Severe illness: Fever and pneumonia or acute respiratory distress syndrome (based on clinical or radiologic evidence) and one of the following:

• A history of travel from countries in or near the Arabian Peninsula within 14 days before symptom onset, or close contact with a symptomatic traveler who developed fever and acute respiratory illness (not necessarily pneumonia) within 14 days after traveling from countries in or near the Arabian Peninsula;
• A history of being in a health care facility (as a patient, worker or visitor) in the Republic of Korea within 14 days before symptom onset;
• A member of a cluster of patients with severe acute respiratory illness (e.g., fever and pneumonia requiring hospitalization) of unknown etiology in which MERS-CoV is being evaluated, in consultation with state and local health departments in the United States.

Milder illness: Fever and symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath) and a history of being in a health care facility (as a patient, worker or visitor) within 14 days before symptom onset in a country or territory in or near the Arabian Peninsula in which recent health care-associated cases of MERS have been identified.

Or

Fever or symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath) and close contact with a confirmed MERS case while the case was ill.

The CDC recommends collecting multiple specimens from PUIs(www.cdc.gov) from different sites after symptom onset for testing with the CDC MERS-CoV real-time reverse transcription polymerase chain reaction assay. This should include a lower respiratory specimen (e.g., sputum, broncheoalveolar lavage fluid or tracheal aspirate), a nasopharyngeal/oropharyngeal swab, and serum.

If someone is considered a PUI, that individual’s close contacts should be identified to local and state health departments, and they should be told to monitor themselves for fever and respiratory illness — seeking medical attention for potential MERS-CoV infection if they become ill within 14 days after contact.

Preparing for Patients With Possible MERS-CoV Infection

AAFP member and infectious disease expert Richard Zimmerman, M.D., M.P.H., professor in the department of family medicine at the University of Pittsburgh Medical Center, told AAFP News that preparing for MERS-CoV starts with getting your supplies, protocols and plans in order now.

“It’s too late to begin preparedness when you’re face-to-face with a patient who traveled and has a fever,” he said.

Besides consistently taking a travel history, Zimmerman suggests bookmarking the CDC’s resources for health care professionals on MERS-CoV(www.cdc.gov) to get the most up-to-date information to direct your care of the patient.

Treatment of patients with MERS-CoV infection is only supportive at this point and should be based on the patient’s clinical condition.

And because transmission of the disease has occurred primarily in health care facilities, the WHO said it’s important to apply standard precautions consistently with all patients. Droplet precautions should be added to standard precautions when providing care to all patients with symptoms of acute respiratory infection. Contact precautions and eye protection should be added when caring for suspected or confirmed cases of MERS-CoV infection. Finally, airborne precautions should be applied when performing aerosol-generating procedures.