MERS- CoV : case definition

1. MERS-CoV: case definition Republic of Lebanon Ministry of Public Health Epidemiological Surveillance Program May 2014

2. Confirmed case • Any person with positive laboratory confirmation of infection with novel coronavirus

3. Probable case • Any possible case with close contact during the last 10 days before onset of illness with a symptomatic confirmed case of novel coronavirus infection. • Close contact is defined as: • Anyone who provided care for a nCoV patient • Or anyone who stayed at the same place while a nCoV patient was ill.

4. Suspected case • Current case definition for suspected case: • Any person with severe acute respiratory infection, with: • Fever, cough, and evidence of pulmonary parenchymal disease • And not already explained by any other infection or etiology • And admitted to hospital • And one of the following: • With history travel within 14 days before onset in a country who reported local cases • Or contact history with a person with ARI who traveled in a country who reported local cases • Or HCW caring for patients with severe ARI • Or the case occurs as part of a cluster.

5. Cases • On Sunday 4th May, several patients were waiting at ER waiting room. Some of them are coughing, other have epistaxis, other show abdominal pain…

6. Case 1 • At ER, MrsNourNour, 35 years old, Lebanese has fever and cough. The cough is productive. No dyspnea is observed. • She is a teacher in public school. She has no travel history, neither her close family. • At physical exam, she is stable, some rhonchus are detected at auscultation. No signs of respiratory failure.

7. Case 2 • At ER, MrKamelKamel, 45 years old, Lebanese has fever and some watery diarrhea. • He is an engineer working in KSA. He came back to Lebanon 4 days ago. He is afraid to have infection with MERS-CoV. • At physical exam, he has no abnormal signs. The temperature was 37.8°C.

8. Case 3 • At ER, MrJadJad, 55 years old, Syrian, resident in Lebanon since 6 years, has fever and dyspnea. • He came back from Tunis 3 days before, where he was in vacation. • At physical exam, he has high grade fever (40°C), inspiratory dyspnea (RR=25), some crepitates are detected at auscultation. • The chest X Rays showed localized condensation at left upper lobe. The CBC counted 12000 WBC (90% PN). The patient is admitted to hospital.

9. Case 4 • At ER, Mrs Layla Abou Layla, 20 years old, Lebanese has fever and cough. The cough is productive. • She is a nursing student actually at Intensive Care Unit. She has no travel history, neither her close family. • At physical exam, the temperature is 39°C, some crepitates are detected at auscultation. • The chest X Rays showed some infiltrates at right side. She is admitted to hospital.

10. Case 5 • At ER, Mrs Alia Alia, 66 years old, Lebanese has fever and cough No dyspnea is observed. • She lives between KSA and Lebanon. She came back from Jeddah 6 days before. • At physical exam, she has fever (38.5°C), blood pressure is 130/80 mmHg, respiratory rate at 25/mn. • The Chest X ray showed several infiltrates in both right and left lungs. The patient is admitted to hospital.

11. Case 6 • At ER, Mr Anwar Anwar, 70 years old, Lebanese has fever, cough and dyspnea. The cough is productive. • He is retired since 2 years after being working as medical doctor in a private cabinet. • He reported that his son had also fever and some acute respiratory infection 5 days ago, his son works in KSA and came for a week end in Lebanon. • At physical exam, there was fever, dyspnea and crepitents. • The Chest X Ray showed patchy infiltrates. The patient was admitted.

12. Case 7 • At ER, the child Nader Nader, 12 years old, Lebanese has fever and cough. The cough is productive. No dyspnea is observed. • He is a student in a public school in Fnaydek (Akkarcaza). He has no travel history, neither his close family. • The family reported several similar cases among siblings and cousins. • At physical exam, he is stable, rhonchus are detected at auscultation. Some dyspnea is noted. Saturation O2 was 75%. The child is admitted to hospital.

13. Case 8 • At ER, MrNadimNadim, 27 years old, Palestinian has fever and cough. No dyspnea is observed. • He is bank employee. He has no travel history, neither his close family. • At physical exam, he is stable, the lung are clear at auscultation. The chest X Ray is normal. • He reported to be close contact of confirmed MERS case.

14. Case 9 • At ER, MrsJamale Jamal, 55 years old, Lebanese has fever and dyspnea. • She is a nurse in hospital in KSA. She went back to Lebanon 2 days before. Two cases of MERS were confirmed in her hospital. • At physical exam, she has fever (38.5°C). • Several infiltrates were observed at the chest X Ray. • The PCR test was done, it is positive.