For health professionals: Middle East respiratory syndrome (MERS)
Find detailed information on Middle East respiratory syndrome (MERS) and its risk to Canadians. Also find resources on identification, reporting, prevention and control.
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What do health professionals need to know about Middle East respiratory syndrome?
Health professionals in Canada have a critical role to play in identifying and reporting potential cases of MERS.
MERS is a viral respiratory disease caused by a novel coronavirus called Middle East respiratory syndrome coronavirus (MERS-CoV). The virus was first identified in Saudi Arabia in 2012.
Coronaviruses are a large family of viruses. They can cause diseases ranging from the common cold to severe acute respiratory syndrome (SARS).
Spectrum of illness
The spectrum of illness caused by the MERS virus is wide-ranging. It can go from an asymptomatic infection to a mild respiratory illness to a severe acute respiratory illness and death.
Typical symptoms include:
- shortness of breath
Pneumonia is common. Gastrointestinal symptoms, such as vomiting and diarrhea, may also be present. Those at greater risk of severe disease appear to include people who:
- are older
- have compromised immune systems
- have chronic medical conditions
Disease distribution (global)
Since 2012, cases of MERS have been reported from countries in the Middle East. The majority of cases are reported from Saudi Arabia.
Several other countries have also reported cases in people who have:
- travelled to the Middle East
- had contact with an ill individual who has travelled to the Middle East
There have not been any reported cases of MERS in Canada.
The MERS virus is considered a zoonotic virus that can lead to secondary infections among people. Many community-acquired infections are thought to be associated with direct or indirect contact with infected dromedary camels or camel-related products. This includes raw milk.
Some of the infections have occurred in clusters of close contacts or in health care settings. This provides good evidence of human-to-human transmission. However, no community-wide transmission has been observed.
Human-to-human transmission has been observed in households in affected countries. However, most human cases reported to date have resulted from human-to-human transmission in health care settings.
An outbreak in South Korea, which began in May 2015, was the largest outbreak of MERS outside the Middle East. It began with a single infected person who travelled to the Middle East, with apparent transmission in South Korea to:
- patients in health care facilities
- visitors of patients and health care workers in health care facilities
- close relatives
Public health risk to Canada
Review a summary of the public health risk to Canada associated with the MERS virus. It includes an overview of key events in the development of MERS outbreaks from the World Health Organization.
Detection and reporting
Health professionals are encouraged to maintain vigilance for cases of MERS.
When assessing patients with MERS-compatible symptoms, obtain an exposure history. This includes recent (within the last 14 days prior to illness onset) epidemiological links to:
- MERS affected areas
- close contact with a confirmed or probable case of MERS
- close contact with a traveller or resident with any acute respiratory illness returning from an affected area
Certain factors increase index of suspicion for MERS. For patients who have been in an affected area within 14 days of illness onset, factors include a history of:
- being in a health care facility as a patient, worker or visitor
- having contact with camels or camel products, such as:
- raw milk or meat, secretions or excretions (including urine)
Watch for any unusual patterns of severe acute respiratory infections or pneumonia.
Health professionals are asked to report cases following usual local, provincial or territorial processes.
Unusual severe acute respiratory illness clusters in community or health care facility settings (and involving health care workers) should be appropriately investigated. This investigation should occur under the direction of local, provincial or territorial authorities.
Access guidelines for detecting, tracking, testing for, analyzing, diagnosing and/or reporting MERS in Canada.
- National Surveillance Guidelines for Human Infection with Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
- Protocol for microbiological investigations of severe acute respiratory infections (SARI)
Review key markers to assist in identification of a MERS case.
Access a detailed form and instructions for reporting potential MERS cases.
Prevention and control
Health care facilities are reminded of the importance of ongoing adherence to strict infection prevention and control practices.
If a patient is suspected or confirmed to have MERS, health care facilities should take appropriate infection prevention and control measures. This is to decrease the risk of transmission of the virus to others.
Access infection prevention and control guidance for Canadian health care facilities and workers caring for patients with suspected or confirmed MERS.
- Infection Prevention and Control Guidance for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Acute Care Settings
Review guidance for public health authorities on containing and managing MERS. This guidance would be used when a case of MERS is suspected or confirmed in Canada.
There is currently no vaccine against the MERS coronavirus or specific treatment for MERS. Treatment is supportive and depends on the patient’s condition.
Access guidance about managing patients with severe acute respiratory infection, including MERS, in the intensive care unit setting.
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