Middle East respiratory syndrome coronavirus infection risk factors
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2], Alejandro Lemor, M.D. [3]
Overview
Some individuals have higher risk of being infected with MERS-CoV. Those who have either close contact with an infected traveler from endemic areas or who travel to endemic areas such as Arabian Peninsula, are at increased risk of contracting Middle East respiratory syndrome (MERS). Healthcare personnel who have close contact with probable or confirmed cases without using recommended infection control precautions, are also more likely to be infected with MERS-CoV. However, according to the available data, individuals with underlying clinical conditions are more likely to contract the infection. The preexisting medical conditions that may increase the risk of infection by MERS-CoV, include: diabetes, cancer, immunodeficiencies and chronic kidney, lung and heart disease.[1]
Risk Factors
Transmission of MERS-CoV is prone to occur in immunocompromised patients, or in patients with other comorbidities, such as diabetes or renal failure.[2] In a study of 23 patients of the largest outbreak so far, in Saudi Arabia, was determined that 74% had underlying diabetes mellitus, 52% renal disease and 43% lung disease, highlighting the impact of underlying comorbidities in the overall risk of infection with MERS-CoV. This evidence is further supported by the fact that cases of infected family members and health-care workers was only reported in 1 to 2% of contacts.[2][3]
Recent Travelers from the Arabian Peninsula
In case of development of fever and symptoms of respiratory distress such as cough or shortness of breath, within 14 days after traveling from countries in or near the Arabian Peninsula, the individual should call ahead to a healthcare provider mentioning the recent travel. Sick patients should stay home and avoid work or school, also delaying future travels, in order to reduce the possibility of spreading illness to others. [4]
Close Contacts of an Ill Traveler from the Arabian Peninsula
In case of close contact with someone who has recently traveled from a country in or near the Arabian Peninsula, and if the traveler has/had fever and symptoms of respiratory illness, such as cough or shortness of breath, it is mandatory monitoring of health status for 14 days, starting from the day of exposure to the ill person.
In case of development of fever and symptoms of respiratory distress such as cough or shortness of breath, within 14 days after traveling from countries in or near the Arabian Peninsula, the individual should call ahead to a healthcare provider mentioning the recent travel. Sick patients should stay home and avoid work or school, also delaying future travels, in order to reduce the possibility of spreading illness to others. [4]
Close Contacts of a Confirmed or Probable Case of MERS
In case of close contact with someone who has a probable or confirmed MERS-CoV infection, the individual should contact a healthcare provider for an evaluation. The healthcare provider may request laboratory testing and outline additional recommendations, depending on the findings of the evaluation and whether or not symptoms are present. The patients will be asked to monitor his health for 14 days, starting from the day of exposure to the ill person. The following symptoms should be investigated:
- Fever (100° Fahrenheit or higher). temperature should be taken twice a day.
- Cough
- Shortness of breath
- Other possible early symptoms include: chills, body aches, sore throat, headache, diarrhea, nausea/vomiting and runny nose.
In case of symptom development, the individual's healthcare provider should be immediately warned. Before the medical appointment, the individual should call the healthcare provider in order to inform him or her about the possible exposure to MERS-CoV. This will help the healthcare provider’s office take steps to keep other people from being infected.[4]
Healthcare Personnel Not Using Recommended Infection-Control Precautions
Healthcare personnel should adhere to the recommended infection control measures, including standard, contact, and airborne precautions, while managing symptomatic close contacts, patients under investigation, and patients who have probable or confirmed MERS-CoV infections. Recommended infection control precautions should also be utilized when collecting specimens.
Healthcare personnel who has had close contact with a confirmed or probable case of MERS, while ill, in case the recommended infection control precautions have not been used (e.g. appropriate use of personal protective equipment), are at increased risk of developing MERS-CoV infection and should be evaluated and monitored by a healthcare professional with a higher index of suspicion. For more information, please see Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle east respiratory syndrome coronavirus infection (MERS-CoV). [4]
References
- ↑ "Symptoms & Complications".
- ↑ 2.0 2.1 Perlman, S. (2013). "The Middle East Respiratory Syndrome--How Worried Should We Be?". mBio. 4 (4): e00531–13–e00531–13. doi:10.1128/mBio.00531-13. ISSN 2150-7511.
- ↑ Assiri, Abdullah; McGeer, Allison; Perl, Trish M.; Price, Connie S.; Al Rabeeah, Abdullah A.; Cummings, Derek A.T.; Alabdullatif, Zaki N.; Assad, Maher; Almulhim, Abdulmohsen; Makhdoom, Hatem; Madani, Hossam; Alhakeem, Rafat; Al-Tawfiq, Jaffar A.; Cotten, Matthew; Watson, Simon J.; Kellam, Paul; Zumla, Alimuddin I.; Memish, Ziad A. (2013). "Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus". New England Journal of Medicine. 369 (5): 407–416. doi:10.1056/NEJMoa1306742. ISSN 0028-4793.
- ↑ 4.0 4.1 4.2 4.3 "CDC MERS Interim Guidance for Health Professionals".