Commentary
The Centers for Disease Control and Prevention has confirmed the first case of the deadly Middle East Respiratory Syndrome coronavirus in the United States.
The patient, a health care worker who recently returned from Riyadh, Saudi Arabia, is in stable condition in an Indiana hospital after being admitted with shortness of breath, cough, and fever on April 27.
No other cases have been reported beyond this single case, but investigators are just beginning to reach out to those who came in contact with the patient, said Dr. Anne Schuchat, assistant surgeon general and director of the CDC’s National Center for Immunization and Respiratory Diseases, during a press briefing.
Courtesy CDC; Maureen Metcalfe and Azaibi Tamin
Middle East Respiratory Syndrome coronavirus has a case fatality rate of about 30% among symptomatic patients.
That list could be quite long, as the patient flew on April 24 from Saudi Arabia to London, then on to Chicago, and then traveled by bus to Indiana. The patient is in good condition, and remains in isolation in Community Hospital in Munster, Indiana, according to a statement from the hospital.
Health officials would not release the name of the airline or bus line the patient traveled on.
Indiana state health officials took specimens from the patient, which were then confirmed late today by the CDC.
There is no specific treatment for the Middle East Respiratory Syndrome coronavirus (MERS-CoV), which has a case fatality rate of about 30% among symptomatic patients.
Since the virus was first reported in 2012 in Saudi Arabia, 263 cases have been confirmed in 12 countries, with 92 deaths. More than 100 other patients have been confirmed and reported by their ministries of health, but are not included in the World Health Organization tally, Dr. Schuchat said.
The Indiana case represents a "very low risk to the broader general public" because MERS-CoV has not shown the ability to spread easily from person to person in the community setting, she said.
"It is very concerning that the virus has spread in hospitals, and we should not be surprised if additional cases are identified among the health care workers who had close contact with this patient before the patient was isolated and special precautions were implemented," she went on to say.
An outbreak in the spring of 2013 involved 23 confirmed cases at four healthcare facilities, and another surge in cases beginning in March of this year has been identified.
It is unknown whether this represents seasonal variation or mutations in the virus that may make it more easily transmissible. At least one isolate has been sequenced by polymerase chain reaction from a patient in Saudi Arabia, and there were no changes in the virus, Dr. Schuchat said.
"With the SARS virus 10, 11 years ago, we did believe there was a change in the virus that led to more explosive transmission. So we’ll continue to look at that, but we don’t have data right now to confirm that that has happened," she said.
For now, the CDC is not advising people change their travel plans, but is recommending that people who develop a fever, cough, or shortness of breath within 14 days after traveling in or near the Arabian Peninsula see a health care provider, Dr. Schuchat said. Others that should monitor their symptoms include those who have close contact with someone who has these symptoms and travel history.
The CDC is also advising people to use basic respiratory illness precautions such as frequent hand washing, avoiding close contact with people who are sick, and disinfecting frequently touched surfaces.
No specific precautions were given for pediatricians or children, other than to ask for a travel history in patients with respiratory symptoms. The youngest case of MERS-CoV was in a 2 year-old, but the median age is around 51 years, she said.
Dr. Schuchat stressed that guidance may change as this "very fluid" situation evolves. The Indiana Department of Health and the CDC will share additional information on their Web sites and host additional press conferences, as needed, she said.
For more information on Middle East Respiratory Syndrome, go to http://www.cdc.gov/coronavirus/mers/index.html.
