MERS-COV PROCEDURE UPDATE JUNE 2018 · 2019-07-31 · a direct epidemiological link with a...

MERS-COV PROCEDURE UPDATE JUNE 2018

according to information available on june 11th, 2018

MERS-COVPROCEDURE

UPDATE

according to information available on june 11th, 2018

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INHOUDSTAFEL

anneX 1.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Who Case definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61.1. Probable case . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

1.1.1. definition 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61.1.2. definition 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61.1.3. definition 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

1.2. Confirmed case. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

anneX 2.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .direct epidemiological link . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.1. definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.2. list of countries with cases in 2017 and 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

anneX 3.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Contact tracing, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

3.1. definition close contact. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83.2. Contact identification and listing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83.3. follow-up by type of contact. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83.4. Contact tracing on flights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

anneX 4.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Biological sampling and laboratory confirmation of MeRs-CoV infection . . . . . . . . . . . . . . . . . . . 104.1. sampling by type of case / contact, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104.2. Confirmation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124.3. algorithm for testing cases under investigation for MeRs-CoV by rRt-PCR8 . . . . . . . . . . . . . . . . . 13

4.4. Inadequate specimen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134.5. Procedure in case of an inconclusive laboratory test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

anneX 5.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Isolation and movement restrictions by type of case / contact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

anneX 6.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Infection Prevention and control measures in case of home or hospital isolation. . . . . . . . . . . . 16

anneX 7.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .transfer to Chu saint-Pierre. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

anneX 8.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .sampling instructions for respiratory samples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208.1. type of sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208.2. Complete questionnaire, parts a and B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

anneX 9.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

anneX 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(footnotes). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

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DECISIONAL FLOWCHART

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ANNEX 1. WHO CASE DEFINITIONS1

1.1. PROBABLE CASE

1.1.1. Definition 1

a febrile acute respiratory illness with clinical, radiological, or histopathological evidence of pulmonary parenchymal disease (e.g. pneumonia or acute Respiratory distress syndrome)2

• and direct epidemiologic link with a laboratory-confirmed MeRs-CoV case (see 2.1);

• and testing for MeRs-CoV is unavailable, negative on a single inadequate specimen or inconclusive (see annex 4.4 and 4.5).

1.1.2. Definition 2

• a febrile acute respiratory illness with clinical, radiological, or histopathological evidence of pulmonary parenchymal disease (e.g. pneumonia or acute Respiratory distress syndrome) that cannot be explained fully by any other etiology;

• and the person resides or travelled in the Middle east, or in countries where MeRs-CoV is known to be circulating in dromedary camels or where human infections have recently occurred;

• and testing for MeRs-CoV is inconclusive. (see annex 4.5)

1.1.3. Definition 3

• an acute febrile respiratory illness of any severity;

• and direct epidemiologic link2 with a laboratory-confirmed MeRs-CoV case;

• and testing for MeRs-CoV is inconclusive. (see annex 4.5)

1.2. CONFIRMED CASE

a person with laboratory confirmation of MeRs-CoV infection, irrespective of clinical signs and symptoms.

1 “Middle east respiratory syndrome Case definition for reporting to Who Interim case definition 26 July 2017“ http://www.who.int/csr/disease/coronavirus_infections/mers-interim-case-definition.pdf?ua=1

2 in immunodeficient patients the infection can present with only diarrhea.

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ANNEX 2. DIRECT EPIDEMIOLOGICAL LINK

2.1. DEFINITION

a direct epidemiological link with a confirmed MeRs-CoV patient may include:

• health care associated exposure, including providing direct care for MeRs-CoV patients, working with health care workers infected with MeRs-CoV, visiting patients or staying in the same close environment of a individuals infected with MeRs-CoV.

• Working together in close proximity or sharing the same environment with individuals infected with MeRs-CoV.

• traveling together with individuals infected with MeRs-CoV in any kind of conveyance

• living in the same household as individuals infected with MeRs-CoV.

• the epidemiological link may have occurred within a 14-day period before or after the onset of illness in the case under consideration.

2.2. LIST OF COUNTRIES WITH CASES IN 2017 AND 2018

(situation on 11/06/2018)

at the end of May 2018, a total of 2220 laboratory-confirmed cases of Middle east respiratory syndrome (MeRs), including 790 associated deaths (case–fatality rate: 35.6%) were reported globally; the majority of these cases were reported from saudi arabia (1844 cases, including 716 related deaths with a case–fatality rate of 38.8%).

