Part II

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Screening of Human and Animal Sera from Egypt and Hong Kong

Sampled 1343 Human, 625 animals

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

Treatment

• SARS: definitive treatment regimen was not clearly established

• MERS CoV: Interferon alpha 2b + ribavirin in vitro 1

• Recent study in Macaque monkeys 2

• No clear data on human treatment

1 Falzarano D et al. Sci Rep 3 2013:1686

2 Falzarano 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

CDC Case Definition

Patient Under Investigation (PUI)

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.

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

Epidemiology Tool Kit

Patient Under Investigation Form

Surveillance Plan: Phasic Response Tiers

Tier Description

0

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

1

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

National Surveillance Goals

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

Geographically focused monitoring of routine surveillance networks

Potential expanded testing from inpatient and outpatient settings in affected area

Expanded testing from inpatient and outpatient settings in affected area

2

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

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

3

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

Possible modification of surveillance platforms and development of new surveillance

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

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