MERS: Who and When to Test
MERS: Who and When to Test
Clinical features and epidemiologic risk factors are used in the United States to determine who should be tested for Middle East Respiratory Syndrome Coronavirus (MERS-CoV). These criteria for testing are based on the fact that Middle East Respiratory Syndrome (MERS) is not endemic in the United States. If transmission of MERS-CoV within the United States is ever confirmed, criteria for who should be tested might change.
- Testing for MERS should occur as soon as possible following onset of illness. Earlier testing increases the likelihood of identifying a true positive test result.
Patients in the United States Who Should Be Tested for MERS-CoV Infection
All MERS diagnostic testing currently available in the United States is completed at CDC or at public health laboratories and is not available through clinical or commercial laboratories. To ensure proper coordination of testing and to avoid delays, clinicians should notify their local or state public health department and inform them that they are evaluating a patient who meets criteria for MERS testing (see below).
Healthcare providers should evaluate and test patients in the United States for MERS-CoV infection if they have an illness consistent with the following clinical features and epidemiologic risk criteria:
| Clinical Features | & | Epidemiologic Risk |
|---|---|---|
| Severe illness:
Patient has fever and pneumonia OR fever and acute respiratory distress syndrome with no other more likely alternative diagnosis |
and ≥1 of the following epidemiologic risk factors | Within 14 days before symptom onset, a history of travel from countries in or near the Arabian Peninsula1
-or- Within 14 days before symptom onset, history of close contact with a person who themselves developed fever and acute respiratory illness within 14 days of residing in or travel to countries in or near the Arabian Peninsula -or- Within 14 days before symptom onset, a history of direct physical contact with camels2 in North, West, or East Africa3 -or- Is a member of a cluster of patients with severe acute respiratory illness of unknown etiology -or- High risk occupational exposure to MERS-CoV, such as laboratory or research personnel4 |
| Milder illness:
Patient has fever or symptoms of respiratory illness (e.g., cough and/or shortness of breath) with no other more likely alternative diagnosis |
and ≥1 of the following epidemiologic risk factors | Within 14 days of symptom onset, a history of being in a health care facility (as a patient, worker, or visitor) in a country or territory in or near the Arabian Peninsula where recent health care–associated cases of MERS have been identified
-or- Within 14 days of symptom onset, a history of direct physical camel contact2 in or near the Arabian Peninsula -or- Within 14 days of symptom onset, a history of close contact5 with a person with confirmed MERS-CoV infection while that person was ill -or- High risk occupational exposure to MERS-CoV, such as laboratory or research personnel4 |
1Countries considered in or near the Arabian Peninsula include: Bahrain; Iraq; Iran; Israel, the West Bank and Gaza; Jordan; Kuwait; Lebanon; Oman; Qatar; Saudi Arabia; Syria; the United Arab Emirates (UAE); and Yemen.
2Direct physical contact could include touching, riding, hugging, kissing, grooming, or exposure to respiratory secretions but does not include consumption of cooked camel meat.
3Because the risk for MERS-CoV transmission from camels in North, West, and East Africa is not yet fully understood, consider MERS evaluation for travelers coming from these regions who develop severe respiratory illness within 14 days of direct physical camel contact.
4Diagnostic and research facilities that handle MERS-CoV should have established procedures instructing their staff in how to prevent and respond to occupational exposures. Laboratory exposure can occur through contact with infected animals and viral specimens without proper precautions and personal protective equipment (PPE).
5Close contact is defined as a) being within approximately 6 feet (2 meters), or within the room or care area, of a confirmed MERS patient for a prolonged period of time (such as caring for, living with, visiting, or sharing a healthcare waiting area or room with, a confirmed MERS patient) while not wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection); or b) having direct contact with infectious secretions of a confirmed MERS patient (e.g., being coughed on) while not wearing recommended personal protective equipment.
The above criteria serve as guidance for who should be tested for MERS-CoV infection. Patients should be evaluated and discussed with jurisdictional public health departments if their clinical features and epidemiologic risk factors are concerning for MERS.
For information about MERS signs and symptoms, visit MERS Clinical Features | CDC.
