RI C HA R D O. B R A J E R
Secretary
DA NIE L S TA L E Y
Director, Division of Public Health
March 23, 2016 – Replaces version posted June 12, 2015
To:
All North Carolina Health Care Providers
From: Zack Moore, MD, MPH Medical Epidemiologist
Re:
Middle-East Respiratory Syndrome Coronavirus (MERS-CoV) (2 pages)
This memo is intended to provide information to all North Carolina clinicians regarding the Middle-East Respiratory
Syndrome Coronavirus or MERS-CoV.
This version has been modified to include updates to the CDC patient under investigation definition.
Summary
MERS-CoV is a novel coronavirus that was first identified in 2012 and has been associated with severe respiratory
infections among persons who live in or have traveled to the Middle East and persons (including health care
providers) exposed to MERS cases outside of the Middle East. The first travel-associated cases in the United States
were confirmed in May, 2014. There has been clear evidence of person-to-person transmission both in household
and healthcare settings, but no evidence of sustained person-to-person transmission in the community.
Case Investigation and Testing
• A person with the following clinical features and epidemiological risk factors should be considered a patient under
investigation:
Clinical Features
Epidemiologic Risk
2
A history of travel from countries in or near the Arabian Peninsula within 14 days
3
before symptom onset, or close contact with a symptomatic traveler who
1
Severe illness
developed fever and acute respiratory illness (not necessarily pneumonia) within
1
2
Fever and pneumonia or acute
14 days after traveling from countries in or near the Arabian Peninsula .
respiratory distress syndrome
and – or –
1
(based on clinical or radiological
A member of a cluster of patients with severe acute respiratory illness (e.g., fever
evidence)
and pneumonia requiring hospitalization) of unknown etiology in which MERS-CoV
is being evaluated, in consultation with state and local health departments in the
US.
Milder illness
1
Fever and symptoms of
respiratory illness (not
necessarily pneumonia; e.g.,
cough, shortness of breath)
A history of being in a healthcare facility (as a patient, worker, or visitor) within 14
days before symptom onset in a country or territory in or near the Arabian
and
2
Peninsula in which recent healthcare-associated cases of MERS have been
identified.
1
Fever or symptoms of respiratory
illness (not necessarily
3
and Close contact with a confirmed MERS case while the case was ill.
pneumonia; e.g., cough,
shortness of breath)
•
Clinicians caring for patients meeting these criteria should immediately contact their local health
department or the state Communicable Disease Branch (919-733-3419; available 24/7) to discuss
laboratory testing and control measures.
Department of Health and Human Services | Division of Public Health
225 N. McDowell St. | 1902 Mail Service Center | Raleigh, NC 27699-1902
919 733 7301 T | 919 733 1020 F
RI C HA R D O. B R A J E R
Secretary
DA NIE L S TA L E Y
Director, Division of Public Health
•
Persons who meet these criteria should also be evaluated for common causes of community-acquired
pneumonia, if not been already done. Examples of respiratory pathogens causing community-acquired
pneumonia include influenza A and B, respiratory syncytial virus, Streptococcus pneumoniae, and Legionella
pneumophila. (Note: Viral culture should not be attempted in cases with a high index of suspicion.) MERS-CoV
infection should still be considered even if another pathogen is identified, since co-infections have been reported.
•
Any clusters of severe acute respiratory illness in healthcare workers in the United States should be thoroughly
investigated. Occurrence of a severe acute respiratory illness cluster of unknown etiology should prompt
immediate notification of local public health for further investigation and testing.
•
Testing for MERS-CoV is available at the North Carolina State Laboratory of Public Health. Testing requires
consultation and pre-approval from the state Communicable Disease Branch. Detailed information about
specimen collection and transport is available at http://slph.ncpublichealth.com/topics.asp.
Infection Control
• Transmission of MERS-CoV has been documented in healthcare settings.
•
Standard, contact, and airborne precautions are recommended for management of patients in healthcare settings
with known or suspected MERS-CoV infection. These include:
o
o
o
Use of fit-tested NIOSH-approved N95 or higher level respirators
Use of gowns, gloves and eye protection
Use of negative-pressure airborne infection isolation rooms if available
•
A facemask should be placed on the patient if an airborne infection isolation room is not available or if the patient
must be moved from his/her room.
