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Middle East respiratory syndrome coronavirus (MERS-CoV) infection for health professionals

Middle East respiratory syndrome (MERS) was first recognised in Saudi Arabia in 2012. It is caused by infection with Middle East respiratory syndrome coronavirus (MERS-CoV). It was formerly called ‘novel coronavirus’. Initially it was confined to travellers in the Middle East, or contacts of travellers to the Middle East, but more recently there has been a health care associated outbreak associated with the Republic of Korea (RoK). For an up to date information on the following see:

Clinical presentation

MERS-CoV infection can cause severe respiratory disease (pneumonia and pneumonitis) and death. However, in some people infection causes a mild influenza-like illness or is asymptomatic. Symptoms may include:

  • fever and chills
  • cough
  • shortness of breath
  • breathing difficulties
  • muscles and joint aches. 

Less common symptoms include: 

  • diarrhoea
  • nausea
  • vomiting.

Severe disease and death is more common in older males and patients with underlying medical conditions. These underlying conditions have included diabetes, kidney disease, high blood pressure, asthma and lung diseases, cancer and cardiovascular disease.

Incubation period

From 2 to 14 days, most commonly 5 days.

Infectious period

Uncertain, cases are likely not infectious during the incubation period.

Transmission

MERS-CoV infection has spread from person to person particularly amongst family members and in health care settings, although the exact mode of transmission is unknown. Some cases have a strong history of exposure to camels or camel products.

Infection control

In the health care setting, airborne and contact precautions in addition to standard precautions, are recommended.

For further details please see the Australian Guidelines for the Prevention and Control of Infection in Healthcare.

Diagnosis

Doctors should consider the possibility of MERS-CoV infection in patients with:

  • an illness consistent with an acute febrile respiratory infection and a history of:
    • travel to, or residence in, the Middle East in the 14 days before illness onset (excluding transiting through an international airport for instance, less than 24 hours stay, remaining within the airport) or
    • contact with health care  facilities in the RoK in the 14 days before illness onset
  • an illness consistent with an acute respiratory infection and contact with a suspected or confirmed MERS-CoV case in the 14 days before illness onset.

Request real time reverse-transcriptase polymerase chain reaction (rRT-PCR) for MERS-CoV on respiratory specimens, preferably lower respiratory tract specimens. If initial tests are negative and MERS-CoV infection is still suspected, repeat testing is recommended. Use appropriate infection control precautions when taking specimens.

* Countries of the Middle East include: Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE) and Yemen.

Treatment

There is no specific treatment for MERS-CoV infection.

Notify

MERS-CoV infection is a notifiable condition under the South Australian Public Health Act 2011.  Notify any suspected or confirmed cases to the South Australian Communicable Disease Control Branch on 1300 232 272 (24 hours /7 days).

Prevention

There is no vaccine available against MERS-CoV infection.

Resources and useful links

Further information for health professionals on MERS-CoV infection is available from the following resources:

 

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