Clinical Review

Identification and Management of Middle East Respiratory Syndrome

Fed Pract. 2015 March;32(3):12-16

References

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Several serology assays have been developed for the detection of MERS-CoV. An immunofluorescence assay should be confirmed with a neutralization test. In certain cases, the diagnosis should be confirmed by nucleic acid sequencing. The CDC has developed MERS-CoV testing kits, which have been provided to state health departments. Any case of suspected or proven MERS-CoV in the U.S. should be reported to the state and local health departments. Visit the CDC website for more information about collecting, handling, and testing clinical specimens from patients under investigation for MERS: http://www.cdc.gov/coronavirus/mers/guidelines -clinical-specimens.html.

Prognosis

Complications from the MERS- CoV infection include severe pneumonia and ARDS requiring mechanical ventilation, multi-organ failure, renal failure requiring dialysis, consumptive coagulopathy, and pericarditis.^{20,21,23,26,27,29} About 30% of people with MERS-CoV have died. SARS-CoV was the first CoV to cause severe lower respiratory disease and death in otherwise healthy humans; MERS-CoV is now the second.⁶ Death occurs a median of 14 days after presentation with a range of 5 to 36 days.^{20,21,23,26,27,29}

Treatment

There is no available specific therapy recommended for MERS-CoV infection; therefore, the management of patients is supportive. As with other CoVs, there is no antiviral agent treatment for MERS-CoV. In experimental settings, combination therapy with interferon-alpha-2b and ribavirin seems promising.³¹ However, critically ill patients with MERS-CoV did not seem to respond favorably when treated with this regimen.³²

Vaccine

There is no licensed vaccine for MERS-CoV, although experimental vaccines are being developed. Vaccines have successfully prevented CoV infection in animal models. The development of an effective vaccine for humans against MERS-CoV may, therefore, be a realistic possibility. Unfortunately, a vaccine is likely years away from approval.

Infection Control Measures

Careful attention to infection control precautions is critical to the containment of MERS-CoV. Patients should be encouraged to inform HCPs about symptoms and potential exposure risks, in particular travel to and/or exposure to travelers from the Arabian Peninsula. This practice should help to limit the transmission of MERS-CoV to HCPs. Standard contact and airborne precautions should be followed in patients with suspected or proven MERS-CoV infection.

Infection control measures should include hand hygiene; avoiding close contact with people who are sick; avoiding touching the eyes, nose, and/or mouth with unwashed hands; and disinfecting frequently touched surfaces. Patients with suspected or proven MERS-CoV should be admitted to single occupancy rooms to diminish the possibility of viral transmission to other patients. All persons entering the room of a patient with suspected or proven MERS-CoV should wear fitted N-95 filtering respirators. Until the mode of transmission is better defined, protective eyewear should be worn during all patient contacts. With implementation of these measures, there has been no institution that has experienced an outbreak of MERS-CoV infection. Unfortunately, the duration of viral shedding is not yet known.

Travel Restrictions

At this time the CDC has not recommended MERS-related travel restrictions. Because the spread of MERS-CoV has occurred in health care institutions, the CDC advises HCPs traveling to the Arabian Peninsula to follow recommendations for infection control of confirmed or suspected cases of MERS-CoV and to monitor their own health closely. Travelers who are going to the Arabian Peninsula for other reasons are advised to follow standard infection control precautions, such as hand washing and avoiding contact with ill people. Visit the CDC website for updated information of travel restrictions: http://www.cdc.gov/coronavirus/mers/travel.html.

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.