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CDC OFFICIAL HEALTH ADVISORY: MERS-CoV PREPAREDNESS

MERS-CoV: Middle East Respiratory Syndrome Coronavirus

(WHAT TO KNOW)

 

SUBJECT:

All state health officials be advised, the CDC Health Advisory has confirmed the first case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Indiana, USA as of (May 1, 2014).

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PURPOSE:

This thread is an endeavor to raise awareness for all State Health Officials regarding MERS-CoV. At this point in time only one (quantity 1) case has been identified and was acquired by the subject during foreign travel to Riyadh, Saudi Arabia. This new virus is believed to be moderately dangerous, but does not appear to be highly infectious, (or capable of becoming pandemic). The incident is currently isolated to one contaminated individual, with key U.S. jurisdictional investigations pertaining to the Indiana-Chicago region, (but also encompassing everywhere and everything the Subject was in contact with from Saudi Arabia to the point the Subject was hospitalized in the U.S.). Below, I’ve provided the reader will official CDC resources, and an important overview with BOLO that identifies the official stakeholders, danger alert level, roles of professionals and the public, preparedness checklists, Safety protocols, and the current status of the CDC investigation with timeline.

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Be On the LookOut (BOLO) for the spread of this virus. All health Departments should immediately report (Patients Under Investigation for MERS-CoV) by following the information contained within this Official website link:

http://www.cdc.gov/coronavirus/mers/data-collection.html

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PRINT THE CDC OFFICIAL PROVIDER PREPAREDNESS CHECKLIST:

http://www.cdc.gov/coronavirus/mers/downloads/checklist-provider-preparedness.pdf

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PRINT THE CDC OFFICIAL FACILITY PREPAREDNESS CHECKLIST:

http://www.cdc.gov/coronavirus/mers/downloads/checklist-facility-preparedness.pdf

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WHO SHOULD BE ON ALERT: The CDC has asked “Please disseminate this information to infectious disease specialists, intensive care physicians, primary care physicians, and infection preventionists, as well as to emergency departments and microbiology laboratories.”

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WHAT TO “BE ON THE LOOKOUT” FOR:

MERS-CoV is a respiratory Coronavirus (like SARS) found primarily in the Middle-East, (where it is also found in Camels and Bats), but also infects humans and has been carried by (individuals infected) to Europe and now to the U.S. This virus is spread by close contact for long periods of time with individuals infected (and is likely transmission due to respiratory droplets) however, caring for or living with the infected Subject has also resulted in transmission of the virus. Most people who were infected with MERS-CoV developed severe acute respiratory illness with symptoms of fever, cough, runny nose, and shortness of breath. Serious clinical suspicion is indicated if a patient under investigation (PUI) has 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 Peninsula1 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.

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=> A “probable case of MERS-CoV” is considered if your patient (presenting with symptoms) has been in contact with other patients who have a KNOWN Lab diagnosis of MERS-CoV.

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=>A “Confirmed Case of MERS-CoV” is defined as an individual whose Lab test results yield a positive result for MERS-CoV.

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=> *Of course patients with these symptoms should be tested for the most likely common causes of pulmonary infection simultaneously, and be aware that H1N1 influenza can coexist simultaneously with MERS-CoV in the infected human.

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WHAT HEALTHCARE PROFESSIONALS MUST DO:

This new virus must be controlled and tracked, therefore, Infection Control Protocols must be implemented to control the spread and all cases that meet the (PUI) criteria must be reported to the CDC.

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ISOLATION PROTOCOL - HEALTHCARE OFFICIALS MUST CONTROL VIRAL SPREAD read the following official instructions here:

http://www.cdc.gov/coronavirus/mers/infection-prevention-control.html

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OFFICIAL CDC REPORTING INSTRUCTIONS (report all PUI’s to CDC, and Local and State Health Departments) information is here:

http://www.cdc.gov/coronavirus/mers/data-collection.html

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OFFICIAL CDC GUIDANCE FOR HEALTH PROFESSIONALS are here:

http://www.cdc.gov/coronavirus/mers/interim-guidance.html

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OFFICIAL CDC GUIDANCE FOR COLLECTING, HANDELING AND TESTING SPECIMENS (Sputum, Nasopharyngeal, & Serum MERS-CoV rRT-PCR, Stool) are here (REMEMBER CO-INFECTION WITH H1N1 INFLUENZA IS POSSIBLE):

http://www.cdc.gov/coronavirus/mers/downloads/guidelines-clinical-specimens.pdf

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SAFETY AND ISOLATION PROTOCOL: (critical to prevent spread)

As of 05-02-2014 and until new information suggests otherwise, (MERS-CoV) safety and containment protocols are the same as (SARS) Safety and Containment protocols. Re-evaluation and updates will be made available if this condition changes. Standard, contact, and airborne precautions are recommended for management of hospitalized patients with known or suspected MERS-CoV infection. This includes:

1. Protocol Implementation: (Contact, Air, and Standard) Isolate as a single room occupant in an Airborne Infection Isolation Room (AIIR Protocol). 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. Limit contact and use PPI. Implement staffing policies to minimize the number of personnel that must enter the room.

2. PPI: Contact protocol, upon entering the room or care areas, wear Gloves, Gowns, Eye protection (goggles or face shield). Air protocol, wear respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator. Discard/launder all items upon exiting the room in accordance with protocol.

3. Disinfection: Follow standard procedures, per hospital policy and manufacturers’ instructions, for cleaning and/or disinfection of (Environmental surfaces and equipment, Textiles and laundry, Food utensils and dishware).

