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First person-to-person MERS transmission reported in US
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An Illinois man became infected with Middle East respiratory syndrome, or MERS, coronavirus after being in close contact with the first imported case in the United States, according to the CDC.
The Illinois resident has no recent history of travel outside the United States and did not seek medical attention; he is reported to be feeling well. US health officials tracked the resident during an investigation of the first US case — a health care worker who traveled from Saudi Arabia to Indiana and whose diagnosis was confirmed May 2. The resident had been tested for active infection on May 5, but test results were negative. On May 16, a follow-up blood test indicated that the man developed antibodies to MERS.
According to David Swerdlow, MD, who is heading the CDC’s response to the MERS infections in the United States, the CDC is not recommending any travel restrictions at this time.
“This latest development does not change CDC’s current recommendations to prevent the spread of MERS,” Swerdlow said in a statement. “It’s possible that as the investigation continues others may also test positive for [MERS] infection but not get sick. Along with state and local health experts, CDC will investigate those initial cases and if new information is learned that requires us to change our prevention recommendations, we can do so.”
Nine days after the first US case was reported in Indiana, a second case was identified in Florida — another health care worker who also traveled from Saudi Arabia. The Indiana and Florida cases are unrelated, according to health officials. Both cases triggered large-scale investigations.
Since the outbreak began in Saudi Arabia in 2012, there have been 572 cases of human infection with MERS, resulting in 173 deaths, according to the CDC.
The CDC recommends that health care providers evaluate patients with fever and pneumonia or acute respiratory distress syndrome for MERS infection if they traveled to countries in the Arabian Peninsula within 14 days of symptom onset, or if they had close contact with a symptomatic traveler with febrile and acute respiratory illness within 14 days after traveling to the Arabian Peninsula or were part of a cluster of patients with severe acute respiratory illness suspected of being MERS. Providers should also test for MERS if the patient had close contact with a confirmed or suspected case while the person was ill.
Perspective
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James M. Hughes, MD, FIDSA
The recent introductions of MERS into the United States by two US citizens who were providing health care services in Saudi Arabia and became ill while traveling home to visit relatives in Indiana and Florida have increased concerns about this emerging viral threat to the US. These episodes remind us yet again of the importance of addressing emerging infectious diseases aggressively wherever they arise, the importance of communication and close collaboration among clinicians, infection control personnel, public health and animal health officials, and the complex challenges involved in the domestic and international efforts to trace and identify the contacts of individuals who may have transmitted an infection during global travel.
The contact tracing effort in the Indiana case has now identified an asymptomatic MERS infection in a person exposed during interactions in an office setting. The ongoing investigation of this secondary case will provide further details of the nature of their interaction and possible clues to the mode of transmission of the virus while efforts to follow up on the contacts of this secondary case proceed. Fortunately, there is no evidence so far that the transmissibility of the virus is increasing, but continued vigilance in the US and around the world is critically important while efforts intensify to address the many gaps in knowledge about this virus and disease, to definitively identify the animal reservoir(s) and mode(s) of transmission of this virus, and to answer many basic questions and provide information on important issues such as the timing of onset, magnitude, and duration of shedding of virus by ill and asymptomatic persons. This ongoing epidemic on the Arabian Peninsula illustrates the critical importance of the current US and global commitments to implementing the global health security agenda.
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