Update, Case Definitions, and GuidanceMERS Update By Dr.Moh'd Alamin.Head of infection control, ER doctor, Meeqat Hospital.

1. UPDATE, CASE
DEFINITIONS, AND
GUIDANCE
MERS UPDATE

2. ?What is MERS
CDC continues to work closely with the World
Health Organization (WHO) and other partners
to better understand the public health risk
Middle East Respiratorypresented by
-). MERSCoV-Coronavirus (MERSSyndrome
CoV used to be called “novel coronavirus,” or
“nCoV

3. What is the new human
coronavirus?
A novel coronavirus was identified in 2012 as
the cause of respiratory illness in people. The
new virus is a beta coronavirus. It is different
from any other coronavirus previously found in
people.

4. Is this virus the same as the
SARS virus?
the samenotisnovel coronavirusNo. The
virus that caused severe acute respiratory
syndrome (SARS) in 2003. However, like the
SARS virus, the novel coronavirus is most
similar to those found in bats. CDC is still
learning about this new virus.

7. The first cluster of two cases
The first cluster of two cases, both fatal,
occurred near Amman, Jordan, in April 2012.
Stored samples from these two cases tested
positive retrospectively for the novel
coronavirus. This cluster was temporally
associated with cases of illness among
workers in a hospital

8. A second cluster
A second cluster occurred in October 2012, in
Saudi Arabia. Of the four individuals in the
household, three were laboratory-confirmed
cases, two of them died

9. MERS Cases and Deaths,
April 2012 - May 2013
 Current as of June 11, 2013
 Countries
 Cases (Deaths)
 France
 2 (1)
 Italy
 3 (0)
 Jordan
 2 (2)
 Qatar
 2 (0)
 Saudi Arabia
 40 (26)
 Tunisia
 2 (0)
 United Kingdom (UK)
 3 (2)
 United Arab Emirates (UAE)
 1 (1)
 Total
 55 (32)

10. MERS Cases and Deaths,
April 2012 - Present
Countries Cases (Deaths)
France 2 (1)
Italy 3 (0)
Jordan 2 (2)
Qatar 2 (0)
Saudi Arabia 53 (32)
Tunisia 2 (0)
United Kingdom (UK) 3 (2)
United Arab Emirates
(UAE)
1 (1)
Total 68 (38)
Current as of June 21, 2013, 9:00 AM EDT

11. -The original source of MERS
,CoV
The original source of MERS-CoV, routes of
transmission to humans, and mode of human-
to-human transmission have not been
determined. Genetic sequencing to date has
determined the virus is most closely related to
coronaviruses detected in bats. CDC is
continuing to collaborate with WHO and
affected countries to better characterize the
epidemiology of MERS-CoV infection in
humans.

12. What are the symptoms of novel
coronavirus infection?
Most people who got infected with the novel
coronavirus developed severe acute
respiratory illness with symptoms of fever,
cough, and shortness of breath. Some
people were reported as having a mild
respiratory illness

13. Case Definitions
 Patient Under Investigation
(PUI)

14. Patient Under Investigation
(PUI)
 A person with an acute respiratory infection,
which may include fever (≥ 38°C , 100.4°F)
and cough; AND
 suspicion of pulmonary parenchymal disease
(e.g., pneumonia or acute respiratory distress
syndrome based on clinical or radiological
evidence of consolidation); AND
 history of travel from the Arabian Peninsula or
neighboring countries* within 10 days; AND

15. Probable Case
 A person fitting the definition above of a “Patient
Under Investigation” with clinical, radiological, or
histopathological evidence of pulmonary
parenchyma disease (e.g. pneumonia or ARDS)
but no possibility of laboratory confirmation either
because the patient or samples are not available
or there is no testing available for other respiratory
infections, AND
 close contact with a laboratory confirmed case,
AND
 not already explained by any other infection or
etiology, including all clinically indicated tests for
community-acquired pneumonia according to local
management guidelines.

16. Confirmed Case
 A person with laboratory confirmation of
infection with the novel coronavirus.

17. Does the virus spread from person
to person?
The virus has been shown to spread between
people who are in close contact.
Transmission from infected patients to
healthcare personnel has also been
observed. Clusters of cases in Saudi Arabia,
Jordan, the UK and France are being
investigated.

18. modes of transmission
 There is clear evidence of human-to-human
transmission, possibly involving different
modes of transmission such as droplet and
contact transmission. But further studies are
required to better understand the risks. The
efficiency of person-to-person transmission of
novel coronavirus is not well characterized.

19. Can I still travel to countries in the Arabian
Peninsula or neighboring countries
Yes. WHO and CDC have not issued travel
health warnings for any country related to
novel coronavirus

20. What if I recently traveled to
countries in the Arabian Peninsula
or
neighboring countries and got sick?
If you develop a fever and symptoms of
lower respiratory illness, such as cough or
shortness of breath, within 10 days after
traveling from countries in the Arabian
, you)1(Peninsula or neighboring countries
should see your healthcare provider and
mention your recent travel

21. What are the treatments?
 There are no specific treatments for
illnesses caused by the novel
coronavirus. Medical care is
supportive and to help relieve
symptoms.

22. Is there a lab test?
Lab tests (polymerase chain reaction or
PCR) for the novel coronavirus are available at
CDC and other international labs. Otherwise,
these tests are not routinely available

23. What should healthcare
providers and health
departments do
For recommendations and guidance on the
case definitions; infection control, including
personal protective equipment guidance; case
investigation; and specimen collection and
shipment,

24. Infection control
recommendations for healthcare
settings
Until the transmission characteristics of the
novel coronavirus are better understood,
patients under investigation and probable and
confirmed cases should be managed
according to CDC’s infection control
recommendations for the coronavirus that
caused SARS.

25. For Healthcare Providers
Infection control recommendations for
healthcare settings
Standard, contact, and airborne precautions are
recommended for management of hospitalized
patients with known or suspected MERS-CoV
infection. These recommendations are
consistent with those recommended for the
coronavirus that caused severe acute
respiratory syndrome (SARS) in 2003. The
recommendations are based on available
information (as of June 10, 2013) and will be re-
evaluated and updated as needed when new
information becomes available