4. Be advised, employee refresher courses are recommended at this time. Vigilant and consistent adherence to standard safety precautions are also advised because some cases may present with very mild symptoms.

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DANGERS PRESENTED, AND USE OF THE (SARS) PROTOCOL IS BASED UPON:

=> The virus is not quite like SARS, but shares common features

=> Suspected high rate of morbidity and a 30% mortality among infected patients

=> Evidence of limited human-to-human transmission

=> Poorly characterized clinical signs and symptoms

=> Unknown modes of transmission of MERS-CoV

=> There is no vaccine or chemoprophylaxis available at this time, care is supportive only to relieve symptoms.

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WHAT THE PUBLIC CAN DO:

=> This is a single isolated incident at this time, and a CDC investigation is under way. However anyone who has traveled to the middle east, or been in contact with someone “known” to have MERS-CoV, and is now experiencing respiratory symptoms, should report to a hospital, inform them of your suspicion, and submit to testing.

=> In general, the public can be more RESILIENT to diseases such as MERS, by covering their mouth when they cough or sneeze, and washing their hands frequently with soap and water for 20 seconds and/or use an alcohol hand sanitizer. Avoid touching your eyes, nose, or mouth with unwashed hands. If you know someone sick, avoid kissing them, and sharing their cups or utensils. Disinfect your home periodically especially your children’s toys, door knobs, and countertops or food-prep areas. Also, if you have an infection and are contagious, compliance with the recommendations of your doctor, and being respectful and conscientious about contaminating others, is important including (staying home) as per your doctors suggestion.

=> There is No need to change travel plans at this time.

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CDC OFFICIAL INVESTIGATION:

A 24/7 investigation is underway via the CDC’s Division of Global Migration and Quarantine (DGMQ), as well as, monitoring via pattern recognition technologies in concert with local, state, and international partners, as well as airlines and the bus company to obtain the passenger manifests from the two flights and information from the bus company to help identify, locate, and interview all contacts and sources to insure public safety. Countries who have had incidence of MERS-CoV in the past currently include: (now the U.S.), also Saudi Arabia, Qatar, Jordan, the United Arab Emirates (UAE), Oman, and Kuwait. Cases in the United Kingdom, France, Italy, Greece, Tunisia, Egypt, and Malaysia.

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TIMELINE OF OUR U.S. INCIDENT:

=> On 2 May 2014, the US IHR National Focal Point reported the first laboratory confirmed Middle East respiratory syndrome coronavirus (MERS-CoV) infection in a male US citizen in his 60s, who lives and works in Riyadh, Saudi Arabia.

=> He traveled to the US from Riyadh to Chicago on 24 April 2014 via London Heathrow with travel from Chicago to Indiana by bus.

=> He reportedly worked in Riyadh. US health officials do not know at this time whether he directly cared for MERS-CoV confirmed cases and what infection control precautions were used.

=>The CDC Team is working with the Indiana State Health Department to collect more data on the patient, what is known now is as follows: He began feeling unwell on or around 14 April 2014 with a low-grade fever without any respiratory symptoms. On 27 April 2014, he developed shortness of breath, cough, increasing fever, and mild runny nose. On 28 April 2014, he was seen in an emergency room. A chest x-ray showed infiltrates in the right lung base and he was admitted to hospital and placed in a private room. Negative pressure room and airborne precautions were reportedly implemented on 29 April 2014; full isolation (standard, contact, and airborne) precautions were implemented on 30 April 2014. A chest computed tomography on 29 April 2014 showed bilateral lung infiltrates. Currently the patient is stable with shortness of breath; he is not intubated.

=>New information will be made available at the website listed below and as the CDC designates as this solitary case unfolds. CDC MERS FAQS: http://www.cdc.gov/coronavirus/mers/faq.html

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IMPORTANT RESOURCES:

CDC MERS-CoV INDEX:

=> http://www.cdc.gov/coronavirus/mers/index.html

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CDC CASE SYMPTOMS & DEFINING CHARACTERISTICS:

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

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CDC OFFICIAL TOOLS FOR HEALTHCARE WORKERS:

=> http://www.cdc.gov/coronavirus/mers/preparedness/resources-preparedness.html

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WHO RECOMMENDATIONS & RESOURCES:

=> http://www.who.int/csr/don/2014_05_05_mers/en/

=> http://www.who.int/csr/disease/coronavirus_infections/en/

=> http://www.who.int/csr/disease/coronavirus_infections/InterimRevisedSurveillanceRecommendations_nCoVinfection_18Mar13.pdf

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ENGLAND PUBLIC HEALTH MERS RISK ASSESSMENT & RESOURCES:

=> http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317140453299

=> http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/NovelCoronavirus2012/

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CDC-MEDSCAPE MERS VIDEO:

=> http://www.medscape.com/viewarticle/802881

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WORLD WIDE MERS DISTRIBUTION:

=> http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6210a4.htm?s_cid=mm6210a4_w

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Home Care for Patients who are Being Evaluated for MERS-CoV:

=> http://www.cdc.gov/coronavirus/mers/hcp/home-care.html

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National Preparedness Community Resource:

=> http://community.fema.govdelivery.com/connect.ti/readynpm/messageshowthread?threadid=45838

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FEMA IdeaScale Resource:

=> http://fema.ideascale.com/a/dtd/ALERT-ALL-STAKEHOLDERS-TO-MERS-CoV-RESOURCES/464926-14692

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