Screening of Human and Animal Sera from Egypt and Hong Kong

Perera et al. Euro Surveill. 2013;18(36):pii=20574

Sampled 1343 Human, 625 animals

Treatment• SARS: definitive treatment regimen was not clearly

established

• MERS CoV: Interferon alpha 2b + ribavirin in vitro1

• Recent study in Macaque monkeys2

• No clear data on human treatment

1Falzarano D et al. Sci Rep 3 2013:16862Falzarano D et al. Nature Medicine 2013 pub online 9/8/13

Vaccines• SARS vaccines were in development

• Possible MERS vaccines:– VLP/nanoparticles with S protein– Constitutive expression of S protein in cell culture

• Developmental stages

Domestic Activities• Case definition and guidance developed and disseminated• 5 MMWRs published• 3 health advisories sent to state/local health departments

• Investigating persons with travel link, severe respiratory illness – 100 samples/31 states: all negative

• Serology developed– MERS-CoV ELISA, MERS-CoV IFA and MERS-CoV MNt

• PCR diagnostics developed and distributed

A person with the following characteristics:Fever (≥38°C, 100.4°F) and pneumonia or acute respiratory distress syndrome (based on clinical or radiological evidence);

AND EITHER

History of travel from countries in or near the Arabian Peninsula within 14 days before symptom onset;

OR

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;

OR

Is 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.

CDC Case DefinitionPatient Under Investigation (PUI)

http://www.cdc.gov/coronavirus/mers/case-def.html

Epidemiology Tool KitPatient Under Investigation Form

Surveillance Plan: Phasic Response TiersTier Description National Surveillance Goals

0No cases in the US, threat of importation, low risk of large-scale outbreak

Utilize key public health networks and current relevant surveillance programs for other pathogens or similar clinical syndromes

1 Imported case(s) linked to exposure in an endemic country

Geographically focused monitoring of routine surveillance networks

Potential expanded testing from inpatient and outpatient settings in affected area

2Secondary or tertiary cases linked to a primary case with known exposure in an endemic country

Expanded testing from inpatient and outpatient settings in affected area

Enhance non-local surveillance by expanding case finding efforts or testing in existing programs

Possible modification of surveillance platforms and development of new surveillance

3Index case in the US without endemic country exposure or efficient transmission of several generations from imported case

Active inpatient, outpatient and community setting surveillance in affected and priority areas

Passive, but broad case finding nationally

Domestic Deployment of CDC MERS-CoV rRT-PCR Assay by LRN

Approved for MERS-CoV testing (44)

Kits will be sent later (6)

Infection Prevention and Control Recommendations

• Standard, Contact and Airborne Precautions– N95 respirators if available– Airborne infection isolation rooms

• Similar recommendations as SARS– High mortality– Human-to human transmission– Unknown modes of transmission– No vaccine or chemoprophylaxis

Infection Control: Checklists

• Prompt triage and testing of patients• Prioritization of available isolation rooms• Plans for appropriate cohorting of patients and

personnel• Training• Sick leave policy