Public Health MERS: How Should Public Health Departments Prepare?

The virus has been called a “threat to the world,” but nothing made the threat more real than when the first case of MERS was confirmed in the U.S.

Justine Brown | June 2, 2014

Middle East Respiratory Syndrome (MERS) has been on the U.S. Centers for Disease Control and Prevention’s radar since it first appeared in Saudi Arabia in 2012. The World Health Organization called the MERS virus a “threat to the world,” because of the unknowns surrounding it, most notably how it spreads. But nothing made the threat more real than when the first case of MERS was confirmed in the U.S. on May 2, 2014.

MERS is a viral respiratory illness caused by a coronavirus called MERS-CoV. MERS has killed at least 175 people worldwide and sickened hundreds in the Middle East. It has spread from ill people to others through close contact, such as caring for or living with an infected person. People infected with MERS commonly experience fever, shortness of breath and coughing. About 30 percent of those infected with the virus die.

Given today’s interconnected world, communicable diseases are truly just a plane ride away. Therefore the potential for MERS-CoV to spread further and cause more cases globally and in the U.S. is significant. Now that MERS has officially reached U.S. soil, what should public health departments and emergency managers be doing to prepare?

The First U.S. Case

On April 24, 2014, a health-care worker who lives and works in Saudi Arabia traveled by plane from Riyadh, Saudi Arabia, to London and from London to Chicago. He then took a bus from Chicago to Indiana. On April 27, he began to experience respiratory symptoms, including shortness of breath, coughing and fever. He went to an emergency room in an Indiana hospital on April 28 and was admitted that day. Because of the patient’s symptoms and travel history, Indiana public health officials tested for MERS-CoV. The Indiana state public health laboratory and CDC confirmed MERS-CoV infection in the patient May 2, 2014, making him the first confirmed U.S. case of the virus. The patient was isolated in a hospital during the course of the illness and later discharged, having fully recovered. 

Public health officials contacted health-care workers, family members and travelers who had close contact with the patient, and so far no further contamination has been confirmed. 

On May 11, 2014, a second U.S. imported case of MERS was confirmed in another health-care worker who traveled from Saudi Arabia to Orlando via London, Boston and Atlanta. At press time, that patient was isolated in a hospital and doing well. The two U.S. cases are not linked. 

While MERS truly burst into the spotlight once the U.S. cases were reported, the CDC has actually been working to prepare for the arrival of the virus since it was first discovered. 

“We began working with state health departments and emergency managers to prepare in the summer of 2013, because we were pretty certain MERS would reach the U.S. one day, we just didn’t know when,” said Jason McDonald, spokesman for the CDC. 

In July 2013, the CDC posted checklists and resource lists for health-care facilities and providers to assist in preparing to implement infection control precautions for MERS-CoV. McDonald said the CDC also developed guidance and tools for health departments to conduct public health investigations, and provided recommendations for health-care infection control and other measures to prevent disease spread. The CDC also developed a test to detect the virus, and in August 2013 that test was distributed to all U.S. state and local health departments. Finally, the agency provided guidance for flight crews, Emergency Medical Service units at airports, and U.S. Customs and Border Protection officers about reporting ill travelers to CDC.

“The discovery of the first case in Indiana was really a heads-up move by the hospital,” McDonald said. “They called for the testing, and we were alerted that they had a positive for MERS that fit the case definition on May 1.”

Samples were then sent overnight to the CDC, and the infection was confirmed on May 2. 

“That started a chain of events,” McDonald said. “We had a team of scientists on the way there immediately. When you are dealing with infectious diseases you need to understand what the patient had been doing and the places where people could have been exposed. It was quite an effort to contact bus riders and plane riders who may have been exposed — 53 in all — and tell them what to look for and what to do.”

Case in Point

The Indiana State Department of Public Health has been praised for its swift action in the case. 

“In some respects it was similar to the H1N1 pandemic we experienced a few years back, where you have a new agent and you are trying to learn about it at the same time you’re trying to control it,” said Amy Reel, public affairs director for the Indiana State Department of Public Health. “This was the first case identified in the U.S., so it was very visible. There was a lot of media attention and a lot of communication with federal agencies. Some of the recommendations were actually being developed during the outbreak.”

For Indiana, good preparation enabled fast response. 

“The preparedness infrastructure that we’ve built since about 2003 with federal funding support was instrumental in allowing us to respond quickly to this outbreak,” said Pam Pontones, Indiana state epidemiologist. “Without that type of support and infrastructure in place this would have been much more difficult.” For the entire article visit: http://www.emergencymgmt.com/health/MERS-How-Can-We-Prepare.html