What is MERS Virus: MERS Stands for “Middle East Respiratory Syndrome (MERS) is a viral respiratory illness” and some time it called as MERS-CoV is the acronym for "Middle East Respiratory Syndrome Coronavirus", the virus that causes MERS. MERS was first detected in Saudi Arabia in 2012. Based on what researchers know so far, people with pre-existing medical conditions (also called comorbidities) may be more likely to become infected with MERS-CoV. Based on information we have to date, the incubation period for MERS (time between when a person is exposed to MERS-CoV and when they start to have symptoms) is usually about 5 or 6 days, but can range from 2-14 days.
Discovery of MERS Virus: Till now it is not certain that from where the virus came from. However, it likely came from an animal source and was first detected in Saudi Arabia in 2012. In addition to humans, MERS-CoV has been found in camels in several countries. It is possible that some people became infected after contact with camels, although more information is needed to figure out the possible role that camels and other animals may play in the transmission of MERS-CoV.
Symptoms and Complications:
Most people confirmed to have MERS-CoV infection have had severe acute respiratory illness with symptoms of:
· shortness of breath
Some people also had gastrointestinal symptoms including diarrhea and nausea/vomiting. For many people with MERS, more severe complications followed, such as pneumonia and kidney failure. About 3-4 out of every 10 people reported with MERS have died.
MERS-CoV, like other coronaviruses, is thought to spread from an infected person’s respiratory secretions, such as through coughing. Person-to-person spread of MERS-CoV, usually after close contact, such as caring for or living with an infected person.
There is currently no treatment for MERS. Because it is a virus, antibiotics are ineffective and at this point doctors are only able to try to treat the symptoms. The CDC and WHO are working on developing treatments and a vaccine for MERS but there is much work to do.
Infection prevention control:
Airborne Infection Isolation Room (AIIR): If an AIIR is not available, the patient should be transferred as soon as is feasible to a facility where an AIIR is available. Pending transfer, place a facemask on the patient and isolate him/her in a single-patient room with the door closed. The patient should not be placed in any room where room exhaust is recirculated without high-efficiency particulate air (HEPA) filtration. Once in an AIIR, the patient’s facemask may be removed. When outside of the AIIR, patients should wear a facemask to contain secretions. Limit transport and movement of the patient outside of the AIIR to medically-essential purposes. Implement staffing policies to minimize the number of personnel that must enter the patient's room. After a potentially infectious patient leaves a room, unprotected individuals, including HCP, should not be allowed in the room until sufficient time has elapsed for enough air changes to remove potentially infectious particles. More information on clearance rates under differing ventilation conditions is available.
Aerosol Generating Procedure: Use a combination of measures to reduce exposures from aerosol-generating procedures when performed on MERS-CoV patients. Limiting the number of HCP present during the procedure to only those essential for patient care and support. Conduct the procedures in a private room and ideally in an AIIR when feasible. Room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized during and shortly after the procedure. HCP should adhere to PPE precautions in this interim guidance (i.e., gloves, a gown, and either a face shield that fully covers the front and sides of the face or goggles, and respiratory protection that is at least as protective as a fit-tested N95 filtering facepiece respirator [e.g., powered air purifying or elastomeric respirator]) during aerosol-generating procedures.
Personal Protective Equipment (PPE) for Healthcare personnel (HCP):
Gloves, Gown, Eye protection (goggles or face shield), Respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator. If a respirator is unavailable, a facemask should be worn. In this situation respirators should be made available as quickly as possible.
Hand Hygiene: HCP should perform hand hygiene frequently, including before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves. Healthcare facilities should ensure that supplies for performing hand hygiene are available.
Other Prevention tips:
|Environmental Infection Control||Follow standard procedures, per hospital policy and manufacturers’ instructions, for cleaning and/or disinfection of:||Use EPA-registered hospital disinfectants to disinfect hard non-porous surfaces.|
|Environmental surfaces and equipment||Follow label instructions for use|
|Textiles and laundry||Searchable EPA website of registered products|
|Food utensils and dishware|
|Duration of Infection Control Precautions||At this time, information is lacking to definitively determine a recommended duration for keeping patients in isolation precautions.||Factors that should be considered include: presence of symptoms related to MERS-CoV, date symptoms resolved, other conditions that would require specific precautions (e.g., tuberculosis, Clostridium difficile) and available laboratory information.|
|Duration of precautions should be determined on a case-by-case basis, in conjunction with local, state, and federal health authorities.|
|Monitoring and Management of Potentially Exposed Personnel||HCP who care for patients with MERS-CoV should be advised to monitor and immediately report any signs or symptoms of acute illness to their supervisor or a facility designated person (e.g., occupational health services) for a period of 14 days after the last known contact with the sick patient.|
|HCP who develop respiratory symptoms or fever after an unprotected exposure (i.e. not wearing recommended PPE at the time of contact) to a patient with MERS-CoV should|
|not report to work or immediately stop working|
|notify their supervisor|
|implement respiratory hygiene and cough etiquette|
|seek prompt medical evaluation|
|comply with work exclusion until they are deemed no longer infectious to others|
|For asymptomatic HCP who had an unprotected exposure (i.e. not wearing recommended PPE at the time of contact) to a patient with MERS-CoV|
|Consider exclusion from work for 14 days to monitor for signs and symptoms of respiratory illness and fever|
|If necessary to ensure adequate staffing of the facility the asymptomatic provider could be considered for continuing work if they wear a facemask for source control (i.e., limiting transmission from exposed HCP to other HCP or patients),|
|The facemask should be worn at all times while in the healthcare facility for 14 days from the last unprotected exposure|
|HCP continuing to work while wearing a facemask should be reminded that if caring for patients under airborne precautions, to change the facemask to respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator (without an exhalation valve) (i.e., the HCP should not wear both a facemask and respirator at the same time.) When respirator use is no longer needed, the HCP should put a facemask back on for source control.|
|Monitoring, Management, and Training of Visitors||Establish procedures for monitoring managing and training visitors.||Visitors who have been in contact with the MERS-CoV patient before and during hospitalization are a possible source of MERS-CoV for other patients, visitors, and staff.|
|Limit visitors to those who are essential for the patient’s wellbeing and care.|
|Visits should be scheduled and controlled to allow for:|
|Screening of symptoms for acute respiratory illness before entering the hospital and upon arrival to hospital|
|Facilities to evaluate risk to the health of the visitor (e.g., visitor might have underlying illness putting them at higher risk for MERS-CoV) and ability to comply with precautions|
|Facilities to provide instruction, before entry into the patient care area on hand hygiene, limiting surfaces touched, and use of PPE according to the current facility policy while in the patient's room|
|Facilities should consider tracking (e.g., logbook) of all visitors who enter patient rooms|
|Visitors should not be present during aerosol-generating procedures|
|Visitors should be instructed to limit their movement within the facility|