•
Additional guidance is available at http://www.cdc.gov/coronavirus/mers/infection-prevention-control.html.
Treatment
• No antivirals are currently available for treatment of MERS-CoV or other novel coronavirus infections.
Reporting
• MERS-CoV infections are reportable in North Carolina. Physicians are required to contact their local health
department or the state Communicable Disease Branch (919-733-3419) as soon as MERS-CoV infection is
reasonably suspected to exist.
This is an evolving situation and recommendations are likely to change as new information becomes available. Updated
information and guidance are available from the CDC at http://www.cdc.gov/coronavirus/mers/index.html.
1
Fever may not be present in some patients, such as those who are very young, elderly, immunosuppressed, or taking certain medications.
Clinical judgement should be used to guide testing of patients in such situations.
2
Countries considered in the Arabian Peninsula and neighboring include: Bahrain; Iraq; Iran; Israel, the West Bank, and Gaza; Jordan;
Kuwait; Lebanon; Oman; Qatar; Saudi Arabia; Syria; the United Arab Emirates (UAE); and Yemen (map on CDC site).
3
Close contact is defined as: a)being within approximately 6 feet (2 meters) or within the room or care area for a prolonged period of time
(e.g., healthcare personnel, household members) while not wearing recommended personal protective equipment (i.e., gowns, gloves,
respirator, eye protection); or b) having direct contact with infectious secretions (e.g., being coughed on) while not wearing recommended
personal protective equipment. Data to inform the definition of close contact are limited. At this time, brief interactions, such as walking by a
person, are considered low risk and do not constitute close contact.
Department of Health and Human Services | Division of Public Health
225 N. McDowell St. | 1902 Mail Service Center | Raleigh, NC 27699-1902
919 733 7301 T | 919 733 1020 F
Reporting Communicable Diseases – Mecklenburg County
To request N.C. Communicable Disease Report Cards, telephone 704.336.2817 or 704.432.1742
Mark all correspondence “CONFIDENTIAL”
Tuberculosis:
TB Clinic
Mecklenburg County Health Department
2845 Beatties Ford Road
Charlotte, NC 28216
Sexually Transmitted Diseases, HIV, & AIDS:
Syphilis and HIV/AIDS Reporting
Other STD Reporting
Mecklenburg County Health Department
700 N. Tryon Street, Suite 214
Charlotte, NC 28202
980-314-9470
FAX 704.432.2493
704-336-3349 or
FAX
704-614-2993
704-432-1742
704.336.6200
All Other Reportable Communicable Diseases including Viral Hepatitis A, B & C:
Report to any of the following nurses:
Freda Grant, RN
704.336.6436
Brian Lackey, RN
704.336.5498
Elizabeth Quinn, RN
704.336.5398
Belinda Worsham, RN
704.336.5490
Vacant
704.353.1270
Shawn Wilson, RN (CD & child care)
704.432-1975
Vacant
704-432-4667
Julie Secrest, RN
704-432-0069
Communicable Disease Control
FAX 704.353.1202
Mecklenburg County Health Department
700 N. Tryon Street, Suite 271
Charlotte, NC 28202
Public Health Emergency 24/7
704-432-0871
Animal Bite Consultation / Zoonoses / Rabies Prevention:
Jose Pena
Communicable Disease Control
Mecklenburg County Health Department
700 N. Tryon Street, suite 214
Charlotte, NC 28202
State Veterinarian
State after hours
FAX
704.336.6440
704.353-1202
919.733-3410
919.733.3419
Suspected Food borne Outbreaks / Restaurant, Lodging, Pool and Institutional Sanitation:
Food & Facilities Sanitation
(Mon-Fri)
704.336.5100
Mecklenburg County Health Department
(evenings; Sat/Sun) 704.432.1054
700 N. Tryon Street, Suite 208
(pager evenings; Sat/Sun) 704.580.0666
Charlotte, NC 28202
FAX 704.336.5306
Revised 1-28-16