Primary prevention

There is currently no vaccine available for the prevention of MERS in humans or camels, although there are three vaccines in development (one to prevent transmission from camels to people, and two for use in humans during outbreaks and longer-term protection of people at high risk).[83][84] Therefore, primary prevention is focused on preventing transmission from infected people and dromedary camels.

General prevention measures include:

  • Wash hands with soap and water (or alcohol-based hand sanitiser)

  • Use appropriate respiratory hygiene measures (e.g., cover mouth and nose when coughing or sneezing)

  • Avoid touching nose, eyes, or mouth if hands have not been washed

  • Clean and disinfect surfaces and objects

  • Avoid close personal contact with people who are unwell.

Prevention of human-to-human transmission:[85][86]

  • Human-to-human transmission occurs most commonly in healthcare settings, and community spread is rare

  • Infection prevention and control measures should be instituted in all suspected or confirmed cases of MERS. Standard precautions and droplet precautions are recommended, as well as airborne precautions when performing aerosol-generating procedures

  • Patients with probable or confirmed infection should be placed in an adequately ventilated single room, clearly segregated from other patient care areas if possible. The number of healthcare workers and visitors should be kept to a minimum

  • In addition to standard precautions, all healthcare workers and visitors when in close contact (i.e., approximately 1 metre) with a probable or confirmed case, should always use:

    • A medical mask

    • Eye protection

    • A clean, non-sterile, long-sleeved gown

    • Gloves

  • Hand hygiene should always be performed before and after contact with the patient and their surroundings, and immediately after the removal of personal protective equipment

  • Movement of the patient outside of the barrier nursing room or area should be avoided unless medically necessary.

These precautions should be implemented for the duration of the symptomatic illness and continued for 24 hours after the resolution of symptoms. Detailed infection prevention and control recommendations are available from the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO):

Centers for Disease Control and Prevention (CDC): interim infection prevention and control recommendations for hospitalized patients with MERS-CoV external link opens in a new window

World Health Organization (WHO): infection prevention and control during health care for probable or confirmed cases of MERS-CoV infection external link opens in a new window

Prevention of camel-to-human transmission:[60][87]

  • In countries where Middle East respiratory syndrome coronavirus (MERS-CoV) infection is prevalent in dromedary camels (i.e., the Arabian Peninsula and its surrounding countries), the following interventions should be considered to prevent camel-to-human transmission:

    • Individuals who are at risk of developing severe infection (i.e., age ≥50 years, diabetes mellitus, heart disease, chronic renal failure, immunocompromised) should avoid direct contact with camels (including nasal and eye discharge, urine, and faeces) and camel products (e.g., milk, meat)

    • Frequent hand washing and use of personal protective equipment while handling dromedary camels, including farmers, veterinarians, market workers, and slaughterhouse workers

    • Educational campaigns that target camel owners and the general public to inform them of the risks of consuming unpasteurised camel products (e.g., milk) and undercooked meat

    • Camels with detectable MERS-CoV RNA should be quarantined and tested at regular intervals

    • Strict regulation of camel movement, including a requirement for MERS-CoV infection clearance prior to importation and transport of camels between farms or to slaughterhouses.

Secondary prevention

MERS is a notifiable disease and all suspected and confirmed cases should be reported to the appropriate authority.

Transmission of the virus can be readily interrupted with the effective implementation of infection control precautions. The essential elements for effective secondary prevention include:[89][85]

  • Effective environmental cleaning and adequate spatial separation of patients with suspected or confirmed infection from other patients

  • Appropriate clinical triage protocols to identify patients presenting with acute respiratory illness who have history of travel within the past 14 days to the Middle East

  • Visitors and healthcare personnel caring for patients with suspected infection should perform appropriate hand hygiene and use personal protective equipment to ensure contact and droplet precautions (e.g., gloves, gowns, face masks)

  • Airborne precautions should also be applied during any aerosol-generating procedures such as endotracheal intubation. Such procedures should only be performed in negative-pressure rooms with adequate ventilation

  • Infection control precautions should be continued up to 24 hours after resolution of all clinical symptoms and at least one negative real-time reverse transcription polymerase chain reaction (RT-PCR)

  • All healthcare contacts and close contacts of patients should be identified and screened for symptoms of infection. Only those who are symptomatic should be tested. Asymptomatic contacts should be followed up daily for 14 days and tested if they develop any symptoms suggestive of infection.

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