{"id":10275,"date":"2025-03-01T14:03:22","date_gmt":"2025-03-01T19:03:22","guid":{"rendered":"https:\/\/dhss.delaware.gov\/dph\/dhan304\/"},"modified":"2025-03-02T00:51:53","modified_gmt":"2025-03-02T05:51:53","slug":"dhan304","status":"publish","type":"page","link":"https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan304\/","title":{"rendered":"php\/alerts\/dhan304 ~  Division of Public Health &#8212; Health Alert  &#8211; Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\n\n\n\n  <br>\n\n\n\n  <div class=\"container\" id=\"main_header\"> \n\n    <!-- BEGIN readspeaker div -->\n\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\n\n      <a accesskey=\"L\" class=\"rsbtn_play\" href=\"https:\/\/app-na.readspeaker.com\/cgi-bin\/rsent?customerid=7262&#038;lang=en_us&#038;readid=main_content&#038;url=https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan304.html\" title=\"Listen to this page using ReadSpeaker\">\n\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\n\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\n\n      <\/a>\n\n    <\/div>\n\n    <!-- END readspeaker div -->\n\n\n\n    \n\n    <header class=\"pull-left\">\n\n      <h1>Delaware Health Alert Network #<!--[type=EDIT name=\"DHAN Number\"]-->304 <!--[END]--> <\/h1>\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->June 10, 2013 12:11 pm <!--[END]--> <\/h2>\n\n    <\/header>\n\n  <\/div><br>\n\n \n\n  <div class=\"container\">\n\n    <div class=\"row\">\n\n      <div class=\"col-md-3\" id=\"leftCol\">\n\n        <div class=\"panel-group\" id=\"accordion\">\n\n          <div class=\"panel sectionmenu_panel\">\n\n            <div class=\"panel-heading\">\n\n              <p class=\"panel-title\"><a class=\"agency_nav\" data-parent=\"#accordion\" data-toggle=\"collapse\" href=\"#collapseOne\"><strong><i class=\"fa fa-align-justify fa-fw\"><\/i> Public Health Menu<\/strong><\/a><\/p>\n\n            <\/div>\n\n\n\n            <div class=\"panel-collapse collapse in\" id=\"collapseOne\">\n\n              <div class=\"panel-body\" id=\"clf_nav\">\n\n                  <ul class=\"nav nav-stacked nav-pills-clf\" id=\"agency_sidebar\">\n    <li><a href=\"\/dph\/\"><h2>Home <i class=\"fa fa-home fa-fw\"><\/i><\/h2><\/a><\/li>\n    <li class=\"toplevel\"><a data-parent=\"#agency_sidebar\" data-toggle=\"collapse\" href=\"#HomeMenu\"><h2>About <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"HomeMenu\">\n        <li><a href=\"\/dph\/about.html\">About DPH<\/a><\/li>\n        <li><a href=\"\/dph\/sections.html\">Sections &#038; 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No cases have been reported in the United States.\n\n\n  The purpose of this HAN Advisory is to provide updated guidance to state health departments and health care providers in the evaluation\n\n\n  of patients for MERS-CoV infection including expansion of availability of laboratory testing and, in consultation with WHO, expansion of\n\n\n  the travel history criteria for patients under investigation from within 10 to 14 days for investigation and modification of the case\n\n\n  definition. Please disseminate this information to infectious diseases specialists, intensive care physicians, internists, infection\n\n\n  preventionists, as well as to emergency departments and microbiology laboratories.<\/em>\n\n\n<\/p>\n\n\n<h3>\n\n\n  Background\n\n\n<\/h3>\n\n\n<p>\n\n\n  <em>MERS-CoV, formerly called \u201cnovel coronavirus,\u201d<\/em> is a beta coronavirus that was first described in September 2012,\n\n\n  when it was reported to have caused fatal acute lower respiratory illness in a man in Saudi Arabia. Genetic sequence analyses have shown\n\n\n  that this new virus is different from other known human coronaviruses, including the one that caused severe acute respiratory syndrome\n\n\n  (SARS). Diagnosis relies on testing with real time reverse transcription polymerase chain reaction (RT-PCR) assays. There is no specific\n\n\n  treatment for MERS-CoV infection; care is supportive.