Update: severe respiratory illness associated with
CDC continues to work in consultation with the World Health Organization (WHO) and other partners to better understand the public health risk posed by the Middle East respiratory syndrome coronavirus (MERS-CoV), formerly known as novel coronavirus, which was 1st reported to cause human infection in September 2012. The continued reporting of new cases indicates that there is an ongoing risk for transmission to humans in the area of the
As of [7 Jun 2013], a total of 55 laboratory-confirmed cases have been reported to WHO. Illness onsets have occurred during April 2012 through [29 May 2013]. Number of confirmed cases of MERS-CoV (N = 55) reported as of [7 Jun 2013], to the WHO, by month of illness onset -- worldwide, 2012-2013. Note that in this figure, the case count for March 2013 assumes that the 2 cases included in the 23 Mar 2013 WHO announcement had symptom onset during March 2013 and that the case count for May 2013 assumes that 6 recently reported cases had symptom onset during May 2013.
All reported cases were directly or indirectly linked to one of 4 countries:
The median age of patients is 56 years (range: 2-94 years), with a male-to-female ratio of 2.6 to 1.0. All patients were aged greater than 24 years, except for 2 children, one aged 2 years and one aged 14 years. All patients had respiratory symptoms during their illness, with the majority experiencing severe acute respiratory disease requiring hospitalization. 31 of the 55 patients are reported to have died (case-fatality rate: 56 percent). Two cases in
The original source(s), route(s) of transmission to humans, and the mode(s) of human-to-human transmission have not been determined. Eight clusters (42 cases) have been reported by 6 countries (
Pneumonia was diagnosed incidentally on radiographic imaging, and he subsequently died with severe respiratory disease. The secondary case is in a man aged 51 years on long-term corticosteroids who shared a room with the index patient during [the period 26-29 Apr 2013] and who remains hospitalized on life support. The incubation period for the secondary case was estimated to be 9-12 days; this is longer than the previously estimated 1-9 days. A larger cluster, consisting of 25 cases including 14 deaths, ongoing since April 2013 in the [governorate] of Al-Ahsa in eastern
In some instances, sampling with nasopharyngeal swabs did not detect MERS-CoV by polymerase chain reaction (PCR); however, MERS-CoV was detected by PCR in lower respiratory tract specimens from these same patients. In the 2 patients reported by
In consultation with WHO, the period for considering evaluation for MERS-CoV infection in persons who develop severe acute lower respiratory illness days after traveling from the Arabian Peninsula or neighboring countries* has been extended from within 10 days to within 14 days of travel. Persons who develop severe acute lower respiratory illness within 14 days after traveling from the
To increase the likelihood of detecting MERS-CoV, CDC recommends collection of specimens from different sites (e.g., a nasopharyngeal swab and a lower respiratory tract specimen, such as sputum, bronchoalveolar lavage, bronchial wash, or tracheal aspirate).
Specimens should be collected at different times after symptom onset, if possible. Lower respiratory tract specimens should be a priority for collection and PCR testing; stool specimens also may be collected.
Specimens should be collected with appropriate infection control precautions.
Testing of specimens for MERS-CoV currently is being conducted at CDC.
FDA issued an EUA on [5 Jun 2013], to authorize use of CDC's novel coronavirus 2012 real-time reverse transcription-PCR assay (NCV-2-12 rRT-PCR assay) to test for MERS-CoV in clinical respiratory, blood, and stool specimens. This EUA is needed because, at this time, there are no FDA-approved tests that identify MERS-CoV in clinical specimens. This assay will be deployed to Laboratory Response Network
(LRN) laboratories in all 50 states over the coming weeks.
In consultation with WHO, the definition of a probable case of MERS-CoV infection has been updated to also include persons with severe acute respiratory illness with no known etiology with an epidemiological link to a confirmed case of MERS-CoV infection. Until the transmission characteristics of MERS-CoV are better understood, patients under investigation and probable and confirmed cases should be managed in health-care facilities using standard, contact, and airborne precautions. As information becomes available, these recommendations will be reevaluated and updated as needed.
Recommendations and guidance on case definitions, infection control (including use of personal protective equipment), case investigation, and specimen collection and testing, are available at the CDC MERS website. The MERS website contains the most current information and guidance, which is subject to change.
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