7/23/2019 Mers Cov Song Sep2015 http://slidepdf.com/reader/full/mers-cov-song-sep2015 1/34 Middle East Respiratory Syndrome Coronavirus (MERS-CoV) CDNA NATIONAL GUIDELINES FOR PUBLIC HEALTH UNITS The Series of National Guidelines !the Guidelines"# ha$e %een de$elo&ed %' the Co((uni)a%le Diseases Net*or+ Australia CDNA# and noted %' the Australian Health Prote)tion Prin)i&al Co((ittee AHPPC#, Their &ur&ose is to &ro$ide nationall' )onsistent -uidan)e to &u%li) health units PHUs# in res&ondin- to a noti.a%le disease e$ent, These -uidelines )a&ture the +no*led-e of e/&erien)ed &rofessionals0 and &ro$ide -uidan)e on %est &ra)ti)e %ased u&on the %est a$aila%le e$iden)e at the ti(e of )o(&letion, Readers should not rel' solel' on the infor(ation )ontained *ithin these -uidelines, Guideline infor(ation is not intended to %e a su%stitute for ad$i)e fro( other rele$ant sour)es in)ludin-0 %ut not li(ited to0 the ad$i)e fro( a health &rofessional, Clini)al 1ud-e(ent and dis)retion (a' %e re2uired in the inter&retation and a&&li)ation of these -uidelines, The (e(%ershi& of the CDNA and the AHPPC0 and the Co((on*ealth of Australia as re&resented %' the De&art(ent of Health !the Co((on*ealth"#0 do not *arrant or re&resent that the infor(ation )ontained in the Guidelines is a))urate0 )urrent or )o(&lete, The CDNA0 the AHPPC and the Co((on*ealth do not a))e&t an' le-al lia%ilit' or res&onsi%ilit' for an' loss0 da(a-es0 )osts or e/&enses in)urred %' the use of0 or relian)e on0 or inter&retation of0 the infor(ation )ontained in the -uidelines, Revision history Version Date Revised by Changes 3,4 35 O)t 6437 De$elo&ed %' 8ERS9Co: SoNG *or+in- -rou& Ori-inal 3,3 67 ;ul' 6435 8ERS9Co: SoNG <or+in- Grou& Presentin- s'&(&to(s= )onta)t (ana-e(ent and )ase de.nitions u&dated to address re$ised e$iden)e follo*in- out%rea+ in Re&u%li) of South >orea, Further (inor u&date a&&ro$ed %' AHPPC Chair ? Se&te(%er 6435 to in)lude <HO re)o((endations on the testin- of as'(&to(ati) )lose )onta)ts in the )onte/t of a hos&ital out%rea+,
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Middle East Respiratory SyndromeCoronavirus (MERS-CoV)
CDNA NATIONAL GUIDELINES FOR PUBLIC HEALTHUNITS
The Series of National Guidelines !the Guidelines"# ha$e %een de$elo&ed
%' the Co((uni)a%le Diseases Net*or+ Australia CDNA# and noted %'
the Australian Health Prote)tion Prin)i&al Co((ittee AHPPC#, Their
&ur&ose is to &ro$ide nationall' )onsistent -uidan)e to &u%li) health units
PHUs# in res&ondin- to a noti.a%le disease e$ent,
These -uidelines )a&ture the +no*led-e of e/&erien)ed &rofessionals0 and
&ro$ide -uidan)e on %est &ra)ti)e %ased u&on the %est a$aila%le e$iden)e
at the ti(e of )o(&letion,
Readers should not rel' solel' on the infor(ation )ontained *ithin these
-uidelines, Guideline infor(ation is not intended to %e a su%stitute for
ad$i)e fro( other rele$ant sour)es in)ludin-0 %ut not li(ited to0 the ad$i)e
fro( a health &rofessional, Clini)al 1ud-e(ent and dis)retion (a' %e
re2uired in the inter&retation and a&&li)ation of these -uidelines,
The (e(%ershi& of the CDNA and the AHPPC0 and the Co((on*ealth of
Australia as re&resented %' the De&art(ent of Health !the
