MERS-CoV: case definition
Republic of Lebanon
Ministry of Public Health
Epidemiological Surveillance Program
May 2014
Confirmed case
• Any person with positive laboratory
confirmation of infection with novel
coronavirus
Probable case
• Any possible case with close contact during
the last 10 days before onset of illness with a
symptomatic confirmed case of novel
coronavirus infection.
• Close contact is defined as:
 Anyone who provided care for a nCoV patient
 Or anyone who stayed at the same place while a
nCoV patient was ill.
Suspected case
• Current case definition for suspected case:
– Any person with severe acute respiratory infection,
with:
1. Fever, cough, and evidence of pulmonary parenchymal
disease
2. And not already explained by any other infection or
etiology
3. And admitted to hospital
4. And one of the following:
– With history travel within 14 days before onset in a country who
reported local cases
– Or contact history with a person with ARI who traveled in a
country who reported local cases
– Or HCW caring for patients with severe ARI
– Or the case occurs as part of a cluster.
Cases
• On Sunday 4th May, several patients were
waiting at ER waiting room. Some of them are
coughing, other have epistaxis, other show
abdominal pain…
Case 1
• At ER, Mrs Nour Nour, 35 years old, Lebanese
has fever and cough. The cough is productive.
No dyspnea is observed.
• She is a teacher in public school. She has no
travel history, neither her close family.
• At physical exam, she is stable, some rhonchus
are detected at auscultation. No signs of
respiratory failure.
Case 2
• At ER, Mr Kamel Kamel, 45 years old,
Lebanese has fever and some watery diarrhea.
• He is an engineer working in KSA. He came
back to Lebanon 4 days ago. He is afraid to
have infection with MERS-CoV.
• At physical exam, he has no abnormal signs.
The temperature was 37.8°C.
Case 3
• At ER, Mr Jad Jad, 55 years old, Syrian, resident in
Lebanon since 6 years, has fever and dyspnea.
• He came back from Tunis 3 days before, where he
was in vacation.
• At physical exam, he has high grade fever (40°C),
inspiratory dyspnea (RR=25), some crepitates are
detected at auscultation.
• The chest X Rays showed localized condensation
at left upper lobe. The CBC counted 12000 WBC
(90% PN). The patient is admitted to hospital.
Case 4
• At ER, Mrs Layla Abou Layla, 20 years old,
Lebanese has fever and cough. The cough is
productive.
• She is a nursing student actually at Intensive Care
Unit. She has no travel history, neither her close
family.
• At physical exam, the temperature is 39°C, some
crepitates are detected at auscultation.
• The chest X Rays showed some infiltrates at right
side. She is admitted to hospital.
Case 5
• At ER, Mrs Alia Alia, 66 years old, Lebanese has
fever and cough No dyspnea is observed.
• She lives between KSA and Lebanon. She came
back from Jeddah 6 days before.
• At physical exam, she has fever (38.5°C), blood
pressure is 130/80 mmHg, respiratory rate at
25/mn.
• The Chest X ray showed several infiltrates in both
right and left lungs. The patient is admitted to
hospital.
Case 6
• At ER, Mr Anwar Anwar, 70 years old, Lebanese has
fever, cough and dyspnea. The cough is productive.
• He is retired since 2 years after being working as
medical doctor in a private cabinet.
• He reported that his son had also fever and some acute
respiratory infection 5 days ago, his son works in KSA
and came for a week end in Lebanon.
• At physical exam, there was fever, dyspnea and
crepitents.
• The Chest X Ray showed patchy infiltrates. The patient
was admitted.
Case 7
• At ER, the child Nader Nader, 12 years old,
Lebanese has fever and cough. The cough is
productive. No dyspnea is observed.
• He is a student in a public school in Fnaydek
(Akkar caza). He has no travel history, neither his
close family.
• The family reported several similar cases among
siblings and cousins.
• At physical exam, he is stable, rhonchus are
detected at auscultation. Some dyspnea is noted.
Saturation O2 was 75%. The child is admitted to
hospital.
Case 8
• At ER, Mr Nadim Nadim, 27 years old, Palestinian
has fever and cough. No dyspnea is observed.
• He is bank employee. He has no travel history,
neither his close family.
• At physical exam, he is stable, the lung are clear
at auscultation. The chest X Ray is normal.
• He reported to be close contact of confirmed
MERS case.
Case 9
• At ER, Mrs Jamale Jamal, 55 years old,
Lebanese has fever and dyspnea.
• She is a nurse in hospital in KSA. She went
back to Lebanon 2 days before. Two cases of
MERS were confirmed in her hospital.
• At physical exam, she has fever (38.5°C).
• Several infiltrates were observed at the chest
X Ray.
• The PCR test was done, it is positive.
Case
Classification
1
Not a suspected case
2
Not a suspected case
3
Not a suspected case
4
Suspected case
5
Suspected case
6
Suspected case
7
Suspected case
8
Probable case
9
Confirmed case