Information for clinical, laboratory and public health personnel on MERS coronavirus

Important information for clinical, laboratory and public health personnel.

Page last updated: 08 July 2019


The CDNA Guidelines have further information about managing confirmed MERS cases

How to manage a suspected MERS case in General Practice

General information about MERS and travel advice


How to manage a suspected MERS case in a hospital setting

Isolate

These recommendations on isolation and PPE for probable and confirmed cases take a deliberately cautious approach by recommending measures that aim to control the transmission of pathogens that can be spread by the airborne route.

If history and/or symptoms are consistent with MERS, the patient, whilst awaiting medical assessment and results of diagnostic tests, should be placed (in order of preference) either:

  1. in a negative pressure room, if available;
  2. in a single well ventilated room in an area away from other patients. The patient should be asked to wear a mask, if practicable, and observe cough etiquette and hand hygiene; or
  3. spatial separation from other patients, with respiratory precautions as above.

The room should have its own toilet and bathroom facilities (if en suite facilities are not available in a suitable location, a commode can be used for short term patient care).

An adjacent clean area for storage of, and putting on, clean PPE and a separate area of adequate size for the safe removal of PPE and the disposal of clinical waste are required.

Movement within a healthcare facility of a suspected/confirmed case of MERS should be kept to a minimum and aerosol generating procedures avoided where possible. The patient should wear a surgical mask during any movement from isolation to any other area of the facility.

Infection prevention: standard, contact and airborne precautions

These include:

  • Hand hygiene according to “5 Moments of Hand Hygiene”.
  • Use of appropriate PPE to be put on when entering patient room:
    • Gloves (nonsterile, disposable)
    • Gown (fluid resistant, disposable)
    • Mucous membrane (respiratory/eye) protection: fit-checked P2/N95 respirator/mask and goggles/face shield should be worn; staff performing aerosol-generating procedures, such as suctioning or endotracheal intubation, should wear a fit-tested P2/N95 respirator or equivalent protection, such as a powered air purifying respirator (PAPR).
  • PPE should be removed in the following order: gloves, gown (before leaving room); mask/goggles (after leaving room; avoid touching front surfaces); perform hand hygiene before and after mask removal.
  • Safe handling and disposal of waste (as infectious waste) and sharps
  • Environmental controls: routine care, cleaning, and disinfection of environmental surfaces, especially frequently touched surfaces in patient-care areas.
Top of page

Where possible all equipment required for patient care should be dedicated for the use of an individual patient.

Further information is available in the Interim infection prevention and control advice for acute care hospitals relating to suspected Middle East respiratory syndrome MERS coronavirus.

Inform

Please remember to inform your local public health unit/communicable disease control branch about the case urgently.

If transferring a patient to a different hospital, please ensure your phone call and letter of referral includes details of relevant travel history, or known exposure to confirmed or probable cases and include details of any relevant treatments or investigations undertaken for the patient. Ensure the ambulance personnel are informed so appropriate PPE can be used.

Testing for MERS

Following isolation and reporting of a suspected MERS case, routine tests for acute pneumonia should be performed where indicated, including consideration of bacterial culture, serology, urinary antigen testing and tests for respiratory viruses.

Suitable respiratory samples for MERS coronavirus testing includes upper respiratory tract viral swabs, nasopharyngeal aspirates, sputum, bronchoalveolar lavage fluid, lung biopsies and post-mortem tissues. There is now increasing evidence that lower respiratory tract specimens such as bronchoalveolar lavage, sputum and tracheal aspirates contain the highest viral loads, therefore, lower respiratory tract specimens should be collected where possible.

The WHO emphasises repeat testing (especially of lower respiratory tract specimens) in compatible cases as initial results may be negative.

Transmission-based contact and airborne precautions must be used when taking respiratory specimens. These are described in NHMRC: Australian Guidelines for the Prevention and Control of Infection in Healthcare – 2010 (particularly section B2.4), and include:

  • Contact precautions, including close attention to hand hygiene
  • Airborne transmission precautions, including routine use of a P2 respirator, disposable gown, gloves, and eye protection when entering a patient care area
  • A requirement for negative pressure air-handling

Laboratory staff should handle specimens under PC2 conditions in accordance with AS/NZS 2243.3:2010 Safety in Laboratories Part 3: Microbiological Safety and Containment.

Specimens should be transported in accordance with current regulatory requirements.

Testing for suspected cases of MERS will be based on detection of target sequences of viral RNA by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR). A confirmed case requires a positive rRT-PCR for two target viral sequences and sequencing where necessary, as per the WHO testing algorithm. Serological testing for MERS may be of use in certain circumstances, but it is not routinely available in Australia.

Reporting

The relevant state/territory public health unit/communicable diseases branch must be notified urgently of any suspected (and probable or confirmed) cases in order to discuss patient testing and/or referral and coordinate management of contacts.

Confirmed and probable cases must be reported to state/territory public health authorities immediately on being classified as such. State and territory authorities should notify the Commonwealth Department of Health which is responsible for reporting to WHO (under International Health Regulations 2005).

Advice for contacts of cases

Contacts of cases should be directed to your state/territory communicable disease branch/centre for advice.

Top of page

State and Territory Communicable disease branch/centres

Further information

WHO situation updates and the latest advice is available from the WHO website

For further information, refer to DFAT’s Smartraveller website information for travellers

United States Centers for Disease Control and Prevention MERS-CoV pages

European Centre for Disease Prevention and Control - MERS