Co((on*ealth"#0 do not *arrant or re&resent that the infor(ation
)ontained in the Guidelines is a))urate0 )urrent or )o(&lete, The CDNA0
the AHPPC and the Co((on*ealth do not a))e&t an' le-al lia%ilit' or
res&onsi%ilit' for an' loss0 da(a-es0 )osts or e/&enses in)urred %' the use
of0 or relian)e on0 or inter&retation of0 the infor(ation )ontained in the
-uidelines,
Revision history
Version Date Revised by Changes3,4 35 O)t
6437De$elo&ed %'8ERS9Co: SoNG*or+in- -rou&
Ori-inal
3,3 67 ;ul'6435
8ERS9Co: SoNG<or+in- Grou&
Presentin- s'&(&to(s= )onta)t(ana-e(ent and )ase de.nitionsu&dated to address re$isede$iden)e follo*in- out%rea+ inRe&u%li) of South >orea, Further
(inor u&date a&&ro$ed %' AHPPCChair ? Se&te(%er 6435 to in)lude<HO re)o((endations on thetestin- of as'(&to(ati) )lose)onta)ts in the )onte/t of ahos&ital out%rea+,
tra$ellin- fro( a re-ion *ith a +no*n 8ERS9Co: out%rea+ at
that ti(e70
OR
B, Fe$er AND s'(&to(s of res&irator' illness e,-,0 )ou-h0 shortness of %reath# AND
o %ein- in a health)are fa)ilit' as a &atient0 *or+er0 or $isitor#
in a )ountr' or territor' in *hi)h re)ent health)are9asso)iated
)ases of 8ERS ha$e %een identi.ed7 *ithin 37 da's %efore
s'(&to( onset0 OR
o %ein- in )onta)t *ith )a(els or ra* )a(el &rodu)ts *ithin
ae)ted )ountries in the 8iddle East *ithin 37 da's %efore
s'(&to( onset,
OR
C, Fe$er OR a)ute s'(&to(s )o(&ati%le *ith 8ERS9Co: AND onset
*ithin 37 da's after )onta)t *ith a &ro%a%le or )on.r(ed 8ERS9Co:
)ase *hile the )ase *as ill,
OR
D, Testin- and initial infe)tion )ontrol and &u%li) health a)tions for8ERS9Co: should also %e )onsidered0 in )onsultation *ith the &u%li)
health unit0 *here there is a )luster of &atients *ith se$ere a)uteres&irator' illness of un+no*n aetiolo-' follo*in- routine(i)ro%iolo-i)al in$esti-ation0 &arti)ularl' *here the )lusterin)ludes health )are *or+ers,
2 Affected countries in the Middle East include Iran, Jordan, Kuwait, Leanon, !"an, #atar,$audi Araia %K$A&, 'nited Ara E"irates %'AE& and (e"en3 $ee section 11) *efinition of contact4 $ee the +orld ealth !r-ani.ation %+!& corona/irus infection wesite 01 for list ofcountries currentl eeriencin- a ME$ outrea
Probable case
• A &erson *ith an a)ute res&irator' infe)tion *ith )lini)al0radiolo-i)al0 or histo&atholo-i)al e$iden)e of &ul(onar'&aren)h'(al disease e,-, &neu(onia or &neu(onitis or A)uteRes&irator' Distress S'ndro(e ARDS##= AND
No &ossi%ilit' of la%orator' )on.r(ation for 8ERS9Co: %e)ausethe &atient or sa(&les are not a$aila%le for testin-= ANDClose )onta)t *ith a la%orator'9)on.r(ed )ase see the Conta)t8ana-e(ent se)tion %elo* for -uidan)e on identif'in- )lose)onta)ts#,
• A )on.r(ed )ase re2uires la%orator' de.niti$e e$iden)e of infe)tion*ith 8ERS9Co:,
Laboratory defnitive evidence
• Dete)tion of 8ERS )orona$irus %' &ol'(erase )hain rea)tion PCR#in a &u%li) health referen)e la%orator' usin- the testin- al-orith(des)ri%ed in A&&endi/ and su((arised %elo*,
Notes@3# Transitin- throu-h an international air&ort 67 hours sta'0
re(ainin- *ithin the air&ort# in the 8iddle East is not )onsidered to%e ris+ fa)tor for infe)tion,
