Australian Government Department of Health
Evaluation of patients with possible MERS in general practice
It
unlikely but possible that a patient in primary care with respiratory symptoms will have Middle Eastern
inis very
Australia
Respiratory Syndrome (MERS), so being alert for the possibility of MERS in the returned traveller is advised. The
transmission risk from a patient with MERS in the early stages of disease with limited symptoms is unknown, therefore
the infection prevention protocols are deliberately cautious.
Identify Symptoms and Exposure History
Does the patient meet any of the below combinations of symptoms and exposures:
NO
1. Fever AND pneumonia or pneumonitis or respiratory distress AND
during the 14 days prior to symptom onset:
Inform and
transfer
 Lived in or travelled to^ the Middle East* or where outbreaks are
occurring#, OR
 Had contact@ with someone who developed fever and acute respiratory
illness of unknown aetiology who has lived in or travelled to the middle
East or where outbreaks are occurring
Immediately notify the
state/territory Public
Health Unit/
Communicable Disease
Branch to discuss referral
and transfer
2. Fever AND symptoms of respiratory illness AND during the 14 days
prior to symptom onset:
 Been in a health care facility in a country# in which recent healthcareassociated cases of MERS are occurring, OR
 Been in contact with camels or raw camel products (milk/ meat) in the
Middle East
3. Fever OR acute non respiratory symptoms AND during the 14 days
YES
prior to symptom onset: Had contact with a probable or confirmed
MERS case when the case was ill
4. Part of a cluster of patients with severe acute respiratory illness of unknown
aetiology, particularly where the cluster involves healthcare workers
YES
Isolate and avoid direct contact without PPE
If the patient is phoning in, tell them not to attend the practice while you seek advice
from state/territory public health authorities.
If the patient presents to the practice, maintain separation between patient and
others and provide the patient with a mask:
 If in the waiting room, remove to a single room. Assign a clinical staff
member to manage the other patients in the waiting room.
 If in consulting room, withdraw from the immediate vicinity of the patient
and don PPE. In general practice, no-one should have direct unprotected
contact with a possible MERS patient. No clinical samples are to be
collected
A single staff member should be assigned to monitor this patient. If required to
approach the patient, pay close attention to hand hygiene; and use appropriate
protection including a fluid repellent P2 mask/respirator, disposable fluid resistant
gown, gloves, and eye protection (e.g. goggles)
Continue with normal
triage and care
AND
Where there is an urgent
clinical need for an
ambulance, this should
precede contact with the
state/territory Public
Health
Unit/Communicable
Disease Branch. The
ambulance and
Emergency Department
must be informed that
the patient is under
investigation for MERS.
If, following discussion
with Public Health
Unit/Communicable
Disease Branch, it is
decided that the patient
does not require further
assessment and/or
testing for MERS, the
patient should be
managed as per usual
practice.
^Note: Transiting through an international airport (<24 hours duration, remaining within the airport) in the Middle East is not
considered to be risk factor for infection. * Affected countries in the Middle East and immediate surrounding areas may be
defined as Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia (KSA), United Arab Emirates (UAE) and Yemen #
http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-mers-cov-countries-lab-confirmed.htm @ See
http://www.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-mers-cov.htm for definition of contacts