MERS in Saudi Arabia and Potential for Travel-associated Cases

Posted August 23, 2019. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.

Be aware that the annual Hajj pilgrimage to Mecca, Saudi Arabia, will take place from August 9 to August 14, 2019. Due to recent cases of Middle East Respiratory Syndrome (MERS-CoV) in Saudi Arabia and several other countries in the Middle East, the Centers for Disease Control and Prevention (CDC) considers that MERS-CoV is a potential risk to travelers attending the Hajj. Healthcare-associated transmission has resulted in several recent hospital outbreaks abroad. More information on Hajj-related travel can be found here: https://wwwnc.cdc.gov/travel/notices/watch/hajj.

Healthcare workers must routinely ask about travel history when evaluating ill patients, use appropriate infection prevention precautions, and consider MERS-CoV as a potential cause for patients with compatible clinical illness and an epidemiologic risk factor (i.e., travel to the Arabian Peninsula). 

Healthcare providers suspecting MERS-CoV as the cause of clinical illness in a returning traveler should immediately contact the SRHD Epidemiology Duty Officer at 509-869-3133.  

Symptoms  

At hospital admission, common signs and symptoms include fever, cough, chills/rigors, headache, dyspnea, and myalgia. Other symptoms can include sore throat, coryza, sputum production, dizziness, nausea/vomiting, diarrhea, and abdominal pain.

Patients Who Should Be Evaluated for MERS Infection  

Healthcare providers should evaluate patients in the U.S. for MERS-CoV infection if they meet the following criteria: 

  1. Fever AND pneumonia or acute respiratory distress syndrome (based on clinical or radiologic evidence)
    AND EITHER:
    1. History of travel from countries in or near the Arabia Peninsula within 14 days before symptom onset, OR
    2. Close contact with a symptomatic traveler who developed fever and acute respiratory distress (not necessarily pneumonia) within 14 days after traveling from countries in or near the Arabian Peninsula, OR
    3. A member of a cluster of patients with severe acute respiratory illness (e.g., fever and pneumonia requiring hospitalization) of unknown etiology in which MERS-CoV is being evaluated, in consultation with state and local health departments.

      OR

  2. Fever AND symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath) AND being in a healthcare facility (a patient, worker or visitor) within 14 days before symptom onset in a country or territory in or near the Arabian Peninsula in which recent healthcare-associated cases of MERS have been identified.

    OR
     
  3. Fever OR symptoms of respiratory illness (not necessarily pneumonia; e.g. cough, shortness of breath) AND close contact with a confirmed MERS-CoV case while the case was ill.

Patients should be evaluated and discussed with a SRHD Epidemiologist on a case-by-case basis if their clinical presentation or exposure history is equivocal (e.g., uncertain history of healthcare exposure).

 For patients under investigation, Washington State Department of Health (DOH) recommends collecting multiple specimens from different sites after symptom onset for testing with the CDC MERS-CoV rRT-PCR assay, including a lower respiratory specimen (e.g., sputum, broncheoalveolar lavage fluid, or tracheal aspirate), a nasopharyngeal/oropharyngeal swab, and serum. Additional guidance for collection, handling, and testing of clinical specimens is available at http://www.cdc.gov/coronavirus/mers/guidelines-clinical-specimens.html. In Washington, specimens are processed at the DOH Public Health Lab.  All testing must be discussed and approved by SRHD.  

Healthcare providers should adhere to recommended infection control measures, including standard, contact, and airborne precautions while managing patients in healthcare settings who are patients under investigation or confirmed cases of MERS-CoV infection.

Additional information available here: https://www.cdc.gov/coronavirus/mers/interim-guidance.html