Middle Eastern Respiratory Syndrome - Corona Virus (MERS-CoV)

introduction

MERS-CoV currently has a ~50% mortality rate
the first reported human infection from MERS-CoV was detected in September 2012.
as of October 2013, WHO has been informed of a total of 139 laboratory-confirmed cases of infection with MERS-CoV, including 60 deaths.
- almost all confirmed cases have presented with, or later developed, acute, serious respiratory illness.
- typical symptoms have included fever, cough, shortness of breath, and breathing difficulties.
- a small number of cases have presented with mild influenza-like symptoms or been asymptomatic.
- a small number of immunocompromised patients have presented with fever and diarrhoea without respiratory symptoms.
- all cases have been linked to the Arabian Peninsula and no cases have been reported in Australia
MERS virus enters host cells via dipeptidyl peptidase 4 (DPP4), these are not expressed in cells in the upper airways suggesting that infection requires inhalation of aerosol ¹⁾

those with symptoms of respiratory tract infection AND history of travel to, or residence in, the Arabian Peninsula, in the 14 days before illness onset.
- countries in the Arabian Peninsula and immediate surrounding areas may be defined as Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen.
- transiting through an international airport (<24 hours stay, remaining within the airport) on the Arabian Peninsula is NOT considered to be a risk factor for infection
individuals with pneumonia or pneumonitis and history of contact with those in point 1 (above) in the 14 days before illness onset.

patients with possible MERS-CoV infection based on the criteria above should be immediately placed in a negative pressure isolation room with contact and airborne precautions implemented.
patient should also be evaluated for common causes of community-acquired pneumonia.
the infectious diseases consultant on call should be notified ASAP
carefully monitor contacts

¹⁾