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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+,



Endorsed %' CDNA@ 67 ;ul' 6435

Noted %' AHPPC@ 37 Au-ust 6435

Released %' Health@ ? Se&te(%er 6435



Middle East Respiratory SyndromeCoronavirus (MERS-CoV)

CDNA NATIONAL GUIDELINES FOR PUBLIC HEALTHUNITS

1. Summary

Public health priority

Ur-ent,

Ad$i)e should %e sou-ht0 *here a&&li)a%le0 fro( the rele$ant state or

territor' )entral )o((uni)a%le diseases a-en)' on the &ro)ess for

re&ortin- of sus&e)ted0 &ro%a%le and )on.r(ed 8ERS9Co: )ases, 8ERS9

Co: infe)tion is a nationall' noti.a%le disease,

Case manaement

Isolate sus&e)ted0 &ro%a%le and )on.r(ed )ases in a sin-le roo( *ith

ne-ati$e &ressure airhandlin- and an ensuite %athroo( if a$aila%le# and

use standard and trans(ission%ased &re)autions )onta)t and air%orne#,

Contact manaement

Close )onta)ts of &ro%a%le and )on.r(ed )ases are su%1e)t to so(e *or+

and tra$el restri)tions and should %e a)ti$el' (onitored for de$elo&(ent

of fe$er and res&irator' s'(&to(s in the 37 da's follo*in- the last

)onta)t0 *hile )asual )onta)ts are su%1e)t to self9(onitorin- onl',

!. "he disease

#n$ectious aents

The 8iddle East res&irator' s'ndro(e )orona$irus 8ERS9Co:#,

Corona$iruses are a lar-e and di$erse fa(il' of $iruses that in)lude

$iruses that are +no*n to )ause illness in hu(ans in)ludin- the )o((on

)old# and ani(als,

Reservoir

It is li+el' that the $irus has )o(e fro( an ani(al sour)e, 8ERS9Co: has

%een dete)ted in )a(els in se$eral 8iddle East )ountries *ith hu(an

)ases of 8ERS9Co: infe)tion, Additionall'0 serolo-i)al e$iden)e of )a(el

e/&osure to 8ERS9Co: or a )losel' related $irus has %een found in )a(els

o$er a *ide area of northern Afri)a and the 8iddle East, It is sus&e)ted0

%ut not )on.r(ed0 that infe)ted )a(els (a' %e the sour)e of the $irus for

so(e hu(an )ases, There are also li(ited re&orts of 8ERS9Co: %ein-dete)ted in %ats,



8ore infor(ation is needed to identif' the &ossi%le role that )a(els0 %ats0

and other ani(als (a' &la' in the trans(ission of 8ERS9Co:, 8ERS9Co: is

-eneti)all' distin)t fro( SARS9Co:0 and a&&ears to %eha$e dierentl'0

%ein- less trans(issi%le %ut *ith a hi-her (ortalit' rate, Ho*e$er0 the full

s&e)tru( of illness re(ains un)lear,

Mode o$ transmission

The (ode or (odes of trans(ission of 8ERS9Co: are not full' +no*n,

There ha$e %een so(e )ases *ith a stron- histor' of e/&osure to )a(els

or )a(el &rodu)ts e,-, (il+#0 in)ludin- at least one )luster *here the

)a(els also tested &ositi$e, Ho*e$er0 there ha$e %een (an' s&oradi)

)ases *ith no histor' of &rior e/&osure to )a(els or other ani(als,

There ha$e %een (ulti&le )lusters of )ases in *hi)h hu(an9to9hu(an

trans(ission has o))urred, These )lusters ha$e %een o%ser$ed in health9

)are fa)ilities0 a(on- fa(il' (e(%ers and %et*een )o9*or+ers, Ho*e$er0

the (e)hanis( %' *hi)h trans(ission o))urred in these instan)es0

*hether res&irator' e,-, )ou-hin-0 sneein-# or dire)t &h'si)al )onta)t

*ith the &atient or $ia fo(ites after )onta(ination of the en$iron(ent %'

the &atient0 is un+no*n,

Infe)tion )ontrol re)o((endations for (ana-in- sus&e)ted0 &ro%a%le and

)on.r(ed )ases are )onsistent *ith those re)o((ended for SARS9Co:

and &ande(i) inuena, As further infor(ation %e)o(es a$aila%le0 thesere)o((endations *ill %e re9e$aluated and u&dated as needed,

