Middle East Respiratory Syndrome Coronavirus
Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Case definition
The Novel Corona virus or what is called Middle East Respiratory Syndrome Coronavirus (MERS-CoV) continuo to pose health risk to the whole world after reporting the first case of human infection on September 2012 and reporting of the new cases continuo to increase indicating that ongoing risk for transmission to humans in other area of the world and probability of nosocomial outbreak that highlight the importance of the proper infection prevention and control procedures
Patient with comorbidities, immunosuppression status, old age, are at increased risk to acquire infection that mainly severe respiratory illness associated with Middle East respiratory syndrome Corona virus and proper intervention need to be applied to protect contacts and treat the patient himself so the important step is to make proper case definition:
Patient under Investigation (PUI)
All health care institutions must report that patient to the local health authorities in order the make surveillance for the case and the contact that person has the following symptoms and signs:
Patient has acute respiratory infection, which may include fever (≥ 38°C) and cough, suspicion of pulmonary parenchymal disease (e.g., pneumonia or acute respiratory distress syndrome based on clinical judgment or radiological evidence of consolidation either X-ray or CT scan); history of travel from the affected area or contacted diseases or query person with MERS-CoV within 14 days
The above symptoms and signs have not explained by any other infection or etiology e.g. community acquired infection
Other group of people have high probability of acquiring infection so they need to be evaluated for the possibility of MERS-CoV infection:
- people who start to have severe acute lower respiratory tract illness of known etiology within 14 days after travel from the affected areas but do not respond to appropriate therapy; OR
- people who start to have severe acute lower respiratory illness who are close contacts of a symptomatic patients who developed fever and acute respiratory illness within 14 days after travel from the affected area
- Any contact person, including a healthcare worker or family member, or had similarly close physical contact.
- Any person who stayed at the same place (e.g. lived with, visited) as the patient while the patient was ill.
Any person who meet the same criteria for the Patient Under Investigation and has clinical, radiological evidence of pulmonary parenchyma disease (e.g. pneumonia or ARDS), but no possibility of laboratory confirmation , may be the patient or samples are not available or there is no testing available for other respiratory infections, AND is a close contact with a laboratory-confirmed case, also The above symptoms and signs have not explained by any other infection or etiology e.g. community acquired infection
Or any person with severe acute respiratory illness with no known etiology, AND an epidemiologic link to a confirmed MERS case.
- The confirmation is laboratory confirmed only with MERS-CoV infection
- Specimens need to be collecetd from different sites (e.g., nasopharyngeal swab ,sputum culture , bronchoalveolar lavage and bronchial wash). Specimens has to be collected at different times after symptom onset, if possible to increase the likelihood of detecting MERS-CoV, Specimens should be collected with appropriate infection control precautions to minimize the risk of exposure to any health care provider
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