6# La%orator' de.niti$e e$iden)e, To )onsider a )ase as la%orator'9)on.r(ed0 one of the follo*in- )onditions (ust %e (et@
o A &ositi$e PCR result for at least t*o dierent s&e)i.) tar-ets
on the 8ERS9Co: -eno(e,o One &ositi$e PCR result for a s&e)i.) tar-et on the 8ERS9Co:
-eno(e and an additional dierent PCR &rodu)t se2uen)ed0)on.r(in- identit' to +no*n se2uen)es of 8ERS9Co:,
See the La%orator' testin- se)tion and A&&endi/ for additional 8ERS9
Co: la%orator' testin- infor(ation,
. /aboratory testin
Patients to %e )onsidered for 8ERS9Co: testin- are des)ri%ed under the
sus&e)ted )ase de.nition a%o$e#, <here a&&li)a%le0 )onsult *ith 'ourstateKterritor' )o((uni)a%le diseases a-en)' to see+ ad$i)e on *hi)h
)olle)tion and trans&ort= and also to fa)ilitate )onta)t (ana-e(ent if
indi)ated,
Trans(ission9%ased )onta)t and air%orne &re)autions (ust %e used *hen
)olle)tin- res&irator' s&e)i(ens , These in)lude@
• Conta)t &re)autions0 in)ludin- )lose attention to hand h'-iene
• Air%orne trans(ission &re)autions0 in)ludin- routine use of a P6(as+Kres&irator0 dis&osa%le -o*n0 -lo$es0 and e'e &rote)tion• Colle)tion in a roo( *ith ne-ati$e &ressure air9handlin- *here
a$aila%le,
Routine tests for a)ute &neu(oniaK&neu(onitis should %e &erfor(ed
*here indi)ated0 in)ludin- %a)terial )ultures0 a)ute and )on$ales)ent
serolo-'0 urinar' anti-en testin- and tests for res&irator' $iruses0
a))ordin- to lo)al &roto)ols,
Serolo-'0 if a$aila%le0 (a' %e useful in )ases *here 8ERS9Co: is stron-l'
sus&e)ted %ut non9)on.r(ed *ith PCR %ut re2uires &aired a)ute and)on$ales)ent sera J see+ e/&ert )lini)al (i)ro%iolo-' ad$i)e, Serolo-' is
In su((ar'0 trans(ission9%ased &re)autions for sus&e)ted0 &ro%a%le and
)on.r(ed )ases should in)lude@
• Pla)e(ent of )ases in a ne-ati$e &ressure roo( *ith an ensuite%athroo(0 if a$aila%le0 or in a sin-le roo( fro( *hi)h the air doesnot )ir)ulate to other areas
• Air%orne trans(ission &re)autions0 in)ludin- routine use of a P6res&irator or N5 (as+#0 lon- slee$ed dis&osa%le -o*n0 -lo$es0and e'e &rote)tion *hen enterin- a &atient )are area
• Conta)t &re)autions0 in)ludin- )lose attention to hand h'-iene
• If transfer of the )on.r(ed or &ro%a%le )ase outside the ne-ati$e&ressure roo( is ne)essar'0 as+ the &atient to *ear a sin-le usesur-i)al fa)e (as+ *hile the' are %ein- transferred and to follo*res&irator' h'-iene and )ou-h eti2uette,
Active case fndingConta)ts see "ontact management se)tion# should %e identi.ed and
ad$ised to i((ediatel' see+ (edi)al ad$i)e should the' de$elo&
s'(&to(s, Conta)ts or )are-i$ers should %e ad$ised to infor( the &u%li)
health a-en)' if the' de$elo& s'(&to(s,
17. Environmental evaluation
<here lo)al trans(ission of 8ERS9Co: is thou-ht &ossi%le0 a thorou-h
re$ie* of )ontri%utin- en$iron(ental fa)tors should %e done, This should
in)lude a re$ie* of infe)tion )ontrol &ro)edures0 and o&&ortunities for
e/&osure to res&irator' or fae)al )onta(ination,
If a )ase has had o))u&ational e/&osure to ani(als it (a' %e a&&ro&riate
to )onsult *ith ani(al health authorities,
11. Contact manaement
As there re(ain -a&s in the understandin- of infe)ti$it' of 8ERS9Co:
)ases and trans(ission (odes the de.nition of )onta)ts is %ased on