#ncubation period

Fro( 6 to 37 da's= (ost )o((onl' 5 da's,

#n$ectious period

The duration of infe)ti$it' for 8ERS9Co: infe)tion is un+no*n, Standard

&re)autions should %e a&&lied throu-hout an' ad(ission= additional

isolation &re)autions should %e )ontinued until at least 67 hours after the

resolution of s'(&to(s,

Gi$en that little infor(ation is )urrentl' a$aila%le on $iral sheddin- and the

&otential for trans(ission of 8ERS9Co:0 testin- to dete)t the $irus (a' %e

ne)essar' to infor( de)ision9(a+in- on infe)tiousness, Patient infor(ation

e,-, a-e0 i((une status and (edi)ation# should also %e )onsidered,

Clinical presentation and outcome

Clini)al &resentation ran-es fro( as'(&to(ati) to se$ere &neu(onia *ith

a)ute res&irator' distress s'ndro(e and (ulti9or-an failure, Nearl' all



s'(&to(ati) &atients ha$e &resented *ith fe$er, Res&irator' s'(&to(s

are )o((on and -astrointestinal s'(&to(s are less )o((onl' re&orted,

T'&i)all'0 the disease starts *ith fe$er and )ou-h, Other )o((on

s'(&to(s are ('al-ia and )hills, Sore throat0 arthral-ia0 d's&noea0

nausea0 $o(itin- and diarrhoea are less )o((onl' &resent, In the 6435

South >orean out%rea+ &neu(onia *as &resent in a (inorit' of &atients at

initial &resentation0 %ut it is un)lear *hether earl' testin- of )onta)ts *ith0

at the ti(e0 (ilder )lini)al (anifestations of 8ERS9Co: infe)tion (a' ha$e

inuen)ed the re&orted s&e)tru( of illness,

Patients *ho de$elo& &neu(onia or &neu(onitis often re2uire (e)hani)al

$entilation and other or-an su&&ort, The )ase fatalit' rate for )on.r(ed

)ases is esti(ated at 4974 &er)ent0 %ut this (a' de)rease *hen the

s&e)tru( of disease is %etter understood0 as su--ested %' lo*er )ase

fatalit' o%ser$ed in the South >orean out%rea+,

Persons at increased ris% o$ disease

The a-e distri%ution of re&orted )ases is s+e*ed hea$il' to the (iddle9

a-ed and elderl', Cases *ho are elderl'0 i((uno)o(&ro(ised or *ith )o9

(or%idities ha$e an in)reased )ase fatalit' rate3,

&isease occurrence and public health sini'cance

As of ;une 6435 there ha$e %een no )on.r(ed 8ERS9Co: )ases re&orted

in Australia,

Countries that ha$e re&orted )ases in the 8iddle East in)lude Iran0 ;ordan0

>u*ait0 Le%anon0 O(an0 atar0 Saudi Ara%ia >SA#0 United Ara% E(irates

UAE# and e(en0 *ith Saudi Ara%ia and UAE %ein- (ost ae)ted,

Persons *ho a)2uired 8ERS9Co: in 8iddle Eastern )ountries ha$e

e/&orted the infe)tion to (an' other )ountries0 *hi)h has resulted in

health fa)ilit' out%rea+s in Fran)e0 the United >in-do(0 and (ost nota%l'

South >orea, For a full list of )ountries *here 8ERS9Co: )ases ha$e %een

dete)ted see the <orld Health Or-aniation <HO# )orona$irus infe)tion*e%site 3,

<HO e/&e)ts that additional )ases of 8ERS9Co: infe)tion *ill %e re&orted

fro( the 8iddle East0 and that it is li+el' that )ases *ill )ontinue to %e

e/&orted to other )ountries %' tourists0 tra$ellers0 -uest *or+ers or

&il-ri(s *ho (i-ht a)2uire infe)tion follo*in- e/&osure to hu(an )ases

&ossi%l' in a health )are settin-#0 or &ossi%l' fro( )a(els or other

un+no*n ani(al sour)es for e/a(&le0 *hile $isitin- far(s or (ar+ets#,

Until (ore is understood a%out the (ode of trans(ission and ris+ fa)torsfor infe)tion0 it is e/&e)ted that s&oradi) )ases *ill )ontinue to o))ur0 *ith



&otential for li(ited trans(ission *ithin households and health)are

settin-s,

. Routine prevention activities

It is re)o((ended that &eo&le *ith si-ni.)ant (edi)al )onditions su)h asdia%etes0 renal disease and )hroni) lun- disease *ho are intendin- to

tra$el to the 8iddle East J in)ludin- those underta+in- the Ha11 or U(rah 9

)onsult a do)tor &rior to tra$el,

Peo&le tra$ellin- in )ountries ae)ted %' 8ERS9Co: should (aintain -ood

h'-iene &ra)ti)es0 a$oid )onta)t *ith ani(als0 es&e)iall' )a(els0 and

refrain fro( )onsu(in- un&asteurised (il+ or under)oo+ed (eat,

Tra$ellers to the 8iddle East and tra$el or-anisations should %e ad$ised of

-eneral tra$el health &re)autions *hi)h *ill lo*er the ris+ of infe)tion in-eneral0 in)ludin- res&irator' $iruses and tra$eller"s diarrhoea, S&e)i.)

e(&hasis should %e &la)ed on@

• hand h'-iene and res&irator' h'-iene

• adherin- to -ood food9safet' &ra)ti)es0

• (aintainin- -ood &ersonal h'-iene,

Tra$el ad$i)e for Australians is a$aila%le at the Australian De&art(ent of

Health 8ERS9Co: *e% &a-e 6, Tra$ellers should )he)+ if there are an'

tra$el restri)tions in &la)e &rior to tra$el,

. Surveillance ob*ectives

• To ra&idl' identif'0 isolate and treat )ases0 and &re$ent trans(issionto their )onta)ts

• To identif' and &ro$ide infor(ation to )onta)ts and ensure that the'are isolated ra&idl' should s'(&to(s o))ur

• To des)ri%e the e&ide(iolo-' of 8ERS9Co: infe)tion in Australia0in)ludin- identif'in- ris+ fa)tors for trans(ission,

+. &ata manaementPro%a%le and )on.r(ed )ases of 8ERS9Co: infe)tion should %e entered

onto the noti.a%le diseases data%ase *ithin one *or+in- da' of

noti.)ationKre&ort, Data for sus&e)ted )ases should %e (aintained

a))ordin- to 1urisdi)tional &roto)ols,

,. Communications

<here a&&li)a%le0 &u%li) health units should i((ediatel' notif' the )entral

stateKterritor' )o((uni)a%le diseases a-en)' of sus&e)ted0 &ro%a%le and

)on.r(ed )ases on)e noti.)ationsKre&orts are re)ei$ed, Pro$ide the )ase"s



a-e0 se/0 &la)e of residen)e0 indi-enous status0 date of onset0 tra$el

histor'0 la%orator' results0 )lini)al status0 li+el' &la)e of a)2uisition0 and

follo*9u& a)tion ta+en,

StateKterritor' )o((uni)a%le disease a-en)ies should i((ediatel' notif'

&ro%a%le and )on.r(ed 8ERS9Co: )ases to the National In)ident Roo(,

. Case de'nition

The )riteria for a sus&e)ted )ase of 8ERS9Co: are to %e used to dire)t

testin- and initial infe)tion )ontrol and &u%li) health a)tions, Sus&e)ted

)ases *ill ulti(atel' %e re)lassi.ed as either ha$in- a dia-nosis of 8ERS9

Co: e/)luded0 or (eetin- the )riteria for a &ro%a%le or )on.r(ed )ase,

The )riteria for &ro%a%le and )on.r(ed )ases of 8ERS9Co: de.ne those

)ases that are to %e re&orted to the National Noti.a%le Diseases

Sur$eillan)e S'ste(,

Suspected case1

>no*led-e and understandin- of 8ERS9Co: infe)tion )ontinues to e/&and,

The follo*in- )riteria are %ased on )ase series re&orted fro( re)ent

out%rea+s and re&resent )o(%inations of s'(&to(s and e&ide(iolo-i)al

)riteria in *hi)h 8ERS9Co: testin- is stron-l' re)o((ended,

Atypical presentations occur, and clinical and public health judgement

should also be used to determine the need for testing in patients who do

not meet the criteria below.