Country number of cases in 2017

number of cases in 2018

saudi arabia 237 83

united arab emirates 7 1

Qatar 3

oman 2 1

lebanon 1

Malaysia 1

total 251 85

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ANNEX 3. CONTACT TRACING3,4

3.1. DEFINITION CLOSE CONTACT

a close contact is defined as a healthcare worker or family member providing direct patient care or anyone who had prolonged (>15 minutes) face-to-face contact with a probable or confirmed symptomatic case in any closed setting. ~ to have had a direct epidemiological link with a probable or confirmed symptomatic case

3.2. CONTACT IDENTIFICATION AND LISTING

once a case is confirmed, contacts are identified by asking about the activities of the case and the activities and roles of the people around the case since onset of illness.

all persons considered to have had significant exposure should be listed as contacts.

efforts should be made to physically identify every listed contact and inform them of their contact status, what it means, the actions that will follow, and the importance of receiving early care if they develop symptoms. the contact should also be provided with preventive information.

3.3. FOLLOW-UP BY TYPE OF CONTACT

Asymptomatic close contact of confirmed MERS-CoV case and unprotected healthcare workers (HCW)

Asymptomatic protected healthcare worker contact

Active monitoring of symptoms until day 14 after last exposure. (Contact is daily actively called by the responsable health professional)

Passive self-monitoring of symptoms until day 14 after last exposure

follow-up:

• twice daily temperature measurements (rectal or oral)

• alert for symptoms: fever and/or cough and/or diarrhea

3.4. CONTACT TRACING ON FLIGHTS

It is advisable for countries to trace contacts of confirmed MeRs cases on flights in accordance with the guidelines for saRs contact tracing in RaGIda5, regardless of flight time. flight attendants should follow the Iata guidelines for infection control. Captains should radio ahead to the destination airport, informing officials of a suspected MeRs-CoV case on board. Passengers should provide identification and contact details to the health authorities within 14 days of the flight (in order to facilitate contact tracing).

If a passenger is suspected of having MeRs-CoV infection during a flight, the potentially infectious pas-senger should be isolated and provided with a surgical face mask. Priority for contact tracing efforts should be given to:

• passengers seated in the same row as the case

• passengers seated two rows in front or behind the case

• all crew members

• passengers providing care for the case

3 eCdC factsheet about Middle east respiratory syndrome coronavirus (MeRs-CoV)4 Who guidelines for investigation of cases of human infection with Middle east Respiratory syndrome Coronavirus (MeRs-

CoV); July 20135 european Centre for disease Prevention and Control. Risk assessment guidelines for infectious diseases transmitted on

aircraft (RaGIda) - Influenza. stockholm: eCdC; 2014

nbossuyt

Sticky Note

vervang "responsable health professional" door "regional public health authorities"

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• passengers living in the same household as the case.

• passengers having had >15 minutes of face-to-face contact with the case

• passengers having had contact with respiratory secretions of the case

depending on the clinical presentation of the case during the flight and feasibility, extending the tracing of contacts beyond three rows to possibly include all passengers and crew members may be considered.

If a crew member is the index case and if all passengers cannot be contacted, efforts should concentrate on passengers seated in the area where the crew member was working during the flight. In addition, all other members of the crew should be traced.

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ANNEX 4. BIOLOGICAL SAMPLING AND LABORATORY CONFIRMATION OF MERS-COV INFECTION

4.1. SAMPLING BY TYPE OF CASE / CONTACT6,7

Probable case Confirmed case Asymptomatic close contact of confirmed MERS-CoV case and unprotected HCW

Asymptomatic protected healthcare worker (HCW) contact

Immediately collect

• upper and if possible lower respiratory tract samples (sputum, Bal, oropharyngeal swabs, nasopharyngeal swabs)

• and serum sample (+ collect second sample minimum 21 days later)

Collect at least weekly (but preferably each 2 - 4 days) a respiratory tract sample.

following the first negative Rt-PCR test, collect daily a respiratory tract sample, until two consecutive upper respiratory tract samples (oropharyngeal swabs) taken at least 24 hours apart test negative on Rt-PCR in a clinically recovered patient (can last beyond 27 days). (see annex 5))

Collect on day 7 after exposure

• oropharyngeal sample

• serum sample


• oropharyngeal sample


• serum sample

no biological sampling

send the samples to the nRC Respiratory Pathogens after contacting Prof. Marc Van Ranst (0475/510158) or sophie Patteet (016/341502)

6 Based on “laboratory testing for Middle east respiratory syndrome coronavirus (MeRs-CoV) Interim guidance updated June 2015”

7 Based on “Investigation of cases of human infection with Middle east respiratory syndrome coronavirus (MeRs-CoV) Interim guidance updated 3 July 2015”

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see https://www.wiv-isp.be/epidemio/nRC/foRMs/aanvraagformulier_respiratoire.pdf

https://www.wiv-isp.be/Epidemio/NRC/FORMS/Aanvraagformulier_respiratoire.pdf

nbossuyt

Sticky Note

vervang "See" door "See page 2 of"

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4.2. CONFIRMATION8

a case may be laboratory confirmed by detection of viral nucleic acid or serology:

• the presence of viral nucleic acid can be confirmed by eithero positive results for nucleic acid amplification assays, such as reverse transcription

polymerase chain reaction (Rt-PCR), for at least two specific genomic targets

o or a single positive target with sequencing of a second target.

