Coronaviruses are enveloped RNA viruses that appear under the microscope as having crown-like projections. The common cold is associated with several viruses including some human coronaviruses. MERS-CoV was first identified in 2012 in Saudi Arabia and has an incubation period of 2-14 days. MERS-CoV causes symptoms such as fever, cough and shortness of breath, and in some cases can cause pneumonia, kidney failure and death. Since 2012 there have been over 800 cases of MERS-CoV including many in Saudi Arabia and the UAE.

2. Corona viruses
• Coronaviruses are :
•The virions appear as 'crown' or 'halo‘
named after Corona (Latin)
•Enveloped RNA Viruses
•Family: Coronaviridae
•Subfamily: Coronavirinae

3. Common cold
• Common cold ‫الشائع‬ ‫البرد‬,‫الزكام‬,‫انفلونزا‬,‫بردة‬
• The common cold has been associated with over 100
different viruses, including Human
Coronavirus and
Rhinovirus.
• Human CoVs may cause of up to 15% of all respiratory
problems.
• The early symptoms of MERS-CoV are non-specific,
therefore, it is not always possible to identify pt’s. with
MERS-CoV early.

4. MERS-CoV
• MERS-CoV
was first identified in 2012 in Saudi Arabia.
• Incubation period: 2 ‐ 14 days
• Period of infectivity: duration of infectivity is unknown.
• Asymptomatic cases as well as patients during the
incubation period might not be contagious.
• http://www.who.int/csr/disease/coronavirus_infections/case_definition/en/

5. Symptoms & Complications
• Most people confirmed to have:
Travel: to KSA within 10 days before onset of illness
Fever (over 38°C)
Cough
Shortness of breath
Some people also had symptoms including
pneumonia and gastrointestinal
Diarrhea, nausea/vomiting and kidney failure.
• Suspicion of pulmonary parenchymal disease (e.g.
pneumonia or ARDS),
• Some infected people had mild symptoms or no
symptoms at all; they recovered.
• http://www.who.int/csr/disease/coronavirus_infections/en/index.
• WHO:Clinical management of severe acute respiratory infections when novel coronavirus is suspected

6. Epidemiological
summary
• Summary:
• Since April 2012 and as of
22 May 2014,
• 815 laboratory-confirmed
cases , including 313
deaths of MERS-CoV
• WHO does not advise special
screening at points of entry nor
does it recommend the
application of any travel or
trade restrictions.
DeathsCases
283689Saudi Arabia:
970UAE
47Qatar
518Jordan
22Oman
13Kuwait
01Egypt
11Yemen
01Lebanon
12Iran
34UK
12Germany
12France
01Italy
01Greece
02Netherlands
13Tunisia
12Algeria
11Malaysia
01Philippines
02USA
31381538.4%
13 June 2014
www.ecdc.europa.eu

8. Transmission Human
• Several of the recent cases acquired the infection in KSA
or UAE and then travelled to another country, including
Greece (1 case), Malaysia (1 case), and the Philippines (1
case). No further transmission has been documented so
far.
• On other hand, exported cases occurred in the past that
resulted in limited further human‐to‐human transmission
(France and UK).

9. Transmission
• The current medical consensus confirms that the
corona virus that causes MERS is to be found in
animals hosts which are camels and bats.
• There are still many unknowns about the spread of
the MERS coronavirus.
• It seems that the virus is not easily transmitted from
person to person, but it's happened a few times that
people were infected after contact with a sick person.

10. Secondary Transmission HCW
• As much as 75% of the recently reported cases appear
to be secondary cases, thus they acquired the infection
from another infected person.
• The majority of these secondary cases, presented with
no or minor symptoms, are mainly healthcare workers
who have been infected within the healthcare setting,
• Although several patients who were in the hospital for
other reasons are also considered to have been
infected with MERS‐CoV in the hospital.

11. Health Care Workers
109/402 (27%)
63 (57.8%)Asymptomatic
35 (32.1%)Hospitalization
7 (6.4%)ICU
4 (3.7%)Died

12. Tertiary Transmission HCW
• Only four cases of transmission
within households have been
reported, and no large family
cluster has been identified.
• To date only two possible tertiary
cases have been reported.

