NY Travel Clinic

CDC Issues alert for Middle East respiratory syndrome in the Arabian Peninsula

The CDC warns that cases of MERS (Middle East Respiratory Syndrome) have been reported in many countries in the Arabian Peninsula. There have also been cases in several other countries in those who traveled to the Arabian Peninsula and their close contacts. MERS is caused by a coronavirus called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Countries in or near the Arabian Peninsula include Bahrain; Iraq; Iran; Israel, the West Bank, and Gaza; Jordan; Kuwait; Lebanon; Oman; Qatar; Saudi Arabia; Syria; the United Arab Emirates (UAE); and Yemen. The CDC recommends you practice enhanced precautions if you travel to these countries.
MERS affects the respiratory system, and most MERS patients developed severe acute respiratory illness with symptoms of shortness of breath, fever, cough, and cold-like symptoms, although some can be asymptomatic (show no symptom). The time between when a person is exposed to MERS-CoV and when they start to have symptoms is about 5 or 6 days, and ranges from 2-14 days.

The disease can be lethal, and 3-4 out of every 10 people with MERS have died. Some affected people also had gastrointestinal symptoms such as nausea, vomiting, and diarrhea. Pneumonia and kidney failure can occur for many people with MERS. Most of those who died had an underlying medical condition. People with pre-existing medical conditions may be more likely to become infected with MERS-CoV, or have complications. If you have a weakened immune system you are also at higher risk for getting MERS or having a severe case.

MERS-CoV can spread from an infected person’s respiratory secretions, such as via coughing. MERS-CoV can spread with close contact with an infected patient, such as living with or caring for an infected person. Infected people can spread MERS-CoV to others in healthcare settings. The CDC defines close contact “ as a) being within approximately 6 feet (2 meters) or within the room or care area for a prolonged period of time (e.g., healthcare personnel, household members) while not wearing recommended personal protective equipment (i.e., gowns, gloves, respirator, eye protection–see Infection Prevention and Control Recommendations); or b) having direct contact with infectious secretions (e.g., being coughed on) while not wearing recommended personal protective equipment (i.e., gowns, gloves, respirator, eye protection.”

MERS-CoV has been detected in some camels, and some MERS patients have had contact with camels. The World Health Organization has posted a general precaution if you will be visiting farms, barns, markets, or other places where animals are present. Travelers must avoid contact with sick animals, and must also avoid consumption of raw or undercooked animal products. If you have a pre-existing condition, you should avoid contact with camels, not drink raw camel milk or raw camel urine, and not eat undercooked meat, especially camel meat.
Prevention and Treatment

There is no vaccine that prevents MERS-CoV infection. You can help protect yourself if you wash your hands often with soap and water for 20 seconds, or use an alcohol-based hand sanitizer. BE SURE TO HELP CHILDREN DO THE SAME. You should cover your nose and mouth with a tissue if you cough or sneeze, then dispose of the tissue in the trash. Don’t touch your eyes, nose and mouth with unwashed hands. You should avoid personal contact, such as kissing, or sharing cups or eating utensils, with those who are sick. Disinfect frequently touched surfaces and objects.
There is no specific treatment for MERS-CoV infection. If you have symptoms of MERS, you should seek immediate medical care to help relieve symptoms, and to prevent complications.

The CDC recommends that “if you develop a fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after traveling from countries in or near the Arabian Peninsula, you should call ahead to a healthcare provider and mention your recent travel. While sick, stay home from work or school and delay future travel to reduce the possibility of spreading illness to others.
If you have had close contact with someone within 14 days after they traveled from a country in or near the Arabian Peninsula, and the traveler has/had fever and symptoms of respiratory illness, such as cough or shortness of breath, you should monitor your health for 14 days, starting from the day you were last exposed to the ill person.

If you develop fever and symptoms of respiratory illness, call your healthcare provider and tell her about your possible exposure to MERS-CoV so she can take steps to keep other people from getting infected. To avoid spreading MERS to others while you’re sick, stay home from work or school and postpone your travel plans. Other early symptoms include body aches, chills, runny nose, sore throat, headache, nausea/vomiting, and diarrhea.
If you have to travel to the Arabian Peninsula, or to countries near it, you must practice vigilance and use the above precautions. Be aware you could still become infected, and to report to a healthcare provider if you have any MERS symptom.