o%ser$ations of &eo&le infe)ted in lar-e out%rea+s0 &arti)ularl' the
out%rea+ in South >orea, The de.nition of )onta)ts and re)o((ended
)ontrol (easures are su%1e)t to re$ie* as (ore infor(ation on 8ERS9Co:
%e)o(es a$aila%le,
#denti'cation o$ contactsAll &ersons )ate-orised as a )onta)t see de.nitions of )lose )onta)ts
and )asual )onta)ts follo*in-# of &ro%a%le and )on.r(ed )ases should
%e follo*ed9u&0 and (onitored for the de$elo&(ent of s'(&to(s for 37
da's after the last e/&osure to the )ase i,e, the (a/i(u( in)u%ation
&eriod#,
Conta)ts of sus&e)ted )ases should also %e )onsidered for )onta)t
(ana-e(ent if there is li+el' to %e a dela' in )on.r(in- or e/)ludin-
8ERS Co: infe)tion in the sus&e)ted )ase0 su)h as dela'ed testin-,
Close Contact de'nition
A )lose )onta)t is de.ned as re2uirin- -reater than 35 (inutes fa)e9to9
fa)e )onta)t *ith a s'(&to(ati) &ro%a%le or )on.r(ed )ase in an'
settin-0 or the sharin- of a )losed s&a)e *ith a s'(&to(ati) &ro%a%le or
)on.r(ed )ase for a &rolon-ed &eriod e,-, (ore than 6 hours#,
Hen)e0 )lose )onta)ts (a' in)lude@
• A health)are *or+er or fa(il' (e(%er &ro$idin- dire)t &atient )areto0 or *ho *ere *ithin )lose $i)init' of an aerosol -eneratin-&ro)edure &erfor(ed on0 or a la%orator' *or+er *ho &erfor(ed
tests on s&e)i(ens fro(0 a )on.r(ed or &ro%a%le )ase0 *ithoutre)o((ended infe)tion )ontrol &re)autions0 in)ludin- not usin- full&ersonal &rote)ti$e e2ui&(ent PPE#,
• OR0 a health)are *or+er0 &atient or $isitor *ho shared the sa(e
)losed s&a)e for a &rolon-ed ti(e e,-, (ore than 6 hours#0 and*ithout re)o((ended infe)tion )ontrol &re)autions0 in)ludin- notusin- full &ersonal &rote)ti$e e2ui&(ent PPE#,
• OR0 &eo&le *ho resided in the sa(e household or household9li+esettin- e,-, dor(itor' roo( in a %oardin- s)hool#,
Conta)t tra)in- %' &u%li) health units should &rioritise identif'in- )lose
)onta)ts &arti)ularl' health)are *or+ers0 and other )lose )onta)ts *ho
(a' %e at hi-her ris+ of se$ere disease0 in)ludin- the elderl' and those
*ith si-ni.)ant )o9(or%idities,
• Casual )onta)t de.nition
• Casual )onta)t is de.ned as an' &erson ha$in- less than 35 (inutesfa)e9to9fa)e )onta)t *ith a s'(&to(ati) &ro%a%le or )on.r(ed )asein an' settin-0 or sharin- a )losed s&a)e *ith a s'(&to(ati)&ro%a%le or )on.r(ed )ase for less than 6 hours, This *ill in)ludehealth)are *or+ers0 other &atients0 or $isitors *ho *ere in the sa(e)losed health)are s&a)e as a )ase0 %ut for shorter &eriods thanthose re2uired for a )lose )onta)t, Other )losed settin-s (i-htin)lude s)hools or oQ)es,
Note that health)are *or+ers and other )onta)ts *ho ha$e ta+en
re)o((ended infe)tion )ontrol &re)autions0 in)ludin- the use of full PPE0
*hile )arin- for a s'(&to(ati) &ro%a%le or )on.r(ed 8ERS9Co: )ase are
not )onsidered to %e )lose )onta)ts, Ho*e$er0 these &eo&le should %e
ad$ised to self9(onitor and if the' de$elo& s'(&to(s )onsistent *ith
8ERS9Co: infe)tion the' should isolate the(sel$es and notif' their &u%li)
health unit or sta health unit so the' )an %e tested and (ana-ed as a
sus&e)ted 8ERS9Co: )ase see re)o((endations %elo* under
Management of symptomatic contacts#,
Other )asual )onta)ts (a' in)lude@