Testin- and initial infe)tion )ontrol and &u%li) health a)tions for 8ERS9Co:

should %e underta+en for &ersons *ith@

A, Fe$er AND &neu(onia or &neu(onitis or a)ute res&irator' distress

s'ndro(e ARDS# AND

o histor' of tra$el fro( or residen)e in ae)ted )ountries in the

8iddle East6 *ithin 37 da's %efore s'(&to( onset0 OR

o )onta)t *ithin the in)u%ation &eriod of 37 da's# *ith a

s'(&to(ati) tra$eller *ho de$elo&ed fe$er and a)ute

res&irator' illness of un+no*n aetiolo-' *ithin 37 da's after

tra$ellin- fro( ae)ted )ountries in the 8iddle East0 OR

o )onta)t *ithin the in)u%ation &eriod of 37 da's# *ith a

s'(&to(ati) tra$eller *ho de$elo&ed fe$er and a)ute

res&irator' illness of un+no*n aetiolo-' *ithin 37 da's after

1 Che)+ for u&dates on the Australian De&art(ent of Health 8ERS9Co:

*e%site htt&@KK***,health,-o$,auKinternetK(ainK&u%lishin-,nsfKContentKoh&9(ers9)o$,ht(#,

http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-mers-cov.htm










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#,



Con'rmed case

• 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

la%oratories )an &ro$ide 8ERS9Co: testin-= a&&ro&riate s&e)i(en t'&e0

)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



also useful to esti(ate se)ondar' infe)tion rates in as'(&to(ati) )ases

follo*in- e/&osure to 8ERS9Co:,

See A&&endi/ for additional 8ERS9Co: la%orator' testin- infor(ation,

0. Case manaement

Response times

On the sa(e da' as noti.)ation of a sus&e)ted0 &ro%a%le or )on.r(ed

)ase0 %e-in follo* u& in$esti-ation and0 *here a&&li)a%le0 notif' 'our

)entral state or territor' )o((uni)a%le diseases a-en)',

Response procedure

Case investigation

The res&onse to a noti.)ation *ill nor(all' %e )arried out in )olla%oration*ith the )lini)ians (ana-in- the )ase0 and %e -uided %' the 8ERS9Co:

&u%li) health unit )he)+list A&&endi/ 6# and the 8ERS9Co: In$esti-ation

For( A&&endi/ 7#,

Reardless o$ ho does the $ollo-up2 P34 sta5should ensure that action has been ta%en 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 thattests %e done

• See+ the treatin- do)torMs &er(ission to )onta)t the )ase orrele$ant )are9-i$er

• Deter(ine if the dia-nosis has %een dis)ussed *ith the )ase orrele$ant )are9-i$er %efore %e-innin- the inter$ie*

• Re$ie* )ase and )onta)t (ana-e(ent

• Ensure a&&ro&riate infe)tion )ontrol -uidelines are follo*ed in)arin- for the )ase

• Identif' the li+el' sour)e of infe)tion,

Note@ If inter$ie*s *ith sus&e)ted )ases are )ondu)ted fa)e9to9fa)e0 the

&erson )ondu)tin- the inter$ie* (ust ha$e a thorou-h understandin- of

infe)tion )ontrol &ra)ti)es and %e )o(&etent in usin- a&&ro&riate PPE,

<here$er &ossi%le0 )ases should %e (ana-ed in hos&ital, If )lini)all'

indi)ated0 )ases (a' %e (ana-ed at ho(e onl' if it )an %e ensured that

the )ase and household )onta)ts are )ounselled a%out ris+ and that

a&&ro&riate infe)tion )ontrol (easures are in &la)e,

Case treatment

In the a%sen)e of &atho-en9s&e)i.) inter$entions0 &atient (ana-e(ent

lar-el' de&ends on su&&orti$e treat(ent0 and $i-ilan)e for and treat(entof )o(&li)ations,



Further ad$i)e on )lini)al (ana-e(ent is a$aila%le fro( <HO 7,

EducationPro$ide 8ERS9Co: Fa)t Sheets A&&endi/ 3# to )ases and their )lose

)onta)ts, Ensure that the' are a*are of the si-ns and s'(&to(s of 8ERS9

Co:0 the re2uire(ents of isolation0 )onta)t details of the PHU and theinfe)tion )ontrol &ra)ti)es that )an &re$ent the trans(ission of 8ERS9Co:,

