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MERS, respiratory infections threaten California-Middle East travelers
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Although no cases of Middle East respiratory syndrome coronavirus have been identified in California as of May, frequent travel between California and the Middle East may pose an ongoing threat of disease importation, according to recent findings.
Researchers from the California Department of Public Health (CDPH) developed a testing plan to identify or rule out suspected MERS-CoV infection in patients who met the CDC’s clinical or travel criteria to be considered a patient under investigation (PUI). After identifying a MERS PUI, the researchers transported specimens taken from the patient to CDPH for MERS-CoV testing. Specimens included at least one upper respiratory tract sample, lower respiratory tract sample, serum sample or stool sample.
Between February 2013 and June 2013, specimens were tested using real-time, reverse transcription PCR (rRT-PCR) assay. For patients with suspected past MERS-CoV, the CDPH sent blood samples to the CDC for MERS-CoV serologic testing. After ruling out MERS-CoV infection, the CDC tested the remaining respiratory specimens from the MERS PUIs for other respiratory pathogens, including influenza A and B viruses, human metapneumovirus, respiratory syncytial virus, adenovirus, parainfluenza virus, enterovirus, rhinovirus and Mycoplasma species.
From February 2013 to November 2014, CDC tested 54 MERS PUIs in California. The median age of the PUIs was 53 years; and 57% were male. Of these, 94% reported travel from the Middle East, and 4% were secondary contacts of those who had traveled to the Middle East.
Although none of the PUIs tested positive for MERS CoVs, 62% were diagnosed with one or more other respiratory viruses, and five were coinfected with rhinovirus plus another respiratory virus. The most prevalent respiratory virus was influenza (35%).
Reported outcomes for 42 of the identified PUIs included hospitalization (71%), ICU admission (26%), intubation (14%), pneumonia diagnosis (50%) and acute respiratory distress syndrome diagnosis (12%).
The researchers said ongoing surveillance is being conducted on MERS PUIs in California, and emphasized the importance of vaccination against influenza among travelers.
“The high rate of influenza detection underscores the need for all travelers to be immunized for influenza,” the researchers wrote. “CDPH continues to evaluate each MERS PUI and expedite MERS-CoV laboratory testing so that prompt implementation of containment procedures and contact investigations may proceed if needed.” – by Jen Byrne
Disclosure: The researchers report no relevant financial disclosures.
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