Laboratory Testing for Middle East Respiratory Syndrome Coronavirus, California, USA, 2013–2014

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Mahtab Shahkarami, Cynthia Yen, Carol A. Glaser, Dongxiang Xia, James Watt, and Debra A. Wadford

Author affiliations: California Department of Public Health, Richmond, California, USA

Abstract

Since Middle East respiratory syndrome coronavirus (MERS-CoV) first emerged, the California Department of Public Health has coordinated efforts to identify possible cases in travelers to California, USA, from affected areas. During 2013–2014, the department investigated 54 travelers for MERS-CoV; none tested positive, but 32 (62%) of 52 travelers with suspected MERS-CoV had other respiratory viruses.

Middle East respiratory syndrome coronavirus (MERS-CoV) has been a global concern since its discovery in Saudi Arabia in 2012. As of April 29, 2015, >1,100 confirmed MERS cases and >420 associated deaths had occurred globally; all cases were linked to the Middle East (1). Importation of MERS-CoV by travelers from the Arabian Peninsula to regions outside the Middle East has been documented (2). In May 2014, the first 2 cases of MERS in the United States were identified in unrelated travelers from Saudi Arabia (3).

Each year, an estimated 16 million international travelers visit California (4), of whom 225,000 are visitors from the Middle East (5); thus, a risk exists for importation of MERS-CoV into California. Furthermore, global events such as the annual Hajj and Umrah pilgrimages draw 11,000 Americans to Saudi Arabia each year (6).

Because of the possible risk for disease transmission, the Centers for Disease Control and Prevention (CDC) and the World Health Organization have issued MERS-CoV travel advisories for pilgrims traveling to Saudi Arabia (7,8). In the fall of 2012, the California Department of Public Health (CDPH) addressed the risk of MERS-CoV importation and convened a working group composed of clinicians, laboratory staff, infection control experts, emergency operations staff, and information officers. This working group regularly reviewed the CDC and World Health Organization updates, scientific publications, and laboratory logistics, and took steps at the state level to prepare for MERS. CDPH developed and disseminated guidance on surveillance, specimen collection for laboratory testing, infection control, and contact tracing (9). A CDPH clinician was available around the clock 7 days a week to assist with individual suspected cases of MERS.

Ms. Shahkarami is a public health microbiologist specialist at the California Department of Public Health. Her main areas of work include molecular diagnostics and surveillance of respiratory viruses in California.

Acknowledgment

We thank Tasha Padilla, Kara Pham, Estela Saguar, Ricardo Berumen III, Chao-Yang Pan, Hugo Guevara, Anthony Moore, Christopher Anderson, and Rosie Glenn-Finer for their technical and epidemiologic support. We also thank local health departments for their assistance in investigations and surveillance.

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Figure. Middle East respiratory syndrome (MERS) coronavirus patients under investigation (PUIs) tested at the California Department of Public Health (CDPH), 2013–2014. Months during which the Hajj takes place are delineated by...

Table

Table. Respiratory viruses detected in MERS patients under investigation tested by California Department of Public Health, 2013–2014

Suggested citation for this article: Shahkarami M, Yen C, Glaser C, Xia D, Watt J, Wadford DA. Laboratory testing for Middle East respiratory syndrome coronavirus, California, USA, 2013–2014. Emerg Infect Dis. 2015 Sep [date cited]. http://dx.doi.org/10.3201/eid2109.150476

DOI: 10.3201/eid2109.150476