• a case confirmed by serology requires demonstration of sero-conversion in 2 samples ideally taken at least 14 days apart, by a screening (elIsa, Ifa) and a neutralization assay.

8 from “laboratory testing for Middle east respiratory syndrome coronavirus (MeRs-CoV) Who Interim guidance updated June 2015”

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4.3. ALGORITHM FOR TESTING CASES UNDER INVESTIGATION FOR MERS-COV BY RRT-PCR8

4.4. INADEQUATE SPECIMEN

an inadequate specimen would include

• a nasopharyngeal swab without an accompanying lower respiratory specimen,

• a specimen that has had improper handling, is judged to be of poor quality by the testing labora-tory, or was taken too late in the course of illness.

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4.5. PROCEDURE IN CASE OF AN INCONCLUSIVE LABORATORY TEST

Patients with an inconclusive initial test should undergo additional virologic and serologic testing to deter-mine if the patient can be classified as a confirmed MeRs case.

It is strongly advised that multiple lower respiratory tract specimens such as sputum, endotracheal aspi-rate, or bronchoalveolar lavage fluid be collected and tested when possible.

If patients do not have signs or symptoms of lower respiratory tract disease and lower tract specimens are not available or clinically indicated, both nasopharyngeal and oropharyngeal swab specimens should be collected.

If initial testing of a nasopharyngeal swab is negative in a patient who is strongly suspected to have MeRs-CoV infection, patients should be retested using a lower respiratory specimen tract or a repeat nasopha-ryngeal specimen with additional oropharyngeal specimen if lower respiratory tract specimens are not possible and appropriately timed paired acute and convalescent sera.

other types of clinical specimens could also be considered for molecular testing if necessary, including blood/serum, urine and stool. these generally have lower titers of virus than respiratory tract specimens but have been used to confirm cases when other specimens were inadequate or unobtainable.

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AN

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nbossuyt

Sticky Note

Vervang "“Strict isolation in hospital (CHU St. Pierre, Brussels) " door “Strict isolation in a hospital that can provide the required infection prevention and control measures ( e.g. CHU St. Pierre, Brussels) "

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l gen

erat

ing

proc

edur

es) a

irbor

ne p

reca

utio

ns.

hom

e is

olat

ion

base

d on

5h

ospi

tal i

sola

tion

base

d on

13,

6 ,7

Isol

atio

n- l

imit

cont

act w

ith th

e ill

per

son

as m

uch

as p

ossi

ble

(diff

eren

t roo

m, >

1 m

dis

tanc

e)- a

nyon

e w

ho is

at

incr

ease

d ris

k of

sev

ere

dise

ase

does

not

car

e fo

r th

e ill

per

son

or

com

e in

to c

lose

con

tact

with

the

ill p

erso

n-

avo

id o

ther

typ

es o

f ex

posu

re t

o th

e ill

per

son

or c

onta

min

ated

ite

ms

in t

he

imm

edia

te e

nviro

nmen

t of

the

ill p

erso

n; fo

r ex

ampl

e, a

void

sha

ring

eatin

g ut

ensi

ls, d

rinks

, tow

els,

was

hclo

ths

or b

ed li

nen.

- Pat

ient

in si

ngle

room

or,

in c

ase

of c

onfir

med

pat

ient

, with

pat

ient

s with

sam

e di

agno

sis

- tra

nspo

rtat

ion

of p

atie

nt o

utsi

de o

f de

sign

ated

roo

m is

kep

t to

a m

inim

um+

pat

ient

sh

ould

wea

r med

ical

mas

k if

outs

ide

room

- ded

icat

e sp

ecifi

c eq

uipm

ent f

or u

se w

ith s

ingl

e pa

tient

In c

ase

of c

linic

al d

eter

iora

tion:

a s

epar

ate

ICu

room

.

