MERS-CoV:
Reporting and Laboratory Testing
Republic of Lebanon
Ministry of Public Health
Epidemiological Surveillance Program
May 2014
Outline
• MOPH documents: MOPH website
• Reporting
• Specimen collection
www.moph.gov.lb
www.moph.gov.lb
Reporting
Reporting
form
Reporting form
A. Reporter
Hospital name:
Date of
reporting: |___|___|_______|
Physician
name:
Mobile
phone:
Reporting form
B. Patient information
Gender:  M
Name:
Date of Birth:
Caza of
residence:
Locality of
residence:
Phone number:
|___|___|_______|
F
Nationality:
 Resident
Residence:  Visitor
 Refugee
Occupation:
Institution:
Reporting form
C. Signs and symptoms
Symptoms onset: |___|___|_______|
Fever (≥ 38°c ): 
Cough: 
If other, specify: 
Dyspnea 
Pathologic chest X-ray 
Reporting form
D. Hospitalization
Hospitalized for this illness?

Since |___|___|_______|
Patient admitted to ICU?

Since |___|___|_______|
Mechanical ventilation?

Since |___|___|_______|
Reporting form
E. Clinical and paraclinical presentation
Diagnosis of pneumonia

Cardiac arrest

Acute Respiratory Distress
Syndrome (ARDS)

Hypotension requiring
vasopressors

Acute Renal Failure

Pregnancy

Multi-organ failure

Other, specify

Reporting form
F. Risk factors/Exposure in the 14 days prior to illness onset
Travel 
Where
Travel of Family member 
Where
Contact with confirmed
MERS-CoV cases 
Who
Contact with non confirmed
MERS-CoV 
Contact with Severe Acute
Respiratory Infection (SARI) 
Health Care Worker 
Who
Who
Where
Reporting form
G. Comorbidities
Cancer

Kidney failure

Diabetes

Chronic liver disease

Chronic lung disease

Heart disease

Asthma

Deficient immune system

Hematogical disorder

Other, specify:

H. Outcome
 Remission
 Still Ill
 Death, date of death
|____|____|_______|
Reporting form
I. Specimens
Sputum
Tracheal
aspirate
Serum (paired
sera)
 date
|____|____|_______|
 date
|____|____|_______|
 date
|____|____|_______|
J. Date and signature:
 date
|____|____|_______|
 date
|____|____|_______|
 date
Blood EDTA
|____|____|_______|
Broncholaveol
ar lavage
Nasal/throat
swab
Reporting to?
• Reporting to MOPH/ESUMOH central
level
–Fax: 01/610920
Specimen collection
Specimen type algorithm
First choice:
Broncho alveolar lavage
Second choice:
Tracheal aspirate (if intubated)
Third choice:
Deep sputum
Fourth choice:
Oropharyngeal or nasopharyngeal swab (in
VTM)
Specimen type: for intubated patient
Tracheal aspirate: 2 specimens (with at least
24 h apart) preferably during the first 3 days
of onset
AND
Intubated patient
Broncho alveolar lavage: if done
AND
Acute serum (during the first week of onset)
Convalescent sera: 3 or 4 weeks later
Specimen type: for non-intubated patient
Sputum: 2 specimens (with at least 24 h
apart) preferably during the first 3 days of
onset
AND
Non-intubated
patient
Broncho alveolar lavage: if done
AND
Acute serum (during the first week of onset)
Convalescent sera: 3 or 4 weeks later
Specimen type
Oropharyngeal swab in VTM: 2 specimens
(with at least 24 h) apart preferably during
the first 3 days of onset
Non-Intubated
patient, with
difficulty to
collect sputum
AND
Broncho alveolar lavage: if done
AND
Acute serum (during the first week of onset)
Convalescent sera: 3 or 4 weeks later
Specimen recipient
Broncho alveolar lavage: if done
In sterile recipient
without additives
Tracheal aspirate
Sputum
Serum
In sterile recipient
with Viral
Transport Media
(VTM)
Oropharyngeal swab
Nasopharyngeal swab
Specimen testing algorithm
Test received at reference laboratory
NO
Q1:
Is there a reporting form?
YES
NO
Q2:
Is the specimen adequately received?
YES
NO
Q3:
Is there an approval from MOPH?
YES
If 3 YES, the test is done.
If no 3 YES,
the test is
not done.
Reporting form is filled for each
suspected case, specifying all
variables. Form is sent by fax to
MOPH, and sent with specimen.
Specimen are kept at 4-8°C if
transported within 48 h (other
wise minus 20°C), and
transported in icebox with ice
packs, and well labeled.
Criteria for approval is to fulfil
the MOPH case definition. Daily
list of approved request is
shared between MOPH and
RHUH.
PPE during specimen collection
•
•
•
•
•
Hand hygiene
Gloves
Long-sleeved gown
Eye protection
Mask:
– Medical mask
– If aerosol producing procedure: mask N95
Specimen referred to?
• Specimen sent to Rafic Hariri University
Hospital
–Dr Rita Feghaly
–Reference test: RT-PCR
Specimen transportation
Labelling
•
•
•
•
Patient name
Date of birth or age
Type of specimen
Date of collection
Local Packing
Local Transport
• In icebox
• With ice packs