Contact screening
Contact screening identified secondary infection in only 4% of 280 close family contacts and 2% of 5065 healthcare facility contacts.[87]Memish ZA, Al-Tawfiq JA, Makhdoom HQ, et al. Screening for Middle East respiratory syndrome coronavirus infection in hospital patients and their healthcare worker and family contacts: a prospective descriptive study. Clin Microbiol Infect. 2014;20:469-474.
http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)60086-0/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/24460984?tool=bestpractice.com
[88]Drosten C, Meyer B, Muller MA, et al. Transmission of MERS-coronavirus in household contacts. N Engl J Med. 2014;371:828-835.
http://www.nejm.org/doi/full/10.1056/NEJMoa1405858#t=article
http://www.ncbi.nlm.nih.gov/pubmed/25162889?tool=bestpractice.com
People who may have been exposed to the virus are advised to monitor their health for 14 days from the last day of possible contact and seek medical attention if they develop symptoms, especially fever, cough, or dyspnea. Isolation or quarantine is not currently warranted.
With an effective reproductive number of less than one, the epidemic potential of the infection is considered low at present unless the virus mutates.[55]Cauchemez S, Van Kerkhove MD, Riley S, et al. Transmission scenarios for Middle East respiratory syndrome coronavirus (MERS-CoV) and how to tell them apart. Euro Surveill. 2013;18:20503.
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20503
http://www.ncbi.nlm.nih.gov/pubmed/23787162?tool=bestpractice.com
[56]Cauchemez S, Fraser C, Van Kerkhove MD, et al. Middle East respiratory syndrome coronavirus: quantification of the extent of the epidemic, surveillance biases, and transmissibility. Lancet Infect Dis. 2014;14:50-56.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3895322
http://www.ncbi.nlm.nih.gov/pubmed/24239323?tool=bestpractice.com
[57]Breban R, Riou J, Fontanet A. Interhuman transmissibility of Middle East respiratory syndrome coronavirus: estimation of pandemic risk. Lancet. 2013;382:694-699.
http://www.ncbi.nlm.nih.gov/pubmed/23831141?tool=bestpractice.com
Although there has been considerable concern over the potential global spread of infection during the annual Hajj pilgrimage to Mecca, where millions of pilgrims from many countries travel to Saudi Arabia, surveillance studies have not identified infection in pilgrims while in Saudi Arabia or after returning home.[89]Raoult D, Charrel R, Gautret P, et al. From the Hajj: it's the flu, idiot. Clin Microbiol Infect. 2014;20:O1.
http://www.ncbi.nlm.nih.gov/pubmed/24256052?tool=bestpractice.com
[90]Memish ZA, Assiri A, Almasri M, et al. Prevalence of MERS-CoV nasal carriage and compliance with the Saudi health recommendations among pilgrims attending the 2013 Hajj. J Infect Dis. 2014;210:1067-1072.
https://academic.oup.com/jid/article/210/7/1067/2908604/Prevalence-of-MERS-CoV-Nasal-Carriage-and
http://www.ncbi.nlm.nih.gov/pubmed/24620019?tool=bestpractice.com
[91]Gautret P, Charrel R, Benkouiten S, et al. Lack of MERS coronavirus but prevalence of influenza virus in French pilgrims after 2013 Hajj. Emerg Infect Dis. 2014;20:728-730.
https://wwwnc.cdc.gov/eid/article/20/4/13-1708_article
http://www.ncbi.nlm.nih.gov/pubmed/24656283?tool=bestpractice.com
[92]Gautret P, Charrel R, Belhouchat K, et al. Lack of nasal carriage of novel corona virus (HCoV-EMC) in French Hajj pilgrims returning from the Hajj 2012, despite a high rate of respiratory symptoms. Clin Microbiol Infect. 2013;19:E315-E317.
http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)61855-3/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/23452263?tool=bestpractice.com
[93]Benkouiten S, Charrel R, Belhouchat K, et al. Circulation of respiratory viruses among pilgrims during the 2012 Hajj pilgrimage. Clin Infect Dis. 2013;57:992-1000.
https://academic.oup.com/cid/article/57/7/992/339029/Circulation-of-Respiratory-Viruses-Among-Pilgrims
http://www.ncbi.nlm.nih.gov/pubmed/23839997?tool=bestpractice.com
[94]Annan A, Owusu M, Marfo KS, et al. High prevalence of common respiratory viruses and no evidence of Middle East respiratory syndrome coronavirus in Hajj pilgrims returning to Ghana, 2013. Trop Med Int Health. 2015;20:807-812.
http://www.ncbi.nlm.nih.gov/pubmed/25688471?tool=bestpractice.com
Asymptomatic patients who test positive
Patients may be asymptomatic but test positive for infection on real-time reverse transcription polymerase chain reaction (RT-PCR) as part of active case monitoring or contact investigations. These patients may go on to develop symptoms during the course of the infection. The potential for transmission from these patients is unknown, and until more is known, patients should be isolated (hospital or home), followed up daily to see whether symptoms have developed, and tested at least weekly. The choice of isolation location depends on numerous factors including hospital bed capacity, the hospital's ability to monitor patients at home, conditions of the household and its occupants, and patient risk factors for developing severe infection. Isolation should continue until two consecutive upper respiratory tract specimens taken at least 24 hours apart test negative on RT-PCR. Further specific guidance for managing the patient in each location is available from the World Health Organization (WHO).[95]World Health Organization. Management of asymptomatic persons who are RT-PCR positive for Middle East respiratory syndrome coronavirus (MERS-CoV). Interim guidance. January 2018 [internet publication].
https://www.who.int/publications/i/item/10665-180973