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Additional Consideration Regarding Testing

Clusters of cases with severe acute respiratory illness (e.g., fever and pneumonia requiring hospitalization) without recognized links to a case of MERS-CoV infection or to travelers from countries in or near the Arabian Peninsula should be evaluated for common respiratory pathogens.

If the illnesses remain unexplained, providers should consider testing for MERS‑CoV, in consultation with DoD/State/local public health points-of-contact.

  • Patients with lower respiratory illness should also be evaluated for common causes of community-acquired pneumonia.  
  • This evaluation should be guided by clinical presentation and epidemiologic and surveillance information.  
  • Testing for MERS-CoV and other respiratory pathogens can be done simultaneously.  
  • Positive results for another respiratory pathogen should not necessarily preclude testing for MERS-CoV because co-infection can occur.

Test results from the Novel Coronavirus 2012 Real-Time RT-PCR Assay are considered to be PRESUMPTIVE at the current time. At present, cases can only be confirmed after laboratory testing at CDC. 

Reporting Patients Under Investigation (PUIs)

DoD healthcare professionals (in coordination with the designated Public Health Emergency Officer) should immediately report to their respective Service and DoD public health activities and the State or local health department any person being evaluated for MERS-CoV infection as a PUI. PUIs should subsequently be reported to CDC using the MERS PUI Short Form. Probable cases should also be reported to CDC. 

Viral Culture in Laboratories

Virus isolation in cell culture and initial characterization of viral agents recovered in cultures of MERS-CoV specimens are NOT recommended at this time.  However, if done, these activities must be performed in a BSL-3 facility using BSL-3 work practices.

Current CDC guidance for health professionals, clinicians, and laboratorians (including case definitions and diagnosis and laboratory testing guidance) can be found at the CDC website. Laboratories should follow the Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Patients

NOTE

The Clinical Specimens Version 2 guidance expanded the “Specimen Type and Priority” section to better describe what specimens are preferred for testing (i.e., Lower respiratory specimens are preferred, but collecting nasopharyngeal and oropharyngeal (NP/OP) specimens, as well as stool and serum, are strongly recommended depending upon the length of time between symptom onset and specimen collection.); expanded the “Blood Components – Serum” section; and revised the “Summary of MERS-CoV rRT-PCR Testing Guidelines for Respiratory Specimens” section that describes reporting MERS-CoV test results and testing for other respiratory pathogens.

The Laboratory Biosafety Version 2 guidance added a section titled “Clinical Laboratory Testing” to describe recommendations when handling potential MERS-CoV specimens in the clinical laboratory setting and expanded the “Packing, Shipping and Transport” section to include updated and useful documents.

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