\n\n\n<\/p>\n\n\n<p>\n\n\n  As of June 7, 2013, 55 laboratory-confirmed cases of MERS-CoV infection have been reported to WHO\u2014two from France, three from\n\n\n  Italy, two from Jordan, two from Qatar, 40 from Saudi Arabia, two from Tunisia, one from the United Arab Emirates, and three from the\n\n\n  United Kingdom (UK). Additional details can be found in the June 7, 2013 <em>MMWR<\/em> Early Release (<a href=\"http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm62e0607a1.htm?s_cid=mm62e0607a1_w\">http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm62e0607a1.htm?s_cid=mm62e0607a1_w<\/a>).\n\n\n  To date, all cases have a direct or indirect link to one of four countries:Saudi Arabia, Qatar, Jordan, and the United Arab Emirates.\n\n\n  <strong>No cases have been reported in the United States.<\/strong> Illness onsets were from April 2012 through May 2013. Of the 55 cases,\n\n\n  31 were fatal, for a case-fatality rate of 56%. The median age of cases is 56 years. All of the patients were aged <span style=\"text-decoration: underline\">><\/span>24 years, except for two children, one aged 2 years and one aged 14 years.\n\n\n<\/p>\n\n\n<p>\n\n\n  Eight clusters of illnesses have been reported by six countries (France, Italy, Jordan, Saudi Arabia, Tunisia, and UK). These clusters\n\n\n  provide clear evidence of human-to-human transmission of MERS-CoV. The largest cluster reported to date consists of 25 cases, 14 of which\n\n\n  were fatal, associated with a health-care facility in Al-Ahsa governorate in Saudi Arabia. Two of the case-patients in that cluster were\n\n\n  health-care personnel who acquired the infection after exposure to patients with confirmed MERS-CoV infection.\n\n\n<\/p>\n\n\n<p>\n\n\n  The first case reported by France was in a person with an underlying immunosuppressive condition who initially had abdominal pain and\n\n\n  diarrhea and subsequently developed respiratory complications. This case raises the possibility that presentations may not initially\n\n\n  include respiratory symptoms. Among\u00a0 cases reported to WHO in which more detailed information is available, most are reported to\n\n\n  have chronic underlying medical conditions or immunosuppression; such persons may be at increased risk of MERS-CoV infection or severe\n\n\n  disease, or both.In some instances, sampling with nasopharyngeal swabs did not detect MERS-CoV by PCR; however, MERS-CoV was detected by\n\n\n  PCR in lower respiratory tract specimens from those same patients. Therefore, lower tract respiratory specimens should be a priority for\n\n\n  collection and PCR testing, in addition to nasopharyngeal swabs.\n\n\n<\/p>\n\n\n<h3>\n\n\n  Recommendations\n\n\n<\/h3>\n\n\n<p>\n\n\n  Recommendations and guidance on MERS-CoV case definitions, case investigation, specimen collection and shipment for testing, and\n\n\n  infection control (including use of personal protective equipment) are available at the CDC MERS website (<a href=\"http:\/\/www.cdc.gov\/coronavirus\/MERS\/index.html\">http:\/\/www.cdc.gov\/coronavirus\/MERS\/index.html<\/a>). Information and guidance posted on\n\n\n  this website may change as we learn more about the virus. Please check CDC\u2019s MERS website regularly for the most current\n\n\n  information. State and local health departments with questions should contact the CDC Emergency Operations Center (770-488-7100 or\n\n\n  <a href=\"mailto:eocreport@cdc.gov\">eocreport@cdc.gov<\/a>).\n\n\n<\/p>\n\n\n<h4>\n\n\n  Surveillance\n\n\n<\/h4>\n\n\n<p>\n\n\n  As a result of investigations suggesting incubation periods for MERS CoV may be longer than 10 days, the time period for considering MERS\n\n\n  in persons who develop severe acute lower respiratory illness days after traveling from the Arabian Peninsula or neighboring countries*\n\n\n  has been extended from within 10 days to within 14 days of travel.\n\n\n<\/p>\n\n\n<p>\n\n\n  In particular, persons who meet the following criteria for \u201cpatient under investigation\u201d (PUI) should be reported to state\n\n\n  and local health departments and evaluated for MERS-CoV infection:\n\n\n<\/p>\n\n\n<ul>\n\n\n  <li>A person with an acute respiratory infection, which may include fever (\u2265 38\u00b0C , 100.4\u00b0F) and cough; AND\n\n\n  <\/li>\n\n\n  <li>Suspicion of pulmonary parenchymal disease (e.g., pneumonia or acute respiratory distress syndrome based on clinical or radiological\n\n\n  evidence of consolidation); AND\n\n\n  <\/li>\n\n\n  <li>History of travel from the Arabian Peninsula or neighboring countries* within 14 days; AND\n\n\n  <\/li>\n\n\n  <li>Symptoms not already explained by any other infection or etiology, including clinically indicated tests for community-acquired\n\n\n  pneumonia<sup>\u2020<\/sup> according to local management guidelines.