#solation and restriction

Cases (ust %e isolated in an a&&ro&riate health fa)ilit'0 unless alternati$e

arran-e(ents are re)o((ended on e/&ert ad$i)e, Health)are *or+ers

and others *ho )o(e into )onta)t *ith sus&e)ted0 &ro%a%le and )on.r(ed

)ases (ust %e &rote)ted a))ordin- to re)o((ended infe)tion )ontrol

-uidelines, :isitors should %e restri)ted to )lose fa(il' (e(%ers,

A ris+ assess(ent should %e underta+en for sus&e)ted )ases *ho initiall'

test ne-ati$e for 8ERS9Co:, If there is no alternati$e dia-nosis and a hi-h

inde/ of sus&i)ion re(ains that su)h )ases (a' ha$e 8ERS9Co: infe)tion0

)onsider )ontinued isolation and use of the re)o((ended infe)tion )ontrol

&re)autions0 &endin- further testin- see La%orator' testin- se)tion and

A&&endi/ # and re9assess(ent,

Gi$en the se$erit' of re&orted infe)tions0 the e$iden)e of li(ited &erson9

to9&erson trans(ission0 and -a&s in +no*led-e of trans(ission &ath*a's0

the re)o((endations on isolation and PPE for (ana-e(ent of sus&e)ted0

&ro%a%le and )on.r(ed )ases ta+e a deli%eratel' )autious a&&roa)h,

Infe)tion )ontrol (easures should %e those a&&li)a%le to )ontrol the

trans(ission of &atho-ens that )an %e s&read %' the air%orne route, These

(easures are detailed in the Interim infection prevention and control

advice for acute care hospitals relating to suspected Middle Eastern

respiratory syndrome coronavirus (MER!"o#$ infections0

htt&@KK***,health,-o$,auK(ers9)orona$irus# ,

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,

http://www.health.gov.au/mers-coronavirus











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



the )re* (e(%er *as *or+in- durin- the i-ht and all of the other(e(%ers of the )re*,

<here resour)es &er(it0 (ore a)ti$e )onta)t tra)in- (a' %e e/tended to

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 ,

http://apps.who.int/iris/bitstream/10665/180973/1/WHO_MERS_IPC_15.2_eng.pdf?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



8ERS9Co:0 and an' tra$el *ithin Australia durin- this &eriod should %e

su%1e)t to dis)ussion *ith &u%li) health authorities,

Close )onta)ts should %e e/)luded fro( s)hools and sensiti$e o))u&ations

or settin-s su)h as health )are0 a-ed )are0 or )hild )are durin- the 37 da's

after last un&rote)ted )onta)t *ith a )ase,

Casual contactsCasual )onta)ts should (onitor their health for 37 da's and re&ort an'

s'(&to(s i((ediatel' to the lo)al &u%li) health unit, There are no

restri)tions on (o$e(ents= ho*e$er )asual )onta)ts should %e ad$ised to

)onta)t the &u%li) health unit if the' de$elo& s'(&to(s,

Healthcare worker close contactsHealth)are *or+er )lose )onta)ts i,e, &ersons e/&osed *hile un&rote)ted0

as des)ri%ed in the Conta)t de.nition se)tion# should not underta+e *or+in a health)are settin- for 37 da's follo*in- the last &ossi%le )onta)t *ith

the )ase, Ho(e 2uarantine is not routinel' re)o((ended durin- this

&eriod if these indi$iduals re(ain as'(&to(ati)0 %ut so(e restri)tions

(a' %e re)o((ended %ased on a ris+ assess(ent of the &arti)ular

)ir)u(stan)es,

De&endin- on arran-e(ents in the 1urisdi)tion0 &u%li) health units (a'

assist infe)tion )ontrol units of health fa)ilities to identif' and (onitor

health)are *or+er )lose )onta)ts,

It is re)o-nised that )lini)al *or+ restri)tions on health)are *or+er )lose

)onta)ts (a' &la)e strain on indi$iduals and on health ser$i)es, This

underlines the i(&ortan)e of ensurin- health)are *or+ers i(&le(ent

a&&ro&riate infe)tion )ontrol &re)autions *hen assessin- and (ana-in-

sus&e)ted0 &ro%a%le and )on.r(ed 8ERS9Co: )ases,

These re)o((endations are %ased on re&orts fro( lar-e health fa)ilit'9

%ased 8ERS9Co: out%rea+s in the 8iddle East and South >orea *hi)h ha$e

in$ol$ed noso)o(ial trans(ission of 8ERS9Co: to %oth &atients and

health)are *or+ers, CDNA *ill )ontinue to (onitor the e(er-in- e$iden)earound 8ERS9Co: trans(ission ris+s in health)are settin-s and re$ise

these re)o((endations as needed,

Management o symptomatic contactsIf fe$er0 res&irator' s'(&to(s0 or other s'(&to(s )onsistent *ith 8ERS9

Co: infe)tion de$elo& *ithin the .rst 37 da's follo*in- the last )onta)t0

the indi$idual should %e i((ediatel' isolated and (ana-ed as &er the

)urrent re)o((endations for sus&e)ted 8ERS9Co: )ases0 *ith ur-ent

testin- for 8ERS9Co: infe)tion underta+en in an en$iron(ent *hi)h

(ini(ises the ris+ of e/&osure to others,



Ill )onta)ts *ho are %ein- e$aluated for 8ERS9Co: infe)tion )an %e

a&&ro&riatel' isolated and (ana-ed at ho(e0 unless their )ondition is

se$ere enou-h to re2uire hos&italisation,

S'(&to(ati) )onta)ts *ho test ne-ati$e for 8ERS9Co: %' PCR *ill still

need to %e (onitored for 37 da's after their last )onta)t *ith a &ro%a%le or

)on.r(ed 8ERS9Co: )ase and (a' re2uire re9testin-, There ha$e %een a

nu(%er of re&orts of 8ERS9Co: )ases *ho initiall' tested ne-ati$e for

8ERS9Co: %' PCR,

1!. Special situations

:utbrea%s in healthcare $acilities

If one or (ore &ro%a%le or )on.r(ed 8ERS9Co: )ases are identi.ed in a

health)are fa)ilit'0 an out%rea+ (ana-e(ent tea( should %e )on$ened0in)ludin- a senior fa)ilit' (ana-er0 an infe)tion )ontrol &ra)titioner and

a&&ro&riate )lini)al sta0 in )onsultation *ith PHU sta as re2uired, Control

(easures (a' in)lude@

• a)ti$e )ase .ndin-0 assess(ent and )are

• isolation andKor )ohortin-

• *or+ restri)tion for health)are *or+ers *ho ha$e had )lose )onta)ti,e, un&rote)ted e/&osure# *ith a )on.r(ed or &ro%a%le )ase