• E/tended fa(il' -rou&s e,-, in an A%ori-inal )o((unit',
• Air)raft &assen-ers *ho *ere seated in the sa(e ro* as the )ase0or in the t*o ro*s in front or t*o ro*s %ehind a s'(&to(ati)&ro%a%le or )on.r(ed 8ERS9Co: )ase, It is noted that to date noinstan)es of trans(ission on airlines ha$e %een identi.ed, Conta)ttra)in- of &eo&le *ho (a' ha$e had )lose )onta)t on lon- %us ortrain tri&s should also %e atte(&ted *here &ossi%le0 usin- si(ilarseatin-K&ro/i(it' )riteria,
• All )re*9(e(%ers on an air)raft *ho *or+ed in the sa(e )a%in areaas a s'(&to(ati) &ro%a%le or )on.r(ed )ase of 8ERS9Co:, If a)re* (e(%er is the s'(&to(ati) 8ERS9Co: )ase0 )onta)t tra)in-eorts should )on)entrate on &assen-ers seated in the area *here
other &ersons *ho ha$e had )asual )onta)t as de.ned a%o$e#0
&arti)ularl' in s)hool0 oQ)e0 or other )losed settin-s, In these)ir)u(stan)es0 the sie of the roo(Ks&a)e and de-ree of se&aration of the
)ase fro( others should %e )onsidered in identif'in- )onta)ts,
Contact assessment
All &ersons identi.ed as ha$in- had )onta)t *ith a s'(&to(ati) &ro%a%le
or )on.r(ed )ase should %e assessed to see if the' should %e )lassi.ed as
a )lose or )asual )onta)t and ha$e de(o-ra&hi) and e&ide(iolo-i)al data
)olle)ted, Infor(ation on )onta)ts should %e (ana-ed a))ordin- to
1urisdi)tional re2uire(ents,
Identi.)ation and assess(ent of the )onta)ts of sus&e)ted )ases (a' %e
deferred &endin- the results of initial la%orator' testin-, Ho*e$er0 )onta)t
tra)in- should %e )onsidered if 8ERS9Co: infe)tion re(ains hi-h on the
list of dierential dia-noses0 e$en if initial la%orator' results are ne-ati$e
or are &endin-,
Contact testin
Routine la%orator' s)reenin- for 8ERS9Co: infe)tion is not re)o((ended
for as'(&to(ati) )onta)ts, One e/)e&tion is in the settin- of a hos&italout%rea+0 *here <HO re)o((ends RT9PCR testin- of noseKthroat s*a%s of
as'(&to(ati) )lose )onta)ts %e )onsidered0 if feasi%le, RT9PCR9&ositi$e
as'(&to(ati) )lose )onta)ts in this settin- should %e isolated0 (onitored
)losel' for s'(&to(s and onl' released fro( isolation follo*in- t*o
ne-ati$e RT9PCR tests se&arated %' 67 hours,6
Serolo-i)al testin- of )onta)ts (a' %e useful if a$aila%le0 in order to hel&
deter(ine the se)ondar' infe)tion9atta)+ rate and the &ro&ortion of
infe)tions that are as'(&to(ati), Conta)ts *ho a-ree to %e tested should
%e ad$ised that serolo-i)al testin- *ill not %e done i((ediatel' and is not%ein- )ondu)ted for )onta)t (ana-e(ent &ur&oses,
Consent should %e sou-ht fro( household and health)are *or+er )lose
)onta)ts for the )olle)tion of the follo*in- sa(&les@
2 <HO re)o((ends that if feasi%le0 and in the )onte/t of a hos&italout%rea+0 all )lose )onta)ts of a )on.r(ed )ase of 8ERS should %etested for the &resen)e of the $irus, See@htt)::as;who;int:iris:itstrea":19665:19873:1:+!<ME$<I=><15;2<en-;df?ua@1 ,
• A %aseline seru( sa(&le0 ideall' *ithin ? da's of e/&osure0 to %estored and tested in &arallel *ith a )on$ales)ent sa(&le,
• A )on$ales)ent seru( sa(&le at least 63 da's after the %aselinesa(&le *as )olle)ted, If (ore than 63 da's ha$e &assed sin)e thelast e/&osure0 onl' a sin-le seru( sa(&le is re2uired,
