MERS-CoV: What You Need to Know

Carson Tahoe Health Epidemiologist, Doris Dimmitt, shares the facts on one of the hottest health topics in the media right now, MERS-CoV.

There is a ton of information in the media right now about MERS.  One important thing to keep in mind is this is a rapidly developing and changing issue so we can expect the stories regarding the what, when, why, and how of MERS will change frequently.  We saw this same phenomenon with the SARS outbreak in 2003.  So much is unknown at this point so stay calm, get the facts and we will move through this together as we always have in the past.

Middle Eastern Respiratory Syndrome or MERS is a viral illness first reported in Saudi Arabia in 2012.  It is thought to be transmitted to humans by camels and bats but nothing has been confirmed at this point.  So to start with, just to be safe, I suggest we all stay away from Arabian camels and bats.  MERS-CoV is a Corona virus similar to the SARS virus and the common cold virus.  The World Health Organization and the CDC have identified 538 confirmed cases (as of May 13, 2014) of MERS in 14 countries, and 148 people have died giving the infection a mortality rate close to 30%. That’s very high.

It is in the news now because, on May 2, 2014, the CDC confirmed the first case in the United States in Indiana, and the second case was identified in Florida on May 11.  The cases are unrelated and both patients are health care providers who recently returned from different parts of the Arabian Peninsula where they were caring for MERS patients.  The CDC has been testing several healthcare workers in Florida who cared for the 2nd MERS case before the patient was placed in a combination of Airborne and Contact isolation. The third case of MERS occurred in a man who was in close contact with the Indiana patient who was the first in the US to officially contract the virus. Before the first patient knew that he had MERS, he held a 30- to a 40-minute, face-to-face business meeting with the man from Illinois. This marks the first known transmission of the virus on US soil — the other two patients are thought to have contracted the virus abroad.

The information so far indicates the virus is transmitted by close contact to a MERS patient.  Currently, there is no evidence of sustained transmission in community settings. The incubation period is 2-14 days, and the symptoms are poorly characterized and very similar to other upper respiratory infections like colds and flu.
The CDC released a case definition for suspected MERS:  Fever of >or = 38°C or 100.4°F, symptoms of pneumonia or severe acute respiratory illness that can’t be attributed to a specific cause. These symptoms must be coupled with a travel history to the Arabian Peninsula in the last 2 weeks, or exposure to someone who has this travel history and is ill with similar symptoms.  Healthcare workers and close family members of ill patients are at the highest risk of infection.

The mode of transmission is currently unknown so a “shotgun” approach including Airborne and Contact Isolation protocols must be initiated ASAP in any suspected case.  These two protocols combined provide the maximum protection when dealing with a disease we don’t yet know enough about to stuff it into one category or another.  So for now, it’s best to do both. Even suspected cases of MERS must be reported to the Health Department immediately, so when the hair stands up on the back of your neck, call your friendly neighborhood infection control professional and make their day.  I know it will make mine. I can be reached at (775) 445-8317.

Like most viral diseases there is currently no cure or vaccine for MERS.  Antiviral drugs are being used but there is not enough data at this point to determine how effective they may be.  The treatment is supportive just like influenza and it is important to remember that these patients will likely require ICU care.

The Health Departments and CDC have issued guidelines for Healthcare Facilities regarding MERS patients and stress the importance of early recognition and isolation to prevent transmission.  We live on a very small planet and we travel all over it. Be prepared by getting the facts.  CDC.gov\MERS will get you there.  Let’s hope this is just a “bug de jour” and will pass us by.  I’ve learned over the years that the best way to protect yourself from something is to be prepared for it.   If you have any questions, please contact me at [email protected].  Thanks, as always, for listening.  Doris Dimmitt