• distri%ution of fa)t sheets and other infor(ation

• e&ide(iolo-i)al studies to deter(ine ris+s for infe)tion,

:utbrea%s in residential care $acilities or otherresidential institutions (e.. prisons or boardinschools)

There ha$e %een fe* if an' re&orts of 8ERS9Co: out%rea+s in institutions

other than in health)are fa)ilities0 and trans(ission *ithin households

a&&ears to %e un)o((on, Ne$ertheless0 it is assu(ed that fello*

residents in an institution *ill %e at -reater ris+ of infe)tion if there has

%een a )on.r(ed )ase li$in- at the institution *hile infe)tious,

If one or (ore &ro%a%le or )on.r(ed 8ERS9Co: )ases are identi.ed in a

residential )are fa)ilit' or institution0 an out%rea+ (ana-e(ent tea(

should %e )on$ened0 in )onsultation *ith PHU sta,

1. Re$erences and additional sources o$in$ormation

Re$erences6



;dditional resources6

<HO FAs on 8ERS9Co:@

htt&@KK***,*ho,intK)srKdiseaseK)orona$irusinfe)tionsKfa2KenK #

<HO 8ERS9Co: su((ar' and literature u&dates@

htt&@KK***,*ho,intK)srKdiseaseK)orona$irusinfe)tionsKar)hi$eu&datesKenK #

<HO U&date on 8ERS Co: trans(ission fro( ani(als to hu(ans0 and interi(

re)o((endations for at ris+ -rou&s 3 ;une 6437#@

htt&@KK***,*ho,intK)srKdiseaseK)orona$irusinfe)tionsK8ERSCo:RA643743,&df #

<HO u&dated tra$el ad$i)e on 8ERS9Co: for Pil-ri(a-es ;une 6437#@

htt&@KK***,*ho,intKithKu&datesK643744KenK #

US CDC 8iddle East res&irator' s'ndro(e *e%site@ htt&@KK***,)d),-o$K)orona$irusK(ersKinde/,ht(l #

ECDC Corona$irus *e%site htt&@KKe)d),euro&a,euKenKhealthto&i)sK)orona$irus9

infe)tionsKPa-esKinde/,as&/#

Pu%li) Health En-land 8iddle East res&irator' s'ndro(e )orona$irus *e%site@

htt&@KK***,h&a,or-,u+KTo&i)sKInfe)tiousDiseasesKInfe)tionsAK8ERSCo:K #

1. ;ppendices

3, 8ERS9Co: Fa)tsheet6, 8ERS9Co: PHU )he)+list, 8ERS9Co: la%orator' testin- infor(ation

7, 8ERS9Co: )ase in$esti-ation for(

1+. <urisdiction speci'c issues

Lin+s to Australian state and territor' &u%li) health le-islation0 and the Co((on*ealth

uarantine A)t and a(end(ents are a$aila%le at@

htt&@KK***,health,-o$,auKinternetK(ainK&u%lishin-,nsfKContentK)da9state9le-islation9lin+s,ht(

http://www.who.int/csr/disease/coronavirus_infections/faq/en/


http://www.who.int/csr/disease/coronavirus_infections/archive_updates/en/


http://www.who.int/csr/disease/coronavirus_infections/MERS_CoV_RA_20140613.pdf



http://www.who.int/ith/updates/20140603/en/


http://www.cdc.gov/coronavirus/mers/index.htmlhttp:/www.cdc.gov/coronavirus/ncv/

http://www.cdc.gov/coronavirus/mers/index.html

http://ecdc.europa.eu/en/healthtopics/coronavirus-infections/Pages/index.aspx



http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/MERSCoV/












http://www.cdc.gov/coronavirus/mers/index.html








;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,



The ori-inal sour)e of the $irus is li+el' to %e ani(als and 8ERS9Co: has %een found in

)a(els in so(e 8iddle Eastern )ountries *here )ases are o))urrin-, Si(ilar $iruses

ha$e also %een re&orted in %ats, Ho*e$er0 )onta)t *ith )a(els and other ani(als does

not a&&ear to e/&lain (ost of the hu(an )ases that are o))urrin-, 8ore infor(ation is

needed to deter(ine the roles that )a(els0 %ats and other ani(als (a' &la' in the

s&read of 8ERS9Co:,

>ho is at ris%?

Peo&le *ho are li$in- in or tra$ellin- to ae)ted areas of the 8iddle East or *ho ha$e

had )onta)t *ith other )ases (a' %e at ris+ of )at)hin- the disease, Peo&le *ith

underl'in- illnesses that (a+e the( (ore $ulnera%le to res&irator' disease0 in)ludin-

those *ith dia%etes0 )hroni) lun- disease0 &re9e/istin- +idne' disease0 or those *ho

ha$e su&&ressed i((une s'ste(s0 (a' %e at a hi-her ris+,

3o is it prevented? There is no $a))ine to &re$ent 8ERS9Co: infe)tion, Peo&le *ho are tra$ellin- to

ae)ted )ountries should &ra)ti)e nor(al h'-iene (easures, <ash 'our hands often0

and use a hand sanitiser if soa& and *ater is not a$aila%le,

It is )urrentl' re)o((ended to (ini(ise )onta)t *ith ani(als in ae)ted )ountries,

<hen $isitin- a far( -ood h'-iene (easures should %e &ra)tised0 su)h as re-ular

hand *ashin- %efore and after tou)hin- ani(als0 a$oidin- )onta)t *ith si)+ ani(als0

and follo*in- -ood food h'-iene &ra)ti)es0 in)ludin- a$oidin- drin+in- ra* (il+0 )a(el

urine or eatin- food that (a' %e )onta(inated *ith ani(al &rodu)ts unless the food is

&ro&erl' *ashed0 &eeled0 or )oo+ed,

Peo&le at hi-h ris+ of se$ere disease due to 8ERS9Co: should )onsider ta+in-

additional &re)autions *hile tra$ellin- in the 8iddle East0 su)h as a$oidin- $isitin-

far(s or (ar+et en$iron(ents *here )a(els are &resent,

>hat should # do i$ # become unell a$ter travel in theMiddle East?

