Evaluation of Patients under Investigation for MERS-CoV Infection, United States, January 2013–October 2014 - Volume 21, Number 7—July 2015 - Emerging Infectious Disease journal - CDC

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Evaluation of Patients under Investigation for MERS-CoV Infection, United States, January 2013–October 2014 - Volume 21, Number 7—July 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 7—July 2015

Dispatch

Evaluation of Patients under Investigation for MERS-CoV Infection, United States, January 2013–October 2014

On This Page

• The Study
• Conclusions
• Suggested Citation

Figures

• Figure 1
• Figure 2

Tables

• Table 1
• Table 2

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• PDF[923 KB - 4 pgs]
• RIS[TXT - 2 KB]

Eileen Schneider , Christina Chommanard, Jessica Rudd, Brett Whitaker, Luis Lowe, and Susan I. Gerber

Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Suggested citation for this article

Abstract

Middle East respiratory syndrome (MERS) cases continue to be reported from the Middle East. Evaluation and testing of patients under investigation (PUIs) for MERS are recommended. In 2013–2014, two imported cases were detected among 490 US PUIs. Continued awareness is needed for early case detection and implementation of infection control measures.

Middle East respiratory syndrome coronavirus (MERS-CoV) infection was first reported in September 2012 in a patient with fatal pneumonia in Saudi Arabia (1). Subsequent investigation showed that earlier MERS-CoV infection had occurred in Jordan in April 2012 among a cluster of patients with pneumonia (2,3). As of February 5, 2015, the World Health Organization had reported 971 laboratory-confirmed cases worldwide and at least 356 related deaths (4). All known reported cases have been linked directly or indirectly to the Middle East region; most have been reported by Saudi Arabia and the United Arab Emirates. Typically, the initial symptoms for MERS patients seeking medical care are fever, chills, cough, shortness of breath, and myalgia. These symptoms often progress to severe lower respiratory tract infection, which may require mechanical ventilation and intensive care (5,6). Several asymptomatic or mild MERS cases have been reported (7), particularly in healthy young adults. Little is known about transmission routes, virus shedding, risk factors, and animal reservoirs, although bats and camels have been implicated in transmission and as reservoirs (8,9). Clusters of human-to-human transmission have been associated with household and health care settings (2,3,5).

Using World Health Organization guidelines and definitions (4), CDC developed guidance for evaluating a patient under investigation (PUI) for MERS-CoV infection, collecting specimens, conducting laboratory testing, and managing infection control (http://www.cdc.gov/coronavirus/mers/index.html). The PUI guidance was created to assist health care providers determine which patients should be considered for MERS-CoV evaluation and testing. To inform state and local health departments of the basic demographic and clinical characteristics of PUIs and on assay use, we summarized the descriptive analysis of PUIs in the United States.

Dr. Schneider is a senior medical epidemiologist with the Division of Viral Diseases, CDC. Her current research interests include respiratory viruses.

Acknowledgment

We thank the state and local health departments, healthcare providers, CDC Emergency Operations Center, and CDC MERS Domestic Response Team for all of their hard work on MERS-CoV, especially in evaluating, testing, and reporting PUIs.

References

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7. Omrani AS, Matin MA, Haddad Q, Al-Nakhli D, Memish ZA, Albarrak AM. A family cluster of Middle East respiratory syndrome coronavirus infections related to a likely unrecognized asymptomatic or mild case. Int J Infect Dis. 2013;17:e668–72. DOIPubMed
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11. Centers for Disease Control and Prevention. Middle East respiratory syndrome (MERS). Data collection [cited 2015 Mar 10].http://www.cdc.gov/coronavirus/mers/data-collection.html
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13. Kapoor M, Pringle K, Kumar A, Dearth S, Liu L, Lovchik J, Clinical and laboratory findings of the first imported case of Middle East respiratory syndrome coronavirus (MERS-CoV) in the United States. Clin Infect Dis. 2014;59:1511–8. DOIPubMed
14. Centers for Disease Control and Prevention. Interim guidelines for collecting, handling, and testing clinical specimens from patients under investigation (PUIs) for Middle East respiratory syndrome coronavirus (MERS-CoV)—version 2 [cited 2015 Mar 10]http://www.cdc.gov/coronavirus/mers/guidelines-clinical-specimens.html
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Figures

• Figure 1. Number of PUIs tested for MERS-CoV (N = 490), by state, United States, January 1, 2013–October 31, 2014. DC, District of Columbia; PUIs, patients under investigation.
• Figure 2. Number of PUIs tested for MERS-CoV (N = 490), by month reported, United States, January 1, 2013–October 31, 2014. PUIs, patients under investigation.

Tables

• Table 1. Characteristics of 490 PUIs for MERS-CoV, United States, January 1, 2013–October 31, 2014
• Table 2. Countries from which 381 PUIs for MERS-CoV infection had traveled within 14 days of symptom onset, United States January 1, 2013–October 31, 2014

Suggested citation for this article: Schneider E, Chommanard C, Rudd J, Whitaker B, Lowe L, Gerber SI. Evaluation of patients under investigation for MERS-CoV infection, United States, January 2013–October 2014. Emerg Infect Dis. 2015 Jul [date cited]. http://dx.doi.org/10.3201/eid2107.141888

DOI: 10.3201/eid2107.141888