South Korea’s Health Ministry reported on 14 June seven new cases of MERS, bringing the total to 145 in an outbreak that the WHO called “large and complex.” All of the cases are believed to be linked to hospital settings and traced to a businessman who had returned from a trip to the Middle East. There have been 14 deaths, all elderly patients or people who had been suffering serious ailments.
The outbreak is the largest outside Saudi Arabia, where the disease was first identified in humans in 2012, and has stirred fears in Asia of a repeat of a 2002-2003 scare when Severe Acute Respiratory Syndrome (SARS) killed about 800 people worldwide.
On 11 June 2015, the CDC issued Updated Information and Guidelines for Evaluation of Patients for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection. CDC continues to recommend that healthcare providers and health departments throughout the US be prepared to detect and manage cases of MERS. Healthcare providers should continue to routinely ask their patients about their travel history and healthcare facility exposure and to consider a diagnosis of MERS-CoV infection in persons who meet the criteria for patient under investigation (PUI), which has been revised to include considerations of recently being in a Korean healthcare facility and is available at http://www.cdc.gov/coronavirus/mers/case-def.html.
Specifically, persons who meet the following updated criteria for PUI should be evaluated for MERS-CoV infection in addition to other common respiratory pathogens3 and reported immediately to state and local health departments:
- Fever AND pneumonia or acute respiratory distress syndrome (based on clinical or radiologic evidence) AND one of the following:
- A history of travel from countries in or near the Arabian Peninsula1 within 14 days before symptom onset, OR close contact4 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 Peninsula1, OR
- A history of being in a healthcare facility (as a patient, worker, or visitor) in the Republic of Korea within 14 days before symptom onset, OR
- A member of a cluster of patients with severe acute respiratory illness (e.g., fever 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,
- Fever AND symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath) AND 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 Peninsula1 in which recent healthcare-associated cases of MERS have been identified,
- Fever OR symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath) AND close contact4 with a confirmed MERS case while the case was ill.
The above criteria serve as guidance for testing; however, patients should be evaluated and discussed with public health departments on a case-by-case basis if their clinical presentation or exposure history is equivocal (e.g., uncertain history of health care exposure).