If 'ou %e)o(e ill or feel un*ell *hile tra$ellin- in the 8iddle East0 'ou should not *ait

until 'ou arri$e %a)+ in Australia to see+ (edi)al assistan)e, Instead 'ou should see ado)tor or -o to the lo)al e(er-en)' de&art(ent,

If 'ou ha$e returned fro( tra$el to the 8iddle East *ithin the last fourteen da's and

de$elo& a fe$er0 )ou-h and other s'(&to(s0 'ou should see 'our do)tor or -o to the

e(er-en)' de&art(ent to *or+ out *h' 'ou are ill, It is i(&ortant that 'ou (ention

'our s'(&to(s and *hi)h )ountries 'ou ha$e $isited in the 8iddle East *hen 'ou .rst

arri$e at the (edi)al &ra)ti)e or hos&ital e(er-en)' de&art(ent,

ou (a' %e as+ed or re2uired to *ear a (as+ and %e se&arated fro( others to &re$ent

further s&read of infe)tion,



3o is it dianosed?

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 #

http://www.who.int/csr/disease/coronavirus_infections/en/






http://www.cdc.gov/coronavirus/mers/

http://www.smartraveller.gov.au/








http://www.cdc.gov/coronavirus/mers/





;ppendi8 !6 P34 MERS-CoV chec%list

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.



;ppendi8 6 MERS-CoV /aboratory testin in$ormation

Samples suitable $or testin

Respiratory samples !pper respiratory tract3, Naso&har'n-eal s*a% andKor oro&har'n-eal s*a%

• naso&har'n-eal@ insert a s*a% into ea)h nostril &arallel to the &alate0 lea$e thes*a% in &la)e for a fe* se)onds to a%sor% se)retions

• oro&har'n-eal@ s*a% the tonsilar %eds0 a$oidin- the ton-ue

• &la)e s*a%s %a)+ into the a))o(&an'in- trans&ort (edia

6, Nasal *ashKas&irates

• )olle)t 69 (L into a sterile0 lea+9&roof0 s)re*9to& dr' sterile )ontainer

Respiratory samples " Lower respiratory tract

3, Bron)hoal$eolar la$a-e0 tra)heal as&irate0 &leural uid

• )olle)t 69 (L into a sterile0 lea+9&roof0 s)re*9to& s&utu( )olle)tion )u& or dr'sterile )ontainer

6, S&utu(

• &atient should rinse hisKher (outh *ith *ater %efore )olle)tion

• e/&e)torate dee& )ou-h s&utu( dire)tl' into a sterile0 lea+9&roof0 s)re*9to& dr'sterile )ontainer

There is no* in)reasin- e$iden)e that lo*er res&irator' tra)t s&e)i(ens )ontain the

hi-hest $iral loads0 therefore0 lo*er res&irator' tra)t s&e)i(ens should %e )olle)ted

*here &ossi%le, Re&eat testin- es&e)iall' of lo*er res&irator' tra)t s&e)i(ens# in

)o(&ati%le )ases should %e &erfor(ed if initial results are ne-ati$e,

Seroloy

Seru( should %e )olle)ted durin- the a)ute &hase of the illness &refera%l' *ithin the

.rst ? da's of s'(&to( onset#0 stored0 and tested in &arallel *ith a )on$ales)ent

seru( )olle)ted or (ore *ee+s after a)ute sa(&le )olle)tion, If no a)ute sa(&le *as

)olle)ted0 a sin-le seru( sa(&le )olle)ted 37 or (ore da's after s'(&to( onset (a'

%e tested,

I((unouores)en)e and neutraliation serolo-' tests are used, Si(ilar to NAT0 a t*o

sta-e a&&roa)h usin- a s)reenin- follo*ed %' a )on.r(ator' test )an %e e(&lo'ed,

For s)reenin- &ur&oses0 an en'(e9i((unosor%ent assa' ELISA# a-ainst

re)o(%inant N &rotein )an %e used0 follo*ed %' )on.r(ator' testin- usin- a *hole

$irus indire)t uores)ent anti%od' IFA# test or (i)roneutraliation, Gi$en that all

serolo-i)al tests de$elo&ed so far ha$e onl' %een $alidated a-ainst a s(all nu(%er of

)on$ales)ent sera fro( 8ERS9Co: )ases0 &ositi$e serolo-i)al test results in the



a%sen)e of nu)lei) a)id testin- NAT# or se2uen)in- are )onsidered &ro%a%le )ases

onl',

Stool

6 J 5 -ra(s of stool for(ed or li2uid# is )olle)ted in a sterile0 lea+9&roof0 s)re*9to& dr'sterile )ontainer,

3andlin o$ specimens in the laboratory

La%orator' sta should handle s&e)i(ens under PC6 )onditions in a))ordan)e *ith

ASKNS 667,@6434 Safet' in La%oratories Part @ 8i)ro%iolo-i)al Safet' and

Contain(ent, S&e)i(ens should %e trans&orted in a))ordan)e *ith )urrent re-ulator'

re2uire(ents,

MERS-CoV testin

NAT usin- re$erse9trans)ri&tase &ol'(erase )hain rea)tion RT9PCR# is the (ethod of

)hoi)e for dete)tion of 8ERS9Co:, Currentl'0 four tar-ets are used for testin-@9

• u&strea( re-ion of the E &rotein u&E# -ene

• o&en readin- fra(es ORF# 3a ORF3a#

• ORF3%

• 8ERS9Co: s&e)i.) nu)leo)a&sid N# &rotein -ene

An al-orith( usin- a s)reenin- assa'0 follo*ed %' )on.r(ator' testin- is

re)o((ended, For s)reenin- &ur&oses0 assa's tar-etin- the u&E -ene area&&ro&riate, Con.r(ator' testin- )an %e &erfor(ed usin- an assa' tar-etin- the