13. Transmission
Source
Primary
Secondary
Primary
Secondary Tertiary
Primary
Primary
Secondary
75%
100%

14. Seasonal transmission
• The number of cases sharply increased follow a seasonal
pattern since mid‐March 2014, essentially in KSA and UAE,
where two important healthcare‐associated outbreaks are
occurring.
• The number of cases who acquired the infection in the
community has also increased since mid‐March. These
cases have no reported contacts with other laboratory
confirmed cases, and some have reported contacts with
animals.

15. Seasonal transmission
Seasonal pattern

16. Close contact
• **Close contact is defined as:
• a) any person who provided care for the patient,
including a healthcare worker or family member, or
had similarly close physical contact; or
• b) any person who stayed at the same place (e.g.
lived with, visited) as the patient while the patient
was ill.

17. Personal Protective Equipment (PPE)
• Gloves
• Gown
• Eye protection
• Surgical mask
• Acceptable respiratory protection devices
(N-95 respirator or higher level)
• Biological Safety Cabinet (BSC) Class II .
http://www.osha.gov/SLTC/etools/respiratory/

18. • ALWAYS wash hands before and after
entering a patient room. Not only does this
protect the patients, it also protects YOU!
Always wash your hands

19. Viral Transport System
• PROCEDURES
• Materials Provided: BD Universal Viral Transport System
includes a capture-cap vial containing 3 mL of transport
medium plus three glass beads. Universal Viral Transport
System supplied with the following specimen collection
swab:
• Two regular size plastic scored shaft swabs with polyester
fiber tips.
• Highest viral titers are present during the
acute illness.
• www.bd.com/ds

20. Viral Transport System
• Universal transporting medium that is
room temperature stable.
• This system is supplied as a sample
collection kit that comprises a
package containing:
• one capture-cap vial of medium and
• two specimen collection swabs.

21. Viral Transport System
• Do not incubate or freeze.
• Once a swab specimen is collected it should
be placed immediately into the transport vial
• Transport the specimen to the laboratory as
soon as possible.
• Specimens are refrigerated at 2 – 8°C.
storage at 4°C or -70°C.

22. EVERY ONE
is responsible
for quality
and safety

23. Respiratory Specimens
• A. Lower respiratory tract
• Sputum
• Deep cough sputum directly into a sterile, leak-proof,
sterile dry container. Refrigerate specimen at 2-8°C.
• Broncheoalveolar lavage, tracheal aspirate, pleural fluid
• Collect 2-3 mL into a sterile, leak-proof, screw-cap sputum
collection cup or sterile dry container. Refrigerate specimen
at 2-8°C.

24. Respiratory Specimens
• B. Upper respiratory tract
• Nasopharyngeal AND oropharyngeal swabs (NP/OP
swabs)
• Use only the synthetic fiber provided swabs. Place swabs
immediately into the viral transport media. NP/OP
specimens can be combined, placing both swabs in the
same vial.

25. Respiratory Specimens
• B. Upper respiratory tract
• Nasopharyngeal swabs - Insert a swab into the nostril
parallel to the palate. Leave the swab in place for a few
seconds to absorb secretions. Swab both nasopharyngeal
areas.
• Oropharyngeal swabs - Swab the posterior pharynx,
avoiding the tongue.

26. Blood
• II. Blood Components
• Serum (for rRT-PCR testing)
• For rRT-PCR testing, a single serum specimen.
• Children and adults:
• Collect 1 tube (5-10 mL) of whole blood in a serum
separator tube. Refrigerate the specimen at 2-8°C and ship
on ice- pack;
• Infants :
• A minimum of 1 mL of whole blood is needed for testing of
pediatric patients. If possible, collect 1 mL a serum
separator tube. Do not freeze.

27. References
• WHO Coronavirus website:
http://www.who.int/csr/disease/coronavirus_infections/en/.
http://www.who.int/csr/disease/coronavirus_infections/NamingCoV_
28May13.pdf
• http://www.who.int/csr/disease/coronavirus_infections/case_definiti
on/en/
• http://www.lematin.ma/express/transmission-du-coronavirus_les-
dromadaires-probablement-
impliques/186277.html#sthash.wmk3a19f.dpuf
• http://www.who.int/csr/disease/coronavirus_infections/en/
• Reusken CB et.al http://www.ncbi.nlm.nih.gov/pubmed/23933067
• http://www.who.int/csr/disease/coronavirus_infections/MERS_CoV
_investigation_guideline_Jul13.pdf?