What is MERS-CoV?

Tying surgical apron

Middle Eastern Respiratory Syndrome (MERS) is a viral respiratory infection caused by coronavirus (MERS-CoV).

MERS-CoV was first identified in Saudi Arabia in 2012 and currently the virus appears to be circulating widely throughout the Arabian Peninsula.

The following countries have reported cases: Jordan, Kuwait, Oman, Qatar, Saudi Arabia, the United Arab Emirates, and Yemen; France, Germany, Greece, Italy, and the United Kingdom; Tunisia and Egypt; Malaysia and the Philippines; and the United States of America.

The virus is not yet fully understood and it isn’t clear what the source is or how people become infected; in some cases the virus has appeared to spread from an infected person to another in close contact e.g. providing unprotected care to a patient. There is currently no vaccine or specific treatment for MERS-CoV, the treatment is supportive and based on the clinical condition of the patient.

It is not always possible to identify patients with MERS-CoV because the symptoms may be non-specific, so it is important that all healthcare workers follow infection, prevention and (IPC) standard precautions consistently for all patients, with the addition of respiratory precautions for patients with symptoms of acute respiratory infection. Contact precautions and eye protection should be followed when treating a patient suspected or confirmed of having MERS-CoV. A fit tested FFP3 mask should be worn when performing aerosolising procedures e.g. suction, intubation.

The clinical symptoms include:

  • fever of 38°C or higher and
  • a lower respiratory tract infection symptoms (cough and / or shortness of breath), or clinical signs of a lower respiratory tract infection and
  • not explained by any other infection or aetiology. 

In addition to one of the following:

  • history of travel to, or residence in an area where infection with MERS-CoV could have been acquired in the past 14 days,
  • close contact during the last 14 days with a confirmed case of MERS-COV infection while the case was symptomatic,
  • healthcare worker based in ICU caring for patients with severe acute respiratory infection, regardless of history of travel or use of PPE,
  • part of a cluster of two or more epidemiologically linked cases within a two week period requiring ICU admission, regardless of history of travel. 

The MERS-CoV can in some cases lead to severe viral pneumonia and sometimes multi-organ failure, so treatment should follow the same guidelines as treating sepsis.

The risk of person to person infection is very low, but please take the following IPC precautions:

  • pre-alert the hospital so they can ensure a suitable isolation bed is available
  • request that the patient wears a disposable face mask
  • staff should wear PPE, if possible an FPP3 respirator, non-sterile surgical gloves, long sleeved, fluid-repellent disposable gown and eye protection. If this is not available wear a surgical face mask, plastic apron and gloves. 

After transporting the patient to hospital, the ambulance will need to be left to ventilate for 20 minutes and cleaned afterwards, using standard disinfectants and detergents.

Published 18th April 2015 

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