Confirmation of the first US case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection is prompting hospitals and other facilities to reevaluate their infection control policies and preparedness plans for dealing with a potentially dangerous infectious disease.
As of May 7, the World Health Organization (WHO) said that it had been informed of a total of 496 laboratory confirmed cases of MERS-CoV infection. To date, since the novel coronavirus that was first identified in Saudi Arabia in 2012, cases have been reported in more than a dozen countries, but all of them have originated in 6 countries in the Arabian Peninsula (the US patient developed symptoms shortly after returning to the United States from Saudi Arabia).
There is no effective vaccine or antiviral treatment available. The infection is often fatal; the WHO said that the 489 cases that had been reported by May 3 included 126 deaths.
US Case Not Unexpected
“We’ve anticipated MERS reaching the [United States], and we’ve prepared for and are taking swift action,” said Centers for Disease Control and Prevention (CDC) Director Tom Frieden, MD, MPH, in a written release. “We’re doing everything possible with hospital, local, and state health officials to find people who may have had contact with this person so they can be evaluated as appropriate.”
As part of overall control measures, public health officials are monitoring close contacts of the US patient. The patient, a 60-year-old US citizen who reportedly works as a health care worker at a hospital in in Riyadh, Saudi Arabia, traveled from Riyadh to Chicago via London’s Heathrow airport and then took a bus to Indiana. When he presented to a local hospital on April 28 with shortness of breath, cough, and fever—symptoms typical of MERS-CoV—hospital physicians suspected the infection because of the patient’s travel history to Saudi Arabia. Public health authorities confirmed on May 2 that MERS-CoV was indeed the cause of the patient’s symptoms.
Focus on Infection Control in Health Care Facilities
Health officials stressed the US case poses little risk to the public. In rare instances, the virus has spread from person to person through close contact, but there is currently no evidence of sustained spread of MERS-CoV in community settings.
However, last year, the largest reported MERS-CoV outbreak to date—ultimately involving 23 confirmed cases in 4 health care facilities in eastern Saudi Arabia—underscored that person-to-person transmission of the virus can occur in health care settings.
A 5-day mission to Saudi Arabia by a WHO team of experts to assess a recent spike in the number of MERS-CoV cases in that country underscored the importance of use of appropriate infection-control practices in the the hospital setting. The WHO team reported on May 7 that the upsurge in cases “can be explained by an increase, possibly seasonal, in the number of primary cases amplified by several outbreaks in hospitals due to breaches in WHO’s recommended infection prevention and control measures.”
On May 2, the CDC sent out a health advisory to “alert clinicians, health officials, and others to increase their index of suspicion to consider MERS-CoV infection in travelers from the Arabian Peninsula and neighboring countries.” The agency also provides a variety of resources for health care facilities, focusing on issues such as implementing appropriate isolation and infection control practices, reviewing communication plans, and confirming contact information for local and state health departments. The goal is to help health care facilities be better prepared to address MERS-CoV and similar threats.
At the University of Michigan Health System (UMHS), for example, preparation for MERS-CoV falls under the system’s general preparation for novel respiratory viruses, said Laraine Washer, MD, assistant professor of medicine and hospital epidemiologist. This preparation is part of a comprehensive approach to emergency and disaster planning known as “all-hazard preparation,” that includes addressing issues such as surge capacity, mass casualties, and communication plans, explained Washer.
Last fall, UMHS temporarily instituted active screening for MERS-CoV during the time of the Hajj, the annual Muslim pilgrimage to Mecca. Southeastern Michigan has a large Arab American population, so there is an increased likelihood that UMHS might see patients returning from the area, Washer noted. After the announcement of the first US MERS-CoV case last week, UMHS sent out updates and communication to all clinicians to be alert for the infection.
“The key is for clinicians and health care workers to have an awareness of who is at risk,” said Washer. “Be alert for respiratory symptoms, especially severe respiratory symptoms. Ask about travel.” The UMHS also reinstituted screening questions for all patients seen in the emergency department. The questions are general and focus on respiratory symptoms and as well as a history of travel to the Middle East region.
If someone screens positive—has symptoms suggestive of MERS-CoV and a recent relevant travel history or close contact with a symptomatic recent traveler from the Arabian peninsula—he or she would be asked to put on a surgical mask. After a physician evaluates the patient, if there are concerns about possible MERS-CoV infection, infection control measures would be put in place. These include such measures as placing the patient in a negative-pressure room (which maintains a flow of air into the room and filters it before it is vented to the outside) and providing health care workers with gloves and gowns and protective equipment, such as eye protection and a N95 mask to filter airborne particles.
At this time, neither the CDC nor the World Health Organization has issued a formal travel warning for any country related to MERS-CoV. In terms of advice for travelers to the region, the CDC outlines some basic suggestions to protect against respiratory infections and other illnesses, including avoiding contact with people who are ill and frequent hand washing with soap and water (or an alcohol-based hand sanitizer if soap and water are not available). Washer said she also asks people to avoid getting on a plane if they are ill. Anyone who develops fever and cough or shortness of breath within 14 days after traveling from countries in or near the Arabian Peninsula should seek medical attention.