ORF3a )o(&ara%le sensiti$it' to u&E -ene#0 ORF3% *hi)h is less sensiti$e than

ORF3a or u&E# or N -ene, It is re)o((ended that &ositi$e s)reenin- tests %e re&orted

to )o((uni)a%le diseases a-en)ies *hilst a*aitin- )on.r(ator' testin-,

<here a$aila%le0 RdR& -ene for the %road dete)tion of β9)orona$irus )lade C# andKor

N -ene se2uen)in- (a' also %e )onsidered for 8ERS9Co: )on.r(ation, As the &ri(ers

for the RdR& se2uen)in- assa' is hi-hl' )onser$ed0 it is not re)o((ended that this

assa' %e used alone for 8ERS9Co: )on.r(ation0 as false &ositi$e results (a' o))ur

fro( )ross9rea)tions *ith other β9)orona$iruses, Further infor(ation a%out la%orator'testin- is a$aila%le at@

• Institute of :irolo-'0 Bonn htt&@KK***,$irolo-'9%onn,deKinde/,&h&VidW74 #

• The US Food and Dru- Ad(inistration htt&@KK***,fda,-o$Kdo*nloadsK8edi)alDe$i)esKSafet'KE(er-en)'SituationsKUC8555?6,&df #,

Testin- al-orith(s (a' also need to %e re$ised &endin- further infor(ation a%out the

$irus0 and the nu(%er of s&e)i(ens re)ei$ed in the la%orator' for testin-,

http://www.virology-bonn.de/index.php?id=40


http://www.fda.gov/downloads/MedicalDevices/Safety/EmergencySituations/UCM355572.pdf










:iral )ulture is -enerall' not &erfor(ed for routine dia-nosis0 and should onl' %e

atte(&ted in la%oratories *ith a&&ro&riate e/&erien)e and )ontain(ent fa)ilities,

8ERS9Co: re&li)ation has %een &re$iousl' o%ser$ed on :ero and LLC98>6 )ells *ithin

5 da's of ino)ulation



;ppendi8 6 MERS-CoV Case #nvestiation =orm

%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&)

2 >ase status € >onfir"ed € =roale € $usected € Ecluded

otification date) : :

ecei/ed date) : :

otifier)

3 =atient contactdetails

Ca"il na"e)

Di/en na"es)

esidential address)

=hone nu"er %ho"e&)

=hone nu"er %wor&)

=hone nu"er %"oile&)

4 Address te € ousehold € A-edBcare facilit € Educational Institution € Assisted

€ Militar arracs € =rison € !ther

€ 'nnown

If !ther, lease secif)

5 Dender € Male € Ce"ale € 'nnown

6 *ate of irth *ate of irth) : : %dd:"":&

7 >ountr ofirth

>ountr of irth)



If not orn in Australia, date of first arri/al in Australia) : : %dd:"":&

Note: if only year known, enter 01/01/[year]

8 Indi-enous

$tatuso Aori-inal ori-in

o Forres $trait Islander ori-in

o oth Aori-inal and Forres $trait Islander ori-in

o ot Aori-inal and Forres $trait Islander ori-in

o ot $tated : 'nnown

9 !nset date offirst s"to"s *id the erson ha/e s"to"s? € (es € o € 'nnown

B If (es, onset date) : : %dd:"":&

B *uration of s"to"s) %das&

10 $"to"s andclinical notes

Acute resirator distress sndro"e € (es € o € 'nnown

Arthral-ia € (es € o € 'nnown

>onGuncti/itis € (es € o € 'nnown

>ou-h € (es € o € 'nnown

*iarrhoea € (es € o € 'nnown

Cati-ue € (es € o € 'nnown

Ce/er € (es € o € 'nnown

B i-hest te"erature) %9>elsius&

B Ce/er onset date) : : %dd:"":&

B Ce/erish selfBreort? € (es € o € 'nnown

>hills or ri-ors € (es € o € 'nnown

eadache € (es € o € 'nnown

Malaise € (es € o € 'nnown

Mal-ia € (es € o € 'nnown



ausea € (es € o € 'nnown

=neu"onia € (es € o € 'nnown

=neu"onitis € (es € o € 'nnown

hinorrhoea € (es € o € 'nnown

$hortness of reath € (es € o € 'nnown

$ore throat € (es € o € 'nnown

Ho"itin- € (es € o € 'nnown

!ther s"to"s € (es € o € 'nnown

B If (es, secif s"to"s)

>linical notes)

11 ositalisationand treat"entdetails

+as the erson hositalised? € (es € o € 'nnown

B a"e of hosital)

B osital hone nu"er)

B *ate ad"itted) : : %dd:"":&

B *ate dischar-ed) : : %dd:"":&

Ad"itted to I>':*'? € (es € o € 'nnown

B u"er of das in I>':*') %das&

!-en thera reuired? € (es € o € 'nnown

Intuation reuired? € (es € o € 'nnown

Mechanical /entilation reuired? € (es € o € 'nnown

osital "edical record:chart nu"er)



12 Ad"ittin-doctor details Is ad"ittin- doctor sa"e as treatin- doctor? € (es € o € 'nnown

B If (es, enter details in the Freatin- *octor section elow;

B If o, record Ad"ittin- *octors na"e)

B =hone nu"er : a-er

13 !utco"e ofillness +hat was the outco"e of the case? € Ali/e € *ied

B If *ied, date of death) : : %dd:"":&

B >ause of death due to ME$B>oH infection? € (es € o € 'nnown

B If death due to other cause, secif)

14 !ccuation%durin- eriod

of interest&

*urin- the eriod of interest, did the erson wor in an of the followin- hi-h risoccuations %settin-s&?

