Centers for Disease Control & Prevention
Middle East Respiratory Syndrome (MERS)
Interim Guidance for Health Professionals:
Patients in the U.S. Who Should Be Evaluated
Healthcare professionals should evaluate patients for MERS-CoV infection (case
definition)
 If they develop fever (≥38°C, 100.4°F) and pneumonia or acute respiratory distress syndrome
(based on clinical or radiological evidence)
AND / ANY ONE OF THE FOLLOWING THREE SCENARIOS:
1. Have history of travel from countries in or near the Arabian Peninsula (i.e., Bahrain, Iraq, Iran,
Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United
Arab Emirates [UAE], and Yemen) within 14 days before symptom onset;
OR
2. Have had close contact* with a symptomatic traveler who developed fever and acute
respiratory illness (not necessarily pneumonia) within 14 days after traveling from countries in
or near the Arabian Peninsula;
*Close contact is defined as:
a. Any person who provided care for the patient, including a healthcare worker or family
member, or had similarly close physical contact; or
b. Any person who stayed at the same place as the patient (i.e., lived with, visited) while the
patient was ill.
OR
3. Is a member of a cluster of patients with severe acute respiratory illness (i.e., fever and
pneumonia requiring hospitalization) of unknown etiology in which MERS-CoV is being
evaluated, in consultation with state and local health departments.
Patients who meet the criteria for a MERs CoV investigation should also be evaluated for
common causes of community-acquired pneumonia (Examples of respiratory pathogens causing
community-acquired pneumonia include influenza A and B, respiratory syncytial virus,
Streptococcus pneumoniae, and Legionella pneumophila). This evaluation should be based on
clinical presentation and epidemiologic and surveillance information. Testing for MERS-CoV
and other respiratory pathogens can be done simultaneously. Positive results for another
respiratory pathogen should not necessarily preclude testing for MERS-CoV.
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Reporting Patients Under Investigation (PUIs)
Healthcare professionals should immediately report to their state or local health department any person being
evaluated for MERS-CoV infection as a patient under investigation (PUI). Health departments should
immediately report PUIs to CDC using the MERS PUI short form below.

Middle East Respiratory Syndrome (MERS) Patient Under Investigation (PUI) Short Form
o Download PDF file
[1 page]
o Download Microsoft Word file
[1 page]
Contact information:
Jewish Hospital & St. Mary's Healthcare Infection Prevention and Control:
Patricia Gould (JH): 502.587.4870
Kim New (FRI): 502.582.7639
Cathy Pattengale (SMEH): 502.361.6708
Louisville Metro Public Health & Wellness (Jefferson County): 502.574.6570
Bullet County Public Health Dept.: 502.955.7837
Hardin County Public Health Dept.: 1.270.765.6196
KY Department for Public Health Reporting line: 1.888.973.7678 or 1.502.564.3418
Specimen Collection__________________________
For suspected MERS-CoV cases, healthcare providers should collect the following specimens for
submission to CDC or the appropriate state public health laboratory: nasopharyngeal swab, oropharyngeal
swab (which can be placed in the same tube of viral transport medium), sputum, serum, and stool/rectal
swab. CDC recommends collecting multiple specimens from different sites at different times after symptom
onset. Recommended infection control precautions should be utilized when collecting specimens. Specimens
can be sent using category B shipping containers. Providers should notify their state or local health
departments if they suspect MERS-CoV infection in a person. State or local health departments should notify
CDC if MERS-CoV infection in a person is suspected. Additional information is available at
http://www.cdc.gov/coronavirus/mers/guidelines-clinical-specimens.html.
Interim Infection Prevention and Control Recommendations for Hospitalized
Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
Standard, contact, and airborne precautions are recommended for management of hospitalized patients
with known or suspected MERS-CoV infection.
As information becomes available, these recommendations will be re-evaluated and updated as needed.
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Key Components of Standard, Contact, and Airborne Precautions
Recommended for Prevention of MERS-CoV Transmission in U.S. Hospitals
For full details of these precautions, see 2007 Guideline for Isolation Precautions: Preventing Transmission
of Infectious Agents in Healthcare Setting.
Component
Patient
Placement
Recommendation(s)

Airborne Infection Isolation Room
(AIIR)
Aerosol
Generating
Procedure



Comments

If an AIIR is not available, the
patient should be transferred as soon
as is feasible to a facility where an
AIIR is available. Pending transfer,
place a facemask on the patient and
isolate him/her in a single-patient
room with the door closed. The
patient should not be placed in any
room where room exhaust is
recirculated without high-efficiency
particulate air (HEPA) filtration.

