Middle East Respiratory Syndrome MERS-CoV - Infection Control

FIGHT MERS-COV
WE CAN STOP THIS
BY;
DR. KHALED M. SAYED
MBBS, M.SC. MEDICAL MICROBIOLOGY &
IMMUNOLOGY
INFECTION CONTROL DIRECTOR, MCC

MERS-COV DR. KHALED M. SAYED 4-4-2017

Infection Prevention and Control Guidelines for
Middle East Respiratory Syndrome Coronavirus
(MERS-CoV)
Update (JAN 2017)

OBJECTIVES
 To Know what’s MERS-CoV
 To Identify suspected, probable and confirmed
cases.
 To understand the infection control measures
which should be followed when dealing with
MERS-CoV suspected or confirmed cases.

WHAT’S MERS?
 MERS is an illness caused by a virus called Middle
East Respiratory Syndrome Coronavirus (MERS-
CoV).
 MERS affects the respiratory system.
 Most MERS patients developed severe acute
respiratory illness with symptoms of fever, cough
and shortness of breath.

WHAT’S MERS?
 Health officials first reported the disease in Saudi
Arabia in September 2012. Through retrospective
investigations, health officials later identified that
the first known cases of MERS occurred in Jordan in
April 2012.
 MERS-CoV has spread from people with the virus to
others through close contact, such as caring for or
living with an infected person.

WHAT’S MERS-COV?
 MERS-CoV is a new member of the beta group of coronavirus
 Positive-sense, single-stranded RNA
 Named for the crown-like projections on the virus surface

MERS-COV UP TO DATE
WORLD WIDE
 Since September 2012, WHO has been notified of 1,936
laboratory-confirmed cases of infection with MERS-CoV.
 From 27 countries in the Middle East, North Africa, Europe, the
United States of America, and Asia.
 80% of whom were reported by the Kingdom of Saudi Arabia
 With 684 deaths related to MERS-CoV.
 Mortality Rate = 35 %

MERS-COV UP TO DATE
WORLD WIDE

MERS-COV UP TO DATE - KSA
 Since April 2012, 1584 laboratory-confirmed cases of
human infection with Middle East respiratory
syndrome coronavirus (MERS-CoV) have been
reported to MOH.
659 cases passed away (May Allah have mercy upon them).
 Mortality rate = 42%

MERS-COV UP TO DATE - KSA

MERS-COV: ORIGINS
 Dromedary camels are the identified
reservoir of MERS-CoV and close
contact with them represent risk
factor for MERS
 Primary cases proved with direct
camel contact

MERS-COV: ORIGINS

MERS-COV IDENTIFICATION IN CAMELS

TRANSMISSION

PRIMARY TRANSMISSION
MERS-CoV causes zoonotic
infections in humans by direct
or indirect contact with
infected dromedary camels or
camel-related products.

SECONDARY TRANSMISSION
 The majority of cases are
secondary and have
resulted from human-to-
human transmission in
health care settings,
related to breaches in
infection prevention and
control (IPC) practices and
less often in households.

TRANSMISSION
 The virus does not appear to transmit
easily from person to person unless there
is close contact, such as providing
clinical care to an infected patient while
not applying strict infection control
measures
 To date, sustained community wide
MERS-CoV transmission has not been
observed.

EPIDEMIOLOGY
The majority of cases have been reported in:
 Adults (98%) and males (66%)
 with a median age of 50 years (range from 9 months to 99 years)
 There are very few reports on children with MERS-CoV infection.
 Incubation period 2–14 days
 Infectious period
– Under investigation (Not believed contagious before onset)

CLINICAL PRESENTATION
* Range of presentations:
– 62 % severe respiratory illness
– 5 % mild symptoms
– 21 % asymptomatic
* The clinical manifestations of MERS-CoV infections range
from asymptomatic infection to severe pneumonia, often
complicated by acute respiratory distress syndrome (ARDS),
septic shock and multi-organ failure leading to death.

* The most common early signs and symptoms
in more severe infections are:
- Fever (98%)
- Chills (87%)
- Cough (83%)
- Dyspnoea (72%)
* Nearly 25% of cases also report
gastrointestinal symptoms such as vomiting
and diarrhoea.
* Fever may be absent in up to 15% of
hospitalized cases

* Rapid progression to severe pneumonia and respiratory
failure usually happens within the first week.
* The presence of at least one co-morbid condition (e.g,
immuno-compromised state, malignancies, obesity,
diabetes, cardiac disease, renal disease and lung
disease) has been reported in 76% of cases, and is
associated with a higher risk of death.

* Reported laboratory abnormalities include leukopenia,
lymphopenia, thrombocytopenia, consumptive
coagulopathy, and elevated serum creatinine, lactate
dehydrogenase and liver enzymes
* Co-infections with other respiratory viruses and
bacterial pathogens have also been reported

OUR GOALS
To ensure early recognition of patients at
risk for MERS-CoV
To prevent nosocomial transmission of
MERS-CoV in HCS
HOW?