\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<p>\n\n\n  In addition, the following persons may be considered for evaluation for MERS-CoV infection:\n\n\n<\/p>\n\n\n<ul>\n\n\n  <li>Persons who develop severe acute lower respiratory illness of known etiology within 14 days after traveling from the Arabian\n\n\n  Peninsula or neighboring countries* but who do not respond to appropriate therapy; OR\n\n\n  <\/li>\n\n\n  <li>Persons who develop severe acute lower respiratory illness who are close contacts<sup>\u2021<\/sup> of a symptomatic traveler who\n\n\n  developed fever and acute respiratory illness within 14 days of traveling from the Arabian Peninsula or neighboring countries.*\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<p>\n\n\n  In addition, CDC recommends that clusters of severe acute respiratory illness (SARI) should be investigated and, if no obvious etiology\n\n\n  is identified, local public health officials should be notified and testing for MERS-CoV conducted if indicated.\n\n\n<\/p>\n\n\n<p>\n\n\n  CDC requests that state and local health departments report PUIs for MERS-CoV and clusters of SARI with no identified etiology to CDC. To\n\n\n  collect data on PUIs, please use CDC\u2019s Interim Health Departments MERS-CoV Investigation\u00a0 Formavailable at\u00a0 <a href=\"http:\/\/www.cdc.gov\/coronavirus\/mers\/guidance.html\">http:\/\/www.cdc.gov\/coronavirus\/mers\/guidance.html<\/a>. State health departments\n\n\n  should FAX completed investigation forms to CDC at 770-488-7107 or attach in an email to <a href=\"email:eocreport@cdc.gov\">eocreport@cdc.gov<\/a> (subject line: MERS-CoV Patient Form).\n\n\n<\/p>\n\n\n<h4>\n\n\n  Laboratory Testing\n\n\n<\/h4>\n\n\n<p>\n\n\n  Testing of specimens for MERS-CoV is currently being conducted at CDC. The Food and Drug Administration (FDA) issued an Emergency Use\n\n\n  Authorization (EUA) on June 5, 2013, to authorize the use of the CDC Novel Coronavirus 2012 Real-time RT-PCR Assay (NCV-2-12 rRT-PCR\n\n\n  Assay) to test for MERS-CoV in clinical respiratory, blood and stool samples. This EUA is needed because, at this time, no FDA-approved\n\n\n  tests that identify MERS-CoV in clinical specimens are available. This assay will be deployed to Laboratory Response Network (LRN)\n\n\n  laboratories in all 50 states over the coming weeks. Updated information about laboratories with the capacity to conduct MERS testing\n\n\n  with the NCV-2-12 rRT-PCR Assay will be provided on CDC\u2019s MERS website (<a href=\"http:\/\/www.cdc.gov\/coronavirus\/mers\/case-def.html\">http:\/\/www.cdc.gov\/coronavirus\/mers\/case-def.html<\/a>).\n\n\n<\/p>\n\n\n<p>\n\n\n  To increase the likelihood of detecting MERS-CoV, CDC recommends collection of specimens from different sites&#8211; for example, a\n\n\n  nasopharyngeal swab and a lower respiratory tract specimen such as sputum, bronchoalveolar lavage, bronchial wash, or tracheal aspirate.\n\n\n  Specimens should be collected at different times after symptom onset, if possible. Lower respiratory tract specimens should be a priority\n\n\n  for collection and PCR testing;stool specimens are of lower priority. Specimens should be collected with appropriate infection control\n\n\n  precautions <a href=\"http:\/\/www.cdc.gov\/coronavirus\/mers\/case-def.html\">http:\/\/www.cdc.gov\/coronavirus\/mers\/case-def.html<\/a>.\n\n\n<\/p>\n\n\n<h4>\n\n\n  Case Definitions\n\n\n<\/h4>\n\n\n<p>\n\n\n  The MERS-CoV case definition continues to evolve and is available at <a href=\"http:\/\/www.cdc.gov\/coronavirus\/mers\/case-def.html\">http:\/\/www.cdc.gov\/coronavirus\/mers\/case-def.html<\/a>. In consultation with WHO, the\n\n\n  definition of a probable case of MERS has been updated to also include persons with severe acute respiratory infection with no known\n\n\n  etiology with an epidemiologic link to a confirmed MERS-CoV case.