread between humans by close contact; new research suggests the virus may also be transmitted to humans from camels. Cases have been identified in multiple countries in the Arabian Peninsula, and a spike in cases in April — more than 200 in Saudi Arabia and the United Arab Emirates that month — has raised concerns. According to the European Centre for Disease Prevention and Control, 495 cases have now been reported worldwide. On May 2, CDC announced the first US case of MERS, in a patient who traveled from Saudi Arabia to Indiana.

The patient, a man in his sixties, lives in Saudi Araba and was working in a hospital in Riyadh where MERS patients were being treated. He flew from Riyadh to London to Chicago on April 24th, and then took a bus to Indianapolis. He experienced flu-like symptoms on April 27th and sought hospital treatment on April 28th. On May 2nd, CDC’s laboratory confirmed that he had MERS. The Chicago Tribune’s Juan Perez Jr. and Andy Grimm report on measures being taken to reduce the risk of the virus spreading:

Medical workers at an Indiana hospital who now have contact with the man are required to wear gloves, masks, gowns and eye protection. He’s being held in a room designed especially for patients with respiratory infections, segregated from the hospital’s air circulation system.

… As the man’s condition appears to improve and nobody else has shown evidence of infection, officials provided the most detailed account to date of the seriousness of care with which public health and Centers for Disease Control and Prevention have taken to investigate and contain the potential spread of MERS in the United States.

Roughly 50 hospital nurses, clerks, aides, dietary experts and other workers who came into contact with the patient before his infection was confirmed are on paid leave — isolated inside their homes as experts watch for signs of symptoms and test for infection during the virus’ known incubation period.

The man no longer needs the oxygen he received during the first part of his hospital stay, and is expected to be able to resume his visit with his family members, who have been asked to remain at home and to wear face masks if they leave. As of May 5th, none of the Indiana hospital workers tested positive for MERS. Because the incubation period can be as long as 14 days, they will be tested again 14 days after their initial contact with the patient.

Maggie Fox of NBC News notes, “The virus has not been known to spread on airplanes or buses. Most cases have been among people caring for sick patients or in very close contact with them.” Nonetheless, CDC is contacting the man’s airplane seat mates.

In order for officials to implement these kinds of control measures promptly, they need to quickly be able to identify a patient who may have MERS (or another serious contagious disease). In a CDC press briefing announcing the identification of this first US MERS case, Anne Schuchat, head of CDC’s National Center for Immunization and Respiratory Diseases, explained, “Because of the patient’s symptoms and travel history, Indiana public health officials tested for MERS-CoV.” Communication between healthcare providers and public-health officials is essential so that providers know what to look out for — in this case, flulike symptoms combined with recent Middle East travel — and can quickly take the necessary measures when a potential case shows up.

In its Healthcare Provider Preparedness Checklist for MERS-CoV, CDC reminds providers to stay up-to-date on the symptoms and case definitions for MERS-CoV, review infection control policies and recommendations (including personal protective equipment for healthcare personnel), be ready to deal with suspected cases in ways that minimize opportunities for the virus to spread, and know how to report potential cases, know how to communicate with state and local public health agencies.

CDC does not currently recommend that people change their travel plans; instead, its website (updated May 2nd) states:

If you are traveling to countries in or near the Arabian Peninsula, CDC recommends that you pay attention to your health during and after your trip. You should see a doctor right away if you develop fever and symptoms of lower respiratory illness, such as cough or shortness of breath, within 14 days after traveling from countries in or near the Arabian Peninsula. Tell the doctor about your recent travel.

A Washington Post editorial notes that millions of pilgrims will visit Saudi Arabia for Ramadan in July and the hajj in October.

More than a decade ago, SARS — severe acute respiratory syndrome, which is also caused by a coronavirus — emerged in China’s Guangdong province and spread to 25 other countries, killing 774 of the 8,000 people who fell ill. Helen Branswell of The Canadian Press noted that many of the confirmed SARS cases were healthcare workers: 20% worldwide, and 43% in Canada.

China faced intense criticism for long delays in informing the public and sharing information with outside doctors after it first identified that the disease was spreading. Following the SARS outbreak, the World Health Organization revised the International Health Regulations to require members states to report disease outbreaks and to strengthen their surveillance and response capabilities. Prompt and complete sharing of information — both domestically and internationally — can help hospitals, public-health officials, and others prepare to respond promptly to potential and confirmed disease cases in order to limit the outbreak’s spread.

One thought on “First case of MERS in the US highlights need for preparedness

  1. What do you have to say about the current camel-kissing craze? Some Saudis doubt that their camels would carry the virus etc.

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