The )olle)tion of naso&har'n-eal NP# s*a%s fro( as'(&to(ati) )onta)ts
for 8ERS9Co: PCR is not re)o((ended, There is little infor(ation
a$aila%le )urrentl' to relia%l' infor( the ti(in- of testin- or the
inter&retation of ne-ati$e test results in this settin-,
Serial PCR testin- of NP s*a%s fro( as'(&to(ati) )lose )onta)ts to dete)t
8ERS9Co: $iral sheddin- (a' %e )ondu)ted as &art of ethi)s9a&&ro$ed
resear)h studies,
Prophyla8isNo s&e)i.) )he(o&ro&h'la/is is a$aila%le for )onta)ts,
Education
Conta)ts should %e )ounselled a%out their ris+ and the s'(&to(s of 8ERS9
Co: and &ro$ided *ith a 8ERS9Co: Fa)t Sheet A&&endi/ 3#, The' should
%e ad$ised to self9isolate if the' de$elo& s'(&to(s0 and to i((ediatel'
notif' their &u%li) health unit and0 if a&&ro&riate0 their fa)ilit' infe)tion
)ontrol unit i,e, for health)are *or+ers#,
9uarantine and restriction
Close contactsHo(e 2uarantine of as'(&to(ati) )lose )onta)ts is not routinel'
re)o((ended0 %ut &eo&le identi.ed as )lose )onta)ts are ad$ised to
(onitor their health for 37 da's after the last &ossi%le )onta)t *ith a
s'(&to(ati) &ro%a%le or )on.r(ed 8ERS9Co: )ase,
Pu%li) health units should )ondu)t a)ti$e dail' (onitorin- of )lose
)onta)ts for s'(&to(s for 37 da's after the last &ossi%le )onta)t *ith a
s'(&to(ati) &ro%a%le or )on.r(ed 8ERS9Co: )ase,
Close )onta)ts should also %e ad$ised to i((ediatel' tele&hone the &u%li)
health unit to arran-e (edi)al assess(ent if the' de$elo& s'(&to(s su)h
as fe$er0 res&irator' s'(&to(s in)ludin- )ou-hin- and shortness of
%reath#0 heada)he0 (us)le &ain or diarrhoea,
Less fre2uent a)ti$e follo*9u& to-ether *ith &assi$e sur$eillan)e (a' %e
ne)essar' if there are lar-e nu(%ers of )lose )onta)ts to (onitor,
Close )onta)ts should also %e ad$ised to not tra$el internationall' for 37
da's after the last )lose )onta)t *ith a &ro%a%le or )on.r(ed )ase of
;ppendi8 16 Middle East Respiratory Syndrome (MERS)=actsheet
>hat is Middle East Respiratory Syndrome (MERS)?
8iddle East Res&irator' S'ndro(e 8ERS# is a $iral illness )aused %' a no$el
)orona$irus0 8iddle East res&irator' S'ndro(e Corona$irus 8ERS9Co:# that *as .rst
identi.ed in Saudi Ara%ia in 6436, Corona$iruses are a lar-e fa(il' of $iruses that
)ause diseases ran-in- fro( the )o((on )old to Se$ere A)ute Res&irator' S'ndro(e
SARS#,
All re)o-nised )ases of 8ERS9Co: infe)tion &eo&le *ho ha$e the disease# ha$e to
date li$ed in or tra$elled to )ountries in the 8iddle East0 or ha$e had )lose )onta)t0
su)h as )arin- for or li$in- *ith0 &eo&le *ho a)2uired the infe)tion in the 8iddle East,
Ho*e$er0 there is no e$iden)e of sustained s&read of the disease *ithin the)o((unit',
There is a ris+ of 8ERS9Co: in the follo*in- 8iddle Eastern )ountries@
• ;ordan0 >u*ait0 O(an0 atar0 Saudi Ara%ia0 the United Ara% E(irates UAE#0 e(en0 Le%anon and Iran,
Peo&le *ho )au-ht the infe)tion in the 8iddle East ha$e tra$elled to a nu(%er of
)ountries outside the 8iddle East and su%se2uentl' de$elo&ed the disease, There
ha$e %een no )ases identi.ed in Australia to date,
It is a $er' serious disease0 and a%out 4 of &eo&le *ith 8ERS9Co: infe)tion ha$e
died fro( the infe)tion or related )o(&li)ations,
>hat are the symptoms?