€ ealthcare € A-edBcare facilit € Educational facilit

€ Assisted Li/in- € Militar institution € >orrectional facilit

€ o hi-h ris occuation € !ther € 'nnown

B If !ther, secif)

B If o hi-h ris occuation $i to net uestion

*ate last attended this wor) : : %dd:"":&

+as the infection acuired in the worlace? € (es € o € 'nnown

*escrition of occuation)

E"loer:facilit na"e

E"loer:facilit street address

E"loer:facilit suur: town

E"loer:facilit state

E"loer:facilit ostcode

E"loer:facilit hone nu"er

E"loer:facilit fa nu"er

>ontact na"e

>ontact e"ail address

15 >ontact with a *id the case ha/e contact with a nown or ossile ME$B>oH case?



nown orossile case%durin- eriodof interest&

€ (es € o € 'nnown

B If (es, secif)

*ate of last contact) : : %dd:"":&

16 Freatin-*octor details

Enter the Treating Dotor!s detai"s#a"e)=ractice na"e %if an&)$treet address)$uur : town) $tate) =ostcode)=hone nu"er) Ca nu"er)E"ail address)>ases "edical record:chart nu"er)

17 =reBeistin-conditions and"edical histor

>ardiac disease %not si"le hertension& € (es € o € 'nnown

>hronic lun- disease € (es € o € 'nnown

*iaetes € (es € o € 'nnown

ae"o-loinoath € (es € o € 'nnown

I""unosuressi/e condition € (es € o € 'nnown

Li/er disease € (es € o € 'nnown

Metaolic disease € (es € o € 'nnown

eurolo-ical disorder € (es € o € 'nnown

!esit € (es € o € 'nnown

enal disease € (es € o € 'nnown

B If (es, are the on dialsis? € (es € o € 'nnown

!ther "edical condition? € (es € o € 'nnown

B If (es, secif)

Is the erson currentl re-nant or was she re-nant durin- the illness?




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?


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&


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&



or wild ani"als? € (es € o € 'nnown

B If (es, were an of these ani"als sic or dead? € (es € o € 'nnown

o If (es, secif)

+ere the aware of an other ani"al:ecreta

%e;-; ats, rodents, stra cats:do-, foes, retiles, etc;& € (es € o € 'nnown

B If (es, secif)

*id the /isit a "aret sellin- li/e ani"als? € (es € o € 'nnown

B If (es, secif)

*id the /isit an other /enue at which li/e ani"als were resent %e;-; far", race

course, .oo or falconr e/ents&? € (es € o € 'nnown

B If (es, secif)

21Coodeosures

%durin- eriodof interest&

*urin- the eriod of interest, where did the nor"all -et their food?%$ecif inds of food and locations&

*id the -et their food fro" an other locations, or did the eat an new tes of

food? € (es € o € 'nnown

B If (es, descrie)

a/e the eaten an foods or drun an e/era-es that the thin could ha/e

een unsafe or caused the" to eco"e ill? € (es € o € 'nnown

B If (es, descrie)

*id the eat an of the followin-)>a"el "eat, ca"el "il or ca"el urine? € (es € o € 'nnown

aw fruits or /e-etales? € (es € o € 'nnown

'ncooed "eat or e--s € (es € o € 'nnown

aw:unasteurised "il or "il roducts? € (es € o € 'nnown

*ried fruits or nuts € (es € o € 'nnown

*id the slau-hter an ani"al or handle raw "eat %e;-; in rearation for a "eal or

reli-ious offerin-&? € (es € o € 'nnown

B If (es, descrie)

*id the tae an traditional "edicines or use an ho"e re"edies?


B If (es, -i/e details)

22

u"aneosures

)onta&t with people whowere ill $uringthe perio$ ofinterest

*urin- the eriod of interest, did the ha/e contact with anone who "i-ht ha/e

had a conta-ious illness while the were still sic? € (es € o € 'nnown


a/e the had contact with ersons who are in close contact with ani"als

ecause of their wor? € (es € o € 'nnown


a/e the had contact with a erson who had a resirator



Note: not

restricted to

Middle East

contacts

illness:diarrhoea:/o"itin-? € (es € o € 'nnown


*id the /isit or care for an sic erson? € (es € o € 'nnown


B If (es, did the ha/e an contact with the sic ersonNs odil fluids, such as

urine, lood, sutu" or faeces? € (es € o € 'nnown

o If (es, -i/e details)

23

ealthcareand hositalresentation

Theseuestionsshoul$ 'eanswere$a'outhealth&arean$ hospital presentation inthe 14 $ays prior to onset

-n&lu$es !ustralian an$ o*erseas presentations

*id the case resent to hosital? € (es € o € 'nnown

B If (es, date of resentation to hosital) : : %dd:"":&

B +as the hosital resentation for ME$ related s"to"s?


o If o, -i/e details of what, when and where)

*id the case /isit an other healthcare facilities durin- the eriod of interest?


B If (es, -i/e date of resentation) : : %dd:"":&

+as the healthcare /isit for ME$B>oH s"to"s?


B If o, -i/e details of what, when and where)

24

>ase Cound

€ >linical =resentation

€ >ontact tracin-:eide"iolo-ical in/esti-ation

€ $creenin-

€ >linical and eide"iolo-

€ !ther) $ecif)



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

sus&e)ted 8iddle Eastern res&irator' s'ndro(e )orona$irus 8ERS9Co:# infe)tions htt&@KK***,health,-o$,auKinternetK(ainK&u%lishin-,nsfKContentK3XEA5D5XFA6A55CA65?BF4443AXE3FKYFileKinteri(9infe)tion9&re$ention,&df #

40 +orld ealth !r-ani.ation %+!&; -nteri .ui$an&e o&uent )lini&al anageent ofse*ere a&ute respiratory infe&tions when no*el &orona*irus is suspe&te$ %htt)::www;who;int:csr:disease:corona/irus<infections:Interi"Duidance<>linicalMana-e"ent

<o/el>orona/irus<11Ce13u;df &;







http://www.health.gov.au/internet/main/publishing.nsf/Content/18EA5D58FA62A556CA257BF0001A8E1F/$File/interim-infection-prevention.pdf


http://www.who.int/csr/disease/coronavirus_infections/InterimGuidance_ClinicalManagement_NovelCoronavirus_11Feb13u.pdf
















Mers Cov Song Sep2015

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Transcript of Mers Cov Song Sep2015