INFECTION CONTROL IS
THE ONLY WAY TO STOP
THE SPREAD OF MERS-COV

10 STEPS TO FIGHT MERS-COV IN OUR CENTER
 1. Maintain strict personal hygiene
 2. Ensure proper use of PPE by staff and patient
 3. Identify and isolate potential MERS-CoV patients early
 4. Allocate adequate facilities for MERS-CoV patients
 5. Follow appropriate housekeeping practices
 6. Monitor staff health – don’t allow sick people at work
 7. Implement stricter visitor policy
 8. Send for home isolation under supervision, when possible
 9. Ensure safe collection and handling of lab samples
 10. Take precautions in the mortuary

CASE DEFINITION
1- Suspected Case
2- Probable Case
3- Confirmed Case

SUSPECTED CASE (PATIENTS WHO
SHOULD BE TESTED FOR MERS-COV)
A. Adults (> 14 years) *
I. Acute respiratory illness with clinical and/or radiological, evidence of pulmonary
parenchymal disease (pneumonia or Acute Respiratory Distress Syndrome).
II. A hospitalized patient with healthcare associated pneumonia based on clinical and
radiological evidence.
III. Upper or lower respiratory illness within 2 weeks after exposure to a confirmed or
probable case of MERS-CoV infection.
IV. Unexplained acute febrile (≥38°C) illness, AND body aches, headache, diarrhea, or
nausea/vomiting, with or without respiratory symptoms, AND leucopenia (WBC<3.5x109/L)
and thrombocytopenia (platelets<150x109/L).
V. Unexplained febrile illness with recent (14 days) exposure to camels or camel products.
* Patients with chronic kidney disease and those with heart failure could present atypically
and high index of suspicion is required

B. Pediatrics (≤ 14 years)
I. Meets the above case definitions and has at least one of the following:
a. History of exposure to a confirmed or suspected MERS in the 14 days
prior to onset of symptoms
b. History of contact with camels or camel products in the 14 days prior
to onset of symptoms
II. Unexplained severe pneumonia
* All suspected cases should have nasopharyngeal swabs or sputum,
and when intubated, lower respiratory secretions samples collected for
MERS-CoV testing
SUSPECTED CASE (PATIENTS WHO
SHOULD BE TESTED FOR MERS-COV)

PROBABLE CASE
 A probable case is a patient in category I or II above
(Adults and pediatrics) with inconclusive laboratory
results for MERS-CoV and other possible pathogens
who is a close contact of a laboratory-confirmed MERS-
CoV case or who works in a hospital where MERS-CoV
cases are cared for or had recent contact with camels
or camel’s products.

CONFIRMED CASE
 A confirmed case is a suspected
case with laboratory confirmation of
MERS-CoV infection.

EARLY DETECTION OF CASES
 Rapid identification of patients with ARI and patients
suspected of MERS- CoV infection is key to prevent
healthcare associated transmission of MERS-CoV or
other respiratory viruses.
 Visual triage should be used for early identification of
all patients with ARI in the Emergency Room and the
Clinics.

VISUAL TRIAGE: ILLNESS CHECKLIST FOR
MERS IN ADULTS

VISUAL TRIAGE: ILLNESS CHECKLIST FOR
MERS IN PEDIATRICS

TRIAGE FOR RAPID IDENTIFICATION OF PATIENTS
WITH ACUTE RESPIRATORY ILLNESS (ARI)
 Identified ARI patients should be asked to wear a
surgical mask. They should be evaluated
immediately in an area separate from other
patients
 Infection control and prevention precautions
should be promptly implemented (Patient
separation 1.2 meter, Respiratory hygiene and
cough etiquette)

ON SUSPICION
Immediately Isolate the Patient

ON SUSPICION
1- Ensure that the quality of specimen is high. Obtain lower
respiratory specimens when possible and oropharyngeal in
addition to nasopharyngeal when not possible.
2- Consider repeat testing when clinical suspicion of MERS-CoV
infection is high if initial test is negative.
3- Continue strict adherence to appropriate infection control
procedures, even if a test is negative, when the clinical
presentation and epidemiological picture is consistent with
MERS-CoV.

ON SUSPICION  FILL THE FORMS
1- Order Samples for MERS-CoV and Influenza A H1N1, And fill
the laboratory request forms (One for each).
2- Fill (Form no.3) Case summary form for suspected and
confirmed MERS-CoV case data collection.

ON SUSPICION  FILL FORMS

CONFIRMED CASE
Algorithm for managing patients with suspected MERS-CoV

QUESTIONS ???

Middle East Respiratory Syndrome MERS-CoV - Infection Control

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