Once in an AIIR, the patient’s
facemask may be removed.

When outside of the AIIR,
patients should wear a facemask to
contain secretions

Limit transport and movement of
the patient outside of the AIIR to
medically-essential purposes.

Implement staffing policies to
minimize the number of personnel
that must enter the patient's room.

After a potentially infectious
patient leaves a room, unprotected
individuals, including HCP, should
not be allowed in the room until
sufficient time has elapsed for enough
air changes to remove potentially
infectious particles. More information
on clearance rates under differing
ventilation conditions is available.
Use a combination of measures to

reduce exposures from aerosol-generating
procedures when performed on MERSCoV patients.
Limiting the number of HCP present
during the procedure to only those
essential for patient care and support.
Conduct the procedures in a private
room and ideally in an AIIR when
feasible. Room doors should be kept
Although there are limited data
available to definitively define a list
of aerosol generating procedures,
procedures that are usually included
are those planned ahead of time, such
as bronchoscopy, sputum induction,
elective intubation and extubation;
and some procedures that often occur
in unplanned, emergent settings and
can be life-saving, such as
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

closed except when entering or leaving the
room, and entry and exit should be
minimized during and shortly after the
procedure.

HCP should adhere to PPE precautions
in this interim guidance (i.e., gloves, a
gown, and either a face shield that fully
covers the front and sides of the face or
goggles, and respiratory protection that is
at least as protective as a fit-tested N95
filtering facepiece respirator [e.g.,
powered air purifying or elastomeric
respirator]) during aerosol-generating
procedures.
Conduct environmental surface
cleaning following procedures (see section
below on environmental infection control).
cardiopulmonary resuscitation,
emergent intubation, and open
suctioning of airways.
Once the patient vacates a room
where aerosol generating procedures
were conducted, unprotected
individuals, including HCP, should
not be allowed in that room until
sufficient time has elapsed for enough
air changes to remove potentially
infectious particles. More information
on clearance rates under differing
ventilation conditions is available.
Personal
Protective
Equipment
(PPE) for
Healthcare
personnel (HCP)




Gloves

Recommended PPE should be
Gowns
worn by HCP upon entry into patient
Eye protection (goggles or face shield)
rooms or care areas.
Respiratory protection that is at least 
Upon exit from the patient room
as protective as a fit-tested NIOSHor care area, PPE should be removed
certified disposable N95 filtering
and either
facepiece respirator.
o
Discarded, or
o
If a respirator is unavailable, a
o
For re-useable PPE,
facemask should be worn. In this
cleaned and disinfected according
situation respirators should be made
to the manufacturer’s reprocessing
available as quickly as possible.
instructions
o
Hand hygiene should be
performed after removal of PPE
Hand Hygiene

HCP should perform hand hygiene

frequently, including before and after all
patient contact, contact with potentially
infectious material, and before putting on
and upon removal of PPE, including
gloves.
Healthcare facilities should ensure that
supplies for performing hand hygiene are
available.

Environmental 
Infection Control
Follow standard procedures, per
hospital policy and manufacturers’
instructions, for cleaning and/or
disinfection of:
o
Environmental surfaces and
equipment
o
Textiles and laundry
Hand hygiene in healthcare
settings can be performed by washing
with soap and water or using alcoholbased hand rubs. If hands are visibly
soiled, use soap and water, not
alcohol-based hand rubs.

Use EPA-registered hospital
disinfectants to disinfect hard nonporous surfaces.
o
Follow label instructions
for use

Searchable EPA website of
registered products
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o
Food utensils and dishware
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