The Indiana State Department of Health (ISDH) has reported and verified the first case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection in the United States. Based on this information, clinicians and health officials should consider MERS-CoV infection a possibility in people who have traveled from the Arabian Peninsula and neighboring countries. This information is particularly important to infectious disease specialists, intensive care physicians, primary care physicians, and infection specialists, as well as emergency departments and microbiology laboratories. Although there is only one confirmed case in the U.S. to date, the CDC has issued a Health Advisory. I’ve heard that camels can get MERS. I hope there is no such thing as camel-to-dog transmission!
Middle East Respiratory Syndrome (MERS) is a viral respiratory illness. MERS belongs to the coronavirus family that includes the common cold and SARS, or severe acute respiratory syndrome, which caused more than 800 deaths globally in 2003. Most people with MERS-CoV developed severe acute respiratory illness with symptoms of fever, cough, and shortness of breath.
Unfortunately, the morbidity rate is high–30% of the people who were infected died. Some people were only reported as having a mild respiratory illness. MERS is caused by a coronavirus called “Middle East Respiratory Syndrome Coronavirus” (MERS-CoV). Generally speaking, you are not in danger if you have not traveled to or from that region or have not been exposed to someone who has traveled to that region. I’ve never been to the Middle East.
Although the origin of MERS is unknown, it likely came from an animal source. I consider that bad news. In addition to humans, camels in Qatar, Egypt and Saudi Arabia, and a bat in Saudi Arabia have contracted the disease. Camels in a few other countries have also tested positive for antibodies to MERS-CoV, indicating they were previously infected with it or a closely related virus.
Here are some details about the virus:
- People who have MERS will develop severe acute lower respiratory illness within 14 days after traveling from countries in or near the Arabian Peninsula.
- Although similar, MERS-CoV is not the same coronavirus that caused severe acute respiratory syndrome (SARS) in 2003. However, like the SARS virus, MERS-CoV is most similar to coronaviruses found in bats. CDC is still learning about MERS.
- The first known cases of MERS-CoV occurred in Jordan in April 2012.
- The virus is associated with respiratory illness and high death rates, although mild and asymptomatic infections have been reported too.
- All reported cases to date have been linked to six countries in the Arabian Peninsula: Saudi Arabia, Qatar, Jordan, the United Arab Emirates (UAE), Oman, and Kuwait. Cases in the United Kingdom, France, Italy, Greece, Tunisia, Egypt, and Malaysia have also been reported in persons who traveled from the Arabian Peninsula.
- There have been a small number of cases in persons who were in close contact with infected travelers. I guess the only way to be safe is to ask every single person you come in contact with whether they’ve recently traveled to the Arabian Peninsula. Not much of an ice breaker.
- Since mid-March 2014, there has been an increase in cases reported from Saudi Arabia and the UAE.
- Public health investigations are ongoing to determine the reason for the increased cases.
- No vaccine or specific treatment is currently available.
- In some cases, the virus has spread from infected people to others through close contact. However, there is currently no evidence of sustained spread of MERS-CoV in community settings.
Countries where cases have been reported:
Countries in the Arabian Peninsula
- Saudi Arabia
- United Arab Emirates (UAE)
Countries with Travel-associated Cases
- United Kingdom (UK)
- United States of America (USA)
How to protect yourself:
- Wash your hands or paws with soap and water for 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer.
- Cover your nose and mouth with a tissue when you cough or sneeze then throw the tissue in the trash.
- Avoid touching your eyes, nose, and mouth with unwashed hands or paws.
- Avoid close contact, such as kissing, sharing cups, or sharing eating utensils, with sick people.
- Clean and disinfect frequently touched surfaces, such as chew toys and doorknobs.
When to take action:
- If you have been in close contact with a symptomatic recent traveler from this area and you develop a fever and acute respiratory illness.
- If you are in close contact with anyone who has a confirmed case of the virus, testing for MERS-CoV and other respiratory pathogens can be done simultaneously.
- If you have been exposed and develop a fever or 100 or higher.
- If you develop a fever above 100 degrees, or respiratory symptoms within 14 days following contact with an infected person.
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