Middle Eastern Respiratory Syndrome - Coronavirus (MERS-CoV) infection management control

The disease

MERS-CoV is a viral respiratory disease caused by a novel coronavirus. Human to human transmission has occurred in healthcare facilities, among family members and co-workers of those who are infected. Current scientific evidence suggests that the likely reservoir is the dromedary camel. Most cases of MERS-CoV infections have had contact with camels or camel products, such as camel milk or meat. While direct or indirect contact with infected dromedary camels from the Arabian Peninsula is strongly associated with many cases there have also been sporadic cases without known exposure to camels or camel products.

There is serological evidence of MERS-CoV exposure in camels across the Arabian Peninsula and Northern Africa. Bats and alpacas may also be carriers of MERS-CoV.

Symptoms

Symptoms of MERS-CoV range from asymptomatic through to severe acute lower respiratory distress and multi-organ failure. Patients typically present with fever, cough, shortness of breath, myalgia and chills. Less common symptoms include nausea, vomiting, diarrhoea, sore throat and arthralgia.

Early symptoms of the disease may be difficult to distinguish from another respiratory tract infection.

Transmission

The mode of transmission of MERS-CoV is not well understood.

While direct contact with camels or camel products has been strongly associated with cases, there have been clusters of cases with no exposure to camels.

Cases where human to human transmission have occurred have been in situations where there is close contact with infected cases, such as caring for infected patients in healthcare settings. It is not known if the mode of transmission was via respiratory droplets, direct contact or via fomites. Mucous membrane inoculation and enteric routes are possible transmission pathways in human to human spread.

For more information about MERS-CoV please see: https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-mers-gen-info-prof.htm

Infection control

Identify

Patients who present with acute respiratory symptoms should always be triaged as high priority and isolated using the recommended precautions where possible. Assessment should always include travel history. Where a history of travel to the Middle East or other region where MERS-CoV has known recent infections, it should be considered a possible diagnosis. While MERS is an unlikely diagnosis in most cases, other infectious respiratory illness might be prevented from being spread in the facility.

Countries that have laboratory confirmed MERS-CoV cases can be found here: https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-mers-cov-countries-lab-confirmed.htm

Isolate

Where symptoms and history are suggestive of a MERS-CoV diagnosis, the patient should be placed in a negative pressure room, ideally with its own ensuite bathroom. Staff caring for the patient should observe standard precautions and contact and airborne transmission-based precautions. Eye protection should be worn to prevent mucous membrane exposure.

For more information about standard and transmission-based precautions please see the Australian guidelines for the prevention and control of infection in Healthcare (2019), sections 3.1 and 3.2: https://app.magicapp.org/#/guideline/6572

For more information about patient placement and personal protective equipment please see The Commonwealth Department of Health: https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-mers-cov-info-clphp.htm

Notify

MERS-CoV is a notifiable condition under the Public Health Regulation (2018). It is notifiable upon:

• pathological request
• provisional diagnosis
• pathology diagnosis.

It is also a controlled notifiable condition. For more information about notifications, case definitions and other notification resources, please see the Communicable disease control guidance – Middle East Respiratory Syndrome Coronavirus (MERS-CoV): http://disease-control.health.qld.gov.au/Condition/762/middle-east-respiratory-syndrome-coronavirus

Public Health Units https://www.health.qld.gov.au/system-governance/contact-us/contact/public-health-units/default.asp

Public Health Regulation (2018) https://www.legislation.qld.gov.au/view/html/inforce/current/sl-2018-0117

Cleaning

Where possible, single use, single patient use or equipment dedicated to the patient for the length of their stay should be used. Where this is not possible, reusable equipment should be cleaned using a TGA approved disinfectant that is appropriate for the equipment.

Environmental cleaning should be carried out routinely and on discharge of a patient from the environment.

For more information about cleaning please refer to local cleaning policies and section 3.1.3 and 3.1.4 of the Australian guidelines for the prevention and control of infection in Healthcare (2019): https://app.magicapp.org/app#/guideline/6572

More Resources

Communicable Diseases Network Australia guidelines: http://www.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-mers-cov.htm

Information on how to manage a suspected MERS case in a hospital setting: https://www.health.gov.au/resources/publications/information-about-mers-for-health-professionals

Information on managing a suspected MERS case in a general practice: https://www.health.gov.au/resources/publications/information-about-mers-for-health-professionals

Centers for Disease Control and Prevention (USA) resources for MERS: https://www.cdc.gov/coronavirus/mers/index.html

World Health Organization MERS resources: https://www.who.int/news-room/fact-sheets/detail/middle-east-respiratory-syndrome-coronavirus-(mers-cov)