On Sunday, May 11, the Centers for Disease Control and Prevention (CDC) confirmed a positive lab result for the second case of MERS-CoV in the United States, in Florida. This case is not related to the case reported in Indiana on Friday, May 2. The CDC has stated that the risk to general public continues to remain extremely low. Transmission requires close contact, described as caring for or living with someone who is infectious with the disease.
On May 1, the patient traveled from Jeddah in Saudi Arabia to Orlando with stops in London, Boston, and Atlanta. While the CDC has not identified an increased risk of exposure during airline travel, out of an abundance of caution, local and state health departments in 20 states are reaching out to over 500 travelers who were on one of the same flights as the patient within the United States. The CDC is not releasing flight information at this time.
The patient is a health care worker who may have worked in a facility with MERS patients in Saudi Arabia and displayed some symptoms during travel including a slight cough, fever, and chills. The patient was visiting family in Orlando and did not visit tourist attractions. The patient was promptly isolated after admission to the hospital and is currently stable and doing well. Household contacts are under voluntary home quarantine until the end of the 14-day incubation period. CDC is testing specimens from close contacts.
CDC has been able to study the virus genome from the Indiana case and noted that the virus is very similar to other specimens, suggesting that the virus has not changed significantly over time. CDC noted that more asymptomatic cases and cases with mild symptoms are being reported from the Arabian peninsula. This is likely the result of better reporting and tracking for the virus, and CDC is anticipating a decrease in the fatality rate as a result of better reporting and tracking of milder cases.
CDC does not recommend changing travel plans but recently updated its travel advisory for the the Arabian peninsula with enhanced precautions for those who plan to work in a healthcare setting. CDC has worked with its airport partners to increase signage in airports about self-reporting of symptoms for travelers. Quarantine and security staff at airports have been refreshed about symptoms of MERS; however, CDC is not recommending screening travelers at this time. CDC has tested over 150 travelers with self-reported symptoms who have returned from Saudi Arabia. All tests, other than the the Indiana and Florida cases, have been negative.
Dr. Tom Frieden, Director, CDC requested that public health agencies remain vigilant in looking for clusters of respiratory illness of unknown etiology. Since MERS is not a virus that can be prevented by vaccine or treated with antivirals, the best protection is meticulous infection control in hospitals. Dr. Frieden noted that the hospitals in both Indiana and Florida have engaged in appropriate response measures.
As of May 12, 2014 there have been 538 laboratory-confirmed cases including 145 deaths reported to World Health Organization since the virus was first identified in 2012. The majority of the cases have been in Saudi Arabia, with 450 cases including 118 deaths. Healthcare workers have made up approximately 20 percent of all cases.
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