\n\n\n<\/p>\n\n\n<h4>\n\n\n  Infection Control\n\n\n<\/h4>\n\n\n<p>\n\n\n  There is clear evidence of limited human-to-human transmission, possibly involving different modes, such as droplet and contact\n\n\n  transmission, but further studies are required to better understand the risks. Until the transmission characteristics of MERS-CoV are\n\n\n  better understood, patients under investigation and probable and confirmed cases should be managed in healthcare facilities using\n\n\n  standard, contact, and airborne precautions. As information becomes available, these recommendations will be re-evaluated and updated as\n\n\n  needed.\n\n\n<\/p>\n\n\n<p>\n\n\n  * Countries considered to be on or neighboring the Arabian Peninsula include Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman,\n\n\n  Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen.\n\n\n<\/p>\n\n\n<p>\n\n\n  <sup>\u2020<\/sup> Examples of respiratory pathogens causing community-acquired pneumonia include influenza A and B, respiratory\n\n\n  syncytial virus, adenovirus, <em>Streptococcus pneumoniae<\/em>, and <em>Legionella pneumophila.<\/em>\n\n\n<\/p>\n\n\n<p>\n\n\n  <sup>\u2021<\/sup> Close contact is defined as 1) any person who provided care for the patient, including a health-care worker or family\n\n\n  member, or who had other similarly close physical contact, or 2) any person who stayed at the same place (e.g., lived with or visited) as\n\n\n  the patient while the patient was ill.\n\n\n<\/p>\n\n\n<h4>\n\n\n  For more information:\n\n\n<\/h4>\n\n\n<p>\n\n\n  For additional information, consult the CDC MERS website at: <a href=\"http:\/\/www.cdc.gov\/coronavirus\/mers\/index.html\">http:\/\/www.cdc.gov\/coronavirus\/mers\/index.html<\/a>\n\n\n<\/p>\n\n\n<p>\n\n\n  Call the Delaware Division of Public Health\u2019s Office of Infectious Disease Epidemiology at (302) 744-1033 if you have questions.\n\n\n<\/p>\n\n\n<p>\n\n\n  ************************************\n\n\n<\/p>\n\n\n<p>\n\n\n  You are receiving this email because you are a registered member of the Delaware Health Alert Network. If you are not a member and would\n\n\n  like to subscribe, please register at <a href=\"https:\/\/healthalertde.org\">https:\/\/healthalertde.org<\/a>\n\n\n<\/p><!--[END]-->\n\n  \n\n        <div class=\"panel panel-danger\">\n\n          <div class=\"panel-heading\">    \n\n      <h2>Categories of Health Alert messages:<\/h2>\n\n       <\/div>\n\n       <div class=\"panel-body\">\n\n      <ul>\n\n        <li><strong>Health Alert:<\/strong> Conveys the highest level of importance; warrants immediate action or attention.<\/li>\n\n        <li><strong>Health Advisory:<\/strong> Provides important information for a specific incident or situation; may not require immediate action.<\/li>\n\n        <li><strong>Health Update:<\/strong> Provides updated information regarding an incident or situation; unlikely to require immediate action.<\/li>\n\n            <\/ul>\n\n         <div><strong>NOTE: This page is for informational purposes only and dated material (e.g. temporary websites) may not be available.<\/strong><\/div>\n\n          <\/div> \n\n        <\/div><br>  \n\n\n\n      <\/div>\n\n    <\/div>\n\n  <\/div><!-- \/container -->\n\n  <\/div>","protected":false},"excerpt":{"rendered":"<p>Listen Delaware Health Alert Network #304 June 10, 2013 12:11 pm Public Health Menu Home About About DPH Sections &#038; Programs Office Locations Contact Info Calendar Services A-Z Services Air &#038; Water Quality Birth, Death, &#038; Marriage Records Clinics Health Data &#038; Statistics Emergency Preparedness Health &#038; Wellness Healthy Homes Healthy Workplaces Laboratory Restaurant Inspections [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":9294,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-10275","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10275","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/comments?post=10275"}],"version-history":[{"count":1,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10275\/revisions"}],"predecessor-version":[{"id":11451,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10275\/revisions\/11451"}],"up":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9294"}],"wp:attachment":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/media?parent=10275"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}