MERS (Middle East Respiratory Syndrome) (cont.)

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What is the treatment for MERS-CoV?

Because MERS-CoV is caused by a similar virus as SARS, the management of MERS-CoV has been extrapolated from experience with the 2002 SARS outbreak and some limited experimental data. Like SARS, patients with MERS-CoV often require oxygen supplementation, and severe cases require mechanical ventilation and intensive-care-unit support. No medication has been proven to treat MERS-CoV, and treatment is based upon the patient's medical condition. Several medications have been tried in both SARS and MERS-CoV without conclusive benefits, and further research is to be done. Management of the individual with MERS is aided by infectious-disease, pulmonary, and critical-care subspecialists.

What is the prognosis of MERS?

MERS is associated with a rapidly progressive severe respiratory illness, and mortality compared to the SARS-CoV outbreak of 2003 is very high. At the time of this writing, a total of 91 cases of MERS have been identified, with 46 deaths, and mortality is at about 50%.

Is it possible to prevent MERS?

Fortunately, MERS-CoV does not appear to spread as easily or rapidly from person to person as the SARS-CoV outbreak of 2003. Travelers to the Arabian peninsula and their close contacts may protect themselves by taking simple measures that help to prevent the spread of germs. Frequent hand hygiene using soap and water, or an alcohol-based hand sanitizer, avoiding close contact with sick people, and avoidance of touching one's eyes, nose, and mouth can prevent the spread of viruses. Caregivers of patients who are not hospitalized should wear a face mask for direct care until the patient has recovered and perform frequent hand hygiene as above.

In the health-care setting, suspected cases of MERS should be placed in airborne infection isolation rooms (AIIR) in which room exhaust is recirculated under high-efficiency particulate air (HEPA) filtration. If not available, the patient should be given a face mask and should be isolated in a single-patient room with the door closed. Staff assigned to the patient, and the patient's movements outside of the isolation area, should be minimized. Before entering the isolation room, health-care workers should wear a gown, gloves, eye shield, and a fit-tested NIOSH-certified disposable N95 filtering respirator; if an N95 mask or respirator is unavailable, a surgical mask should be worn. Before exiting the room, personal protective equipment should be discarded in the room. Hand hygiene must be performed with soap and water or an alcohol-based hand sanitizer after exiting.

Preventing an outbreak requires identification of the first infected patients as soon as possible before the infection spreads further. Those who have been exposed to an infected person should be carefully monitored for fever or respiratory symptoms. Exposure is defined as living with or caring for an infected person, being within 3 feet of the infected person, and exposure to bodily fluids or direct physical contact with an infected person. The Centers for Disease Control and Prevention does not mandate quarantine measures for exposed individuals who are otherwise healthy. Local public-health authorities should be consulted promptly when a MERS-CoV diagnosis is considered. At the time of this writing, because of limited person-to-person transmission, MERS is not formally designated a pandemic nor has it achieved public-health-emergency status. However, it is recognized to have this potential, and public-health authorities have made steps to assure preparedness.

Medically Reviewed by a Doctor on 12/10/2013

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