• 8ost )on.r(ed )ases ha$e had a ra&id onset of serious res&irator' illness0 *ithfe$er0 )ou-h0 and shortness of %reath0 leadin- to &neu(onia,
• A $ariet' of other s'(&to(s ha$e %een re&orted in so(e )ases0 in)ludin-(us)le &ain0 diarrhoea0 $o(itin- and nausea,
• An in)reasin- nu(%er of infe)tions are %ein- identi.ed in &eo&le *ith onl' (ilds'(&to(s or no s'(&to(s as'(&to(ati)# *ho *ere tested %e)ause the' *ere)lose )onta)ts of seriousl'9ill )ases,
3o is it spread?
It is not 'et understood e/a)tl' ho* &eo&le are %e)o(in- infe)ted, In so(e )ases
there a&&ears to ha$e %een s&read fro( an infe)ted &erson to another &erson in )lose
)onta)t, This has %een seen a(on- fa(il' (e(%ers0 and other &atients and health
)are *or+ers in hos&itals )arin- for &eo&le *ith 8ERS9Co: infe)tion, Ho*e$er0 the
$irus does not see( to s&read easil' fro( &erson9to9&erson,
8ERS9Co: is dia-nosed %' .ndin- -eneti) (aterial fro( the $irus in res&irator'
sa(&les su)h as s*a%s fro( the %a)+ of the throat and uid fro( the lun-s, Testin- for
8ERS9Co: is done in &u%li) health la%oratories,
3o is it treated?
There is )urrentl' no s&e)i.) treat(ent for &eo&le *ho are si)+ *ith 8ERS0 %ut -eneral
su&&orti$e (edi)al )are )an %e life9sa$in-,
>hat is the public health response?
The <orld Health Or-aniation <HO# is *or+in- *ith ae)ted )ountries to (ini(ise
the ris+ of s&read and .nd out (ore a%out the disease,
There ha$e %een no )on.r(ed )ases in Australia0 %ut s&e)ial &ro)edures to &re$ent
the s&read of 8ERS9Co: *ould %e &ut in &la)e in the e$ent of an' sus&e)ted or
)on.r(ed )ases, These *ould in)lude@
• As+in- the si)+ &erson to *ear a sur-i)al (as+
• Health9)are *or+ers seein- &atients and la%orator' sta handlin- s&e)i(ens*ould follo* s&e)ial safet' -uidelines0 in)ludin- *earin- &rote)ti$e e2ui&(ent,
• Do)tors and la%oratories *ould infor( stateK territor' health de&art(ents ofsus&e)ted )ases,
• Pu%li) Health authorities *ould follo* u& an' )ase to identif' their )onta)ts so
as to hel& &re$ent s&read of the disease, Close )onta)ts of &eo&le dia-nosed orsus&e)ted of ha$in- 8ERS9Co: infe)tion *ould %e -i$en infor(ation a%out theris+ of infe)tion0 and *ould %e tested for the disease if ne)essar',
Pu%li) health unit sta *ill in$esti-ate all )ases to .nd out ho* the infe)tion o))urred0
identif' other &eo&le at ris+ of infe)tion0 i(&le(ent )ontrol (easures and &ro$ide
other ad$i)e,
=urther in$ormation
• <orld Health Or-aniation <HO# 8ERS9Co: u&dates ***,*ho,intK)srKdiseaseK)orona$irusinfe)tionsKenK #
• Australian De&art(ent of Health J 8ERS )orona$irus *e%site htt&@KK***,health,-o$,auKinternetK(ainK&u%lishin-,nsfKContentKoh&9(ers9)o$,ht(#
• Centers for Disease Control and Pre$ention USA# htt&@KK***,)d),-o$K)orona$irusK(ersK #
• Australian De&art(ent of Forei-n Aairs and Trade &ro$ides infor(ation fortra$ellers on the S(artra$eller *e%site ***,s(artra$eller,-o$,auK #
4sin the MERS-CoV #nvestiation $orm2 contact thepatient@s doctor to6
• Con.r( the onset date and s'(&to(s of the illness
• Con.r( results of rele$ant &atholo-' tests0 or re)o((end that tests %e done
• Find out if the )ase or rele$ant )are9-i$er has %een told *hat the dia-nosis is%efore %e-innin- the inter$ie*
• See+ the do)torMs &er(ission to )onta)t the )ase or rele$ant )are9-i$er
• Re$ie* )ase (ana-e(ent in)ludin- infe)tion )ontrol (easures %ein- used in)arin- for the )ase
#ntervie the case or care-iver to complete e8posure and
contact history and other details• Co(&lete the e/&osure histor' and other se)tions of the 8ERS9Co:
