Interim Guidance for Health Professionals
Healthcare professionals should evaluate patients for MERS-CoV infection if they develop fever and pneumonia within 14 days after traveling from countries in or near the Arabian Peninsula.1 They should also evaluate patients for MERS-CoV infection if they have had close contact2 with a symptomatic recent traveler from this area who has fever and acute respiratory illness. Additional information is provided in CDC’s definition of a patient under investigation (PUI).
Patients who meet the criteria for a PUI should also be evaluated for common causes of community-acquired pneumonia.3 This evaluation should be based on clinical presentation and epidemiologic and surveillance information. Testing for MERS-CoV and other respiratory pathogens can be done simultaneously. Positive results for another respiratory pathogen should not necessarily preclude testing for MERS-CoV.4
Clusters5 of patients with severe acute respiratory illness (e.g., fever and pneumonia requiring hospitalization) should be evaluated for common respiratory pathogens.3 If the illnesses remain unexplained, providers should consider testing for MERS-CoV, in consultation with state and local health departments.
Healthcare professionals should immediately report to their state or local health department any person being evaluated for MERS-CoV infection as a patient under investigation (PUI). Health departments should immediately report PUIs to CDC using the MERS PUI short form below.
- Middle East Respiratory Syndrome (MERS) Patient Under Investigation (PUI) Short Form
- (In Arabic)
- (In Urdu)
Health departments should send completed investigation short forms by FAX to CDC at 770-488-7107 or attach the short form to an e-mail to firstname.lastname@example.org (subject line: MERS Patient Form).
To date, little is known about the pathogenic potential and transmission dynamics of MERS-CoV. To increase the likelihood of detecting MERS-CoV infection, CDC recommends collecting multiple specimens from different sites at different times after symptom onset. For more information, see CDC’s Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from PUIs for MERS-CoV.
Many state health department laboratories are approved for MERS-CoV testing using CDC’s rRT-PCR assay. Contact your state health department to notify them of PUIs and to request MERS-CoV testing. If your state health department is unable to test, contact CDC’s EOC at 770-488-7100.
Appropriate infection-control measures should be used while managing patients who are PUIs or who have probable or confirmed MERS-CoV infections. For CDC guidance on MERS-CoV infection control in healthcare settings, see Interim Infection Prevention and Control Recommendations for Hospitalized Patients with MERS-CoV. For CDC interim guidance to prevent MERS-CoV from spreading in homes and communities if there is ever a case in the U.S., see Interim Home Care and Isolation Guidance for MERS-CoV.
Healthcare professionals should carefully monitor for the appearance of fever and respiratory symptoms in any person who has had close contact2 with a confirmed case, probable case, or a PUI while the person was ill.
If fever and respiratory symptoms develop within the first 14 days following the contact, the individual should be evaluated for MERS-CoV infection.
- Countries considered in or near the Arabian Peninsula include: Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen.
- 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.
- Examples of respiratory pathogens causing community-acquired pneumonia include influenza A and B, respiratory syncytial virus, Streptococcus pneumoniae, and Legionella pneumophila.
- Previous interim guidance from CDC recommended limiting MERS-CoV testing to patients who did not have another infection or etiology identified. CDC has changed this recommendation as detailed in this interim guidance document.
- In accordance with the World Health Organization’s guidance for MERS-CoV, a cluster is defined as two or more persons with onset of symptoms within the same 14 days period, and who are associated with a specific setting such as a classroom, workplace, household, extended family, hospital, other residential institution, military barracks, or recreational camp. See WHO’s Interim Surveillance Recommendations for Human Infection with Middle East Respiratory Syndrome Coronavirus.