People Who May Be at Increased Risk for MERS

Recent Travelers from the Arabian Peninsula

If you develop a fever* and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after traveling from countries in or near the Arabian Peninsula**, you should call ahead to a healthcare provider and mention your recent travel.

Close Contacts of an Ill Traveler from the Arabian Peninsula

If you have had close contact*** with someone within 14 days after they traveled from a country in or near the Arabian Peninsula**, and the traveler has/had fever* and symptoms of respiratory illness, such as cough or shortness of breath, you should monitor your health for 14 days, starting from the day you were last exposed to the ill person.

If you develop fever* and symptoms of respiratory illness, such as cough or shortness of breath, you should call ahead to a healthcare provider and mention your recent contact with the traveler.

Close Contacts of a Confirmed Case of MERS

If you have had close contact*** with someone who has a confirmed MERS-CoV infection, you should contact a healthcare provider for an evaluation. Your healthcare provider may request laboratory testing and outline additional recommendations, depending on the findings of your evaluation and whether you have symptoms. You most likely will be asked to monitor your health for 14 days, starting from the day you were last exposed to the ill person. Watch for these symptoms:

• Fever*. Take your temperature twice a day.
• Coughing
• Shortness of breath
• Other early symptoms to watch for are chills, body aches, sore throat, headache, diarrhea, nausea/vomiting, and runny nose.

If you develop symptoms, call ahead to your healthcare provider as soon as possible and tell him or her about your possible exposure to MERS-CoV so the office can take steps to keep other people from getting infected. Ask your healthcare provider to call the local or state health department.

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Healthcare Personnel Not Using Recommended Infection-Control Precautions

Healthcare personnel should adhere to recommended infection control measures, including standard, contact, and airborne precautions, while managing symptomatic close contacts, patients under investigation, and patients who have probable or confirmed MERS-CoV infections. They should also use recommended infection control precautions when collecting specimens.

Healthcare personnel who had close contact*** with a confirmed case of MERS while the case was ill, if not using recommended infection control precautions (e.g. appropriate use of personal protective equipment), are at increased risk of developing MERS-CoV infection. These individuals should be evaluated and monitored by a healthcare professional with a higher index of suspicion. For more information, see Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV).

People with Exposure to Camels

MERS-CoV has been found in some camels, and some MERS patients have reported contact with camels. However, we do not know exactly how people become infected with MERS-CoV.

The World Health Organization has posted a general precaution for anyone visiting farms, markets, barns, or other places where animals are present. Travelers should practice general hygiene measures, including regular handwashing before and after touching animals, and avoiding contact with sick animals. Travelers should also avoid consumption of raw or undercooked animal products. For more information, see WHO’s Frequently Asked Questions on MERS-CoV. (Should people avoid contact with camels or camel products? Is it safe to visit farms, markets, or camel fairs?)

The World Health Organization considers certain groups to be at high risk for severe MERS. These groups include people with diabetes, kidney failure, or chronic lung disease, and people who have weakened immune systems. The World Health Organization recommends that these groups take additional precautions:

• Avoid contact with camels
• Do not drink raw camel milk or raw camel urine
• Do not eat undercooked meat, particularly camel meat

*Fever may not be present in some patients, such as those who are very young, elderly, immunosuppressed, or taking certain medications. Clinical judgement should be used to guide testing of patients in such situations.

**Countries considered in the Arabian Peninsula and neighboring include: Bahrain; Iraq; Iran; Israel, the West Bank, and Gaza; Jordan; Kuwait; Lebanon; Oman; Qatar; Saudi Arabia; Syria; the United Arab Emirates (UAE); and Yemen.

***Close contact is defined as a) being within approximately 6 feet (2 meters), or within the room or care area, of a confirmed MERS case for a prolonged period of time (such as caring for, living with, visiting, or sharing a healthcare waiting area or room with, a confirmed MERS case) while not wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection); or b) having direct contact with infectious secretions of a confirmed MERS case (e.g., being coughed on) while not wearing recommended personal protective equipment. See CDC’s Interim Infection Prevention and Control Recommendations for Hospitalized Patients with MERS. Data to inform the definition of close contact are limited; considerations when assessing close contact include the duration of exposure (e.g., longer exposure time likely increases exposure risk) and the clinical symptoms of the person with MERS (e.g., coughing likely increases exposure risk). Special consideration should be given to those exposed in healthcare settings. For detailed information regarding healthcare personnel (HCP) please review CDC’s Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Middle East Respiratory Syndrome (MERS-CoV) Exposure. Transient interactions, such as walking by a person with MERS, are not thought to constitute an exposure; however, final determination should be made in consultation with public health authorities.

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