In$esti-ation For(,
• Identif' )lose )onta)ts a))ordin- to the )onta)t de.nition,
=ollo-up patient@s contacts to6
• Assess ris+ of 8ERS9Co: trans(ission and )lassif' as )lose or )asual )onta)ts
• Deter(ine )urrent s'(&to(s0 if an'0 and ad$ise on a)ti$e dail' (onitorin- ofs'(&to(s %' &u%li) health unit )lose )onta)ts# or &assi$e sur$eillan)e )asual
)onta)ts#• E/&lain s'(&to(s and need to i((ediatel' re&ort an' ne* s'(&to(s
• E/&lain to health)are0 a-ed )are0 and )hild)are *or+er )lose )onta)ts the needfor *or+ restri)tions durin- the &otential in)u%ation &eriod after e/&osure
• E/&lain to s)hool student )lose )onta)ts or their )arers# the need for e/)lusiondurin- the &otential in)u%ation &eriod after e/&osure
• Pro$ide a 8ERS9Co: Disease Fa)tsheet
• Arran-e serolo-i)al testin- if a$aila%le and a&&ro&riate,
Aoti$y central *urisdictional communicable disease control
aency
Central communicable disease control aency to noti$yCommonealth &epartment o$ 3ealth2 :Bce o$ 3ealthProtection
Consider need $or media release and desinate a mediaspo%esperson.
%ote& 'his is an eample form incorporating most of the )elds contained in the %etEpi (database$ formthat has been prepared for national reporting. "entral disease control agencies in individual jurisdictionsshould be consulted regarding their speci)c data collection re*uirements.
1 Inter/iew +as the erson inter/iewed? € (es € o € ot alicale
B If (es, date of inter/iew) : : %dd:"":&
B If o, secif reason not inter/iewed %and if so"eone else was inter/iewed&)
If (es, nu"er of wees -estation at onset of s"to"s) %wees&
B =reBeistin- "edications and conditions notes)
Are the a current s"oer? € (es € o € 'nnown
If (es, nu"er of ac ears) %ac:rs;&
B *o the drin alcohol? € (es € o € 'nnown
If (es, a/era-e nu"er of standard drins er wee) %$*:wee&
18
Fra/el in theMiddle Eastand contactwith othercases
>hec thecurrent casedefinition for alist of affectedcountries;
*urin- the eriod of interest, did the case tra/el to the Middle East?
€ (es € o € 'nnown
Note: Transiting through an international airport (<24 hours stay, reaining withinthe !irport" in the #i$$le %ast is not &onsi$ere$ to 'e risk fa&tor for infe&tion
$% &' (roeed diret"y to )*estion 22+ ,*-an E./os*res
*id the articiate in an =il-ri"a-es or festi/als whilst in the Middle East durin-the 14 das rior to onset? %e;-; the aGG or '"rah&
€ (es € o € 'nnown
B If (es, -i/e details of what, when and where)
19
Locations/isited durin-
incuationeriod
%durin- eriodof interest&
*urin- the eriod of interest, did the /isit an of the followin- /enuesor locations in the Middle East?
€ osital € !ther health facilit
€ Car" € $wa" "arsh
€ oo:ettin- .oo € >a"in-
€ Aattoir € untin-
€ Ani"al "aret € $tocards
€ i/er:lae € A-ricultural show
20
Ani"aleosures
%durin- eriod
of interest&
)onsi$er any &onta&t with li*e or $ea$ anials that they ha*e ha$ in&lu$ing*isiting pla&es where anials are kept, e*en if they $i$n+t ha*e $ire&t &onta&t withthe
*id the ha/e contact with ca"els? € (es € o € 'nnown
B If (es, secif)
*id the ha/e contact with do"estic %includin- household ets&
10 +orld ealth !r-ani.ation %+!&; >orona/irus infections;%htt)::www;who;int:csr:disease:corona/irus<infections:en: &20 Australian *eart"ent of ealth; ME$ corona/irus we a-e;%htt)::www;health;-o/;au:internet:"ain:ulishin-;nsf:>ontent:ohB"ersBco/;ht"&; Interi( infe)tion &re$ention and )ontrol ad$i)e for a)ute )are hos&itals relatin- to