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6/22/2017 » 6/25/2017
2017 OSAP Annual Conference

Middle East Respiratory Syndrome Coronavirus Toolkit
 Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Toolkit




Coronaviruses, named for the crown-like spikes on their surface, are common viruses that most people around the world get some time in their life. Human coronaviruses usually cause mild to moderate upper-respiratory tract illnesses.

A novel coronavirus now called "Middle East Respiratory Syndrome Coronavirus” (MERS-CoV) was identified in 2012 as the cause of respiratory illness in people causing fever, cough, and shortness of breath. Globally, from September 2012 to May 12, the World Health Organization (WHO) has been informed of a total of 536 laboratory-confirmed cases of infection with MERS-CoV; 145 have died.

According to the US Centers for Disease Control and Prevention (CDC), so far, all the cases have been linked to countries in the Arabian Peninsula. This virus has spread from ill people to others through close contact, such as caring for or living with an infected person. However, there is no evidence of sustained spreading in community settings.

On May 2, 2014, the first U.S. case of MERS was confirmed in a traveler from Saudi Arabia to the U.S. The traveler is considered to be fully recovered and has been released from the hospital. Public health officials have contacted healthcare workers, family members, and travelers who had close contact with the patient. At this time, none of these contacts has had evidence of being infected with MERS-CoV.

On May 11, 2014, a second U.S. imported case of MERS was confirmed in a traveler who also came to the U.S. from Saudi Arabia. This patient is currently hospitalized and doing well. People who had close contact with this patient are being contacted. The two U.S. cases are not linked.


On May 16, 2014, an Illinois resident who had contact with the first case of MERS in the U.S. tested positive for MERS-CoV.

Thus far, all human-to-human transmission has occurred either in a household, work environment, or health care setting. While the mode of transmission currently remains unknown, in some cases, the virus appears to pass from an infected person to another person in close contact.

The full picture on the source of the infection also is not yet clear. Strains of MERS‐CoV that match human strains have been isolated from camels in Egypt, Qatar, and Saudi Arabia. These and other studies have found MERS‐CoV antibodies in camels across Africa and the Middle East.

MERS-CoV infection generally presents as pneumonia, but has also caused kidney failure. The most common symptoms observed are fever, cough, and breathing difficulties, while atypical symptoms such as diarrhea have also been recorded in patients with immunosuppression.

Regulations & Guidelines

(1) Interim Infection Prevention and Control Recommendations for Hospitalized Patients with MERS-CoV (as of May 2, 2014)

(2) Morbidity & Mortality Weekly Report (as of May 14, 2014)


(1) Global Alert and Response (May 7, 2014)

(2) WHO statement on the Fifth Meeting of the IHR Emergency Committee concerning MERS-CoV (May 13, 2014)


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Best Practices
Key Learnings as of May 2014

Globally, the conditions for a Public Health Emergency of International Concern (PHEIC) have not yet been met. However, there is concern regarding the recent sharp rise in cases; systemic weaknesses in infection prevention and control, as well as gaps in critical information; and possible exportation of cases to especially vulnerable countries.

The MERS situation in the U.S. represents a very low risk to the general public in this country. CDC and other public health partners continue to investigate and respond to the changing situation to prevent the spread of MERS-CoV in the U.S.

In dentistry, persons who have contracted MERS are unlikely to visit a dental practice. However, dental clinicians are an important part of the healthcare system and should be knowledgeable of MERS and other transmissible diseases. Click HERE for a "Healthcare Provider Preparedness Checklist for MERS-CoV" checklist developed by CDC.  The checklist addresses CDC's Interim Infection Prevention and Control Recommendations for Hospitalized Patients with MERS-CoV. Standard, contact and airborne precautions are recommended for managment of hospitalized patients with known or suspected MERS-CoV infection.

Click HERE for a suggested script developed by OSAP for front office staff addressing early identification and deferral of patients with flu-like symptoms.

Related Articles

(1) CDC-compiled list of Article, Resources and More

(2) CIDRAP-compiled List of Links, Twitter Feeds, Recent Articles and More


(1) Centers for Disease Control and Prevention

(2) World Health Organization


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Instructional Resources

(1) Be on the alert for this novel coronavirus. A CDC video for healthcare providers. (Requires Medscape Login, free)

(2) Interview of Dr. Mike Osterholm (OSAP keynote speaker for 2014 Symposium) by Dr. Nancy Synderman on NBC's Today Show (May 18, 2014)

Image Library

(1) Images from CDC

(2) Health Map on Emerging Diseases (including SARS)


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Patient Resources

CDC's travel notice has been upgraded to a Level 2 Alert,which includes enhanced precautions for travelers to countries in or near the Arabian Peninsula who plan to work in health-care settings. These travelers should review CDC's recommendations for infection control for confirmed or suspected MERS patients before they depart, practice these precautions while in the area, and monitor their health closely during and after their travel.

CDC Feature - MERS Imported to US

(1) Up-to-date information for the general public in English, Spanish and Arabic

(2) Podcast - Unraveling the Mysteries of MERS (3/11/14)


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