Health Alert 2014 2014 Alert #10: Severe Acute Respiratory Illness in Returning Travelers • The first two US cases of infection with the virus causing the Middle East Respiratory Syndrome (MERS) have recently been reported in Indiana and Florida. No US case of avian influenza A (H7N9) has occurred to date. o There have been no cases of either MERS or H7N9 in New York City to date • Report to the Health Department any persons with severe acute respiratory infection and: o Recent travel to the Arabian Peninsula or neighboring countries and suspected MERS coronavirus infection. o Recent travel to mainland China and suspected avian influenza A (H7N9) infection. Please distribute to staff in the Departments of Critical Care, Emergency Medicine, Family Practice, Geriatrics, Internal Medicine, Infectious Disease, Infection Control, Obstetrics, Pediatrics, Pulmonary Medicine, Pharmacy, and Laboratory Medicine May 13, 2014 Dear Colleagues, We are reminding New York City clinicians about the importance of taking a travel history in patients with severe acute respiratory illness necessitating hospitalization. Two recent international outbreaks of concern may affect travelers returning to New York City, though no cases of either have occurred in the city: 1) An outbreak of MERS coronavirus has been occurring for approximately two years in the Middle East, primarily involving Saudi Arabia, Jordan, Qatar, and the United Arab Emirates. As of May 12, 2014, CDC has confirmed 536 cases, with 139 deaths. Most cases have occurred in Saudi Arabia. Risk factors for acquisition are currently unknown. While infection is likely acquired from an animal vector species, personto- person transmission has been documented among some close contacts of cases, including healthcare workers. Most cases have occurred in the Middle East, though several have occurred in returning travelers or their close contacts in several countries, including the first two cases in United States, which recently occurred in Indiana and Florida. These two cases are not related to each other. NYC clinicians should remain vigilant, especially with potential Ramadan travel by New Yorkers occurring in June and July. Clinical features have included acute respiratory distress syndrome (ARDS), renal failure requiring hemodialysis, consumptive coagulopathy, and pericarditis. Many patients have also experienced gastrointestinal symptoms as part of their illness. 2) An outbreak of avian influenza A (H7N9) virus has recently affected several provinces in eastern China, with 434 human cases and 158 deaths reported. Most cases have had direct or indirect contact with poultry. One case of person-to-person transmission has been documented, and a few small family clusters have occurred in which person-to-person transmission could not be ruled out. No cases have been documented in the United States. Clinical features have included severe respiratory illness, including ARDS and multi-organ failure in fatal cases. Screening and Diagnostic Testing for Suspect Cases To rapidly detect the importation of either MERS Co-V or avian influenza into NYC, we request that providers: • Ask about international travel in patients with severe respiratory illness requiring hospitalization. • Report patients to the Health Department who have severe acute respiratory illness requiring hospitalization and meet one of the following criteria: o Traveled to the Arabian Peninsula or surrounding countries* in the 14 days before illness onset. o Traveled to mainland China in the 10 days before illness onset. • Where possible, acquire both lower and upper respiratory tract specimens for diagnosis. Place clinical samples in viral transport medium, and contact the Health Department to arrange transport for diagnostic testing at our Public Health Laboratory. • Do not perform viral cultures. *Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen Infection Control Clinicians caring for patients under investigation for either MERS or avian influenza A (H7N9) infection should adhere to Standard, Contact, and Airborne Precautions, including eye protection. Posters for Clinical Settings To remind staff to consider travel history when evaluating patients with severe acute respiratory illness, two posters are available for use in your facility: 1. A poster listing Guidelines for Clinicians, which will help medical staff to recognize, triage and report suspected MERS or H7N9 cases, and 2. A “STOP” poster for entrances and triage stations, which asks patients who recently traveled and have fever and respiratory symptoms (as well as rash, vomiting and diarrhea, to cover generic symptoms applicable to other travel-related diseases) to identify themselves to staff immediately. It is available in English, Spanish and Chinese.
Posted on: Fri, 23 May 2014 18:01:00 +0000
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