hyg

iene

- han

d hy

gien

e fo

llow

ing

all c

onta

ct w

ith th

e ill

per

son

or h

is/h

er im

med

iate

env

ironm

ent a

nd im

med

iate

ly a

fter

rem

ovin

g an

y ite

m o

f PPe

- Res

pira

tory

hyg

iene

and

cou

gh e

tique

tte

hom

e is

olat

ion

base

d on

8h

ospi

tal i

sola

tion

base

d on

13,

9 ,10

PPe

- w

ithin

a 1

met

re r

ange

: c

areg

iver

sho

uld

wea

r a

med

ical

mas

k +

rem

ove

safe

ly

imm

edia

tely

aft

erw

ards

- hea

lth c

arer

sho

uld

avoi

d to

uchi

ng fa

ce, e

yes

or m

outh

with

(glo

ved)

han

ds-

use

dis

posa

ble

glov

es a

nd p

rote

ctiv

e cl

othi

ng (

e.g.

pla

stic

apr

ons)

to

prov

ide

oral

or

res

pira

tory

car

e, w

hen

hand

ling

stoo

l an

d ur

ine

and

whe

n cl

eani

ng o

r ha

ndlin

g su

rfac

es, c

loth

ing

or li

nen

soile

d w

ith b

ody

fluid

s.

- with

in a

1 m

etre

rang

e : u

se g

love

s, g

own,

eye

wea

r and

med

ical

mas

k +

rem

ove

safe

ly

imm

edia

tely

aft

erw

ards

- hea

lth c

arer

sho

uld

avoi

d to

uchi

ng fa

ce, e

yes

or m

outh

with

(glo

ved)

han

ds

Vent

ilatio

n/w

hen

perf

orm

ing

aero

sol-

gene

ratin

g pr

oced

ures

shar

ed s

pace

s (e

.g.

kitc

hen,

bat

hroo

m)

and

the

ill p

erso

n’s

room

sho

uld

be w

ell

vent

ilate

d (e

.g. k

eep

win

dow

s op

en)

- Pla

ce p

atie

nt in

airb

orne

pre

caut

ion

room

with

>=

12

air c

hang

es/h

our p

lus

cont

rol o

f ai

rflow

dire

ctio

n-

use

par

ticul

ate

resp

irato

r w

hen

ente

ring

and

prov

idin

g ca

re w

ithin

pat

ient

isol

atio

n fa

cilit

ies

16se

e “R

apid

adv

ice

note

on

hom

e ca

re fo

r pat

ient

s w

ith M

iddl

e ea

st re

spira

tory

syn

drom

e co

rona

viru

s (M

eRs-

CoV

) inf

ectio

n pr

esen

ting

with

mild

sym

ptom

s an

d m

anag

emen

t of c

onta

cts.

Wh

o, 2

013.

” 17

see

“Inf

ectio

n co

ntro

l str

ateg

ies

for s

peci

fic p

roce

dure

s in

hea

lth-c

are

faci

litie

s : a

qui

ck re

fere

nce

guid

e : e

pide

mic

-pro

ne a

nd p

ande

mic

-pro

ne a

cute

resp

irato

ry d

isea

ses.

Wh

o, 2

008.

” 18

see

“Clin

ical

man

agem

ent o

f sev

ere

acut

e re

spira

tory

infe

ctio

n w

hen

Mid

dle

east

resp

irato

ry s

yndr

ome

coro

navi

rus

(MeR

s-Co

V) i

nfec

tion

is s

uspe

cted

. Wh

o, 2

015.

”

17

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oW

Cha

Rt

hom

e is

olat

ion

base

d on

11h

ospi

tal i

sola

tion

base

d on

13,

12,13

Clea

ning

and

laun

dry

dis

card

mat

eria

ls u

sed

to c

over

the

mou

th o

r nos

e, o

r cle

an th

em a

ppro

pria

tely

aft

er u

se (e

.g.

was

h ha

ndke

rchi

efs

usin

g re

gula

r soa

p or

det

erge

nt a

nd w

ater

).ea

ting

uten

sils

and

dis

hes

shou

ld b

e cl

eane

d w

ith s

oap

and

wat

er a

fter

use

.Cl

ean

freq

uent

ly t

ouch

ed s

urfa

ces

such

as

beds

ide

tabl

es,

bedf

ram

e, a

nd o

ther

bed

room

fu

rnitu

re d

aily

with

regu

lar h

ouse

hold

cle

aner

s or

a d

ilute

d bl

each

14 s

olut

ion

(1 p

art

blea

ch to

99

part

s w

ater

).Cl

ean

bath

room

and

toile

t sur

face

s dai

ly w

ith re

gula

r hou

seho

ld c

lean

ers o

r a d

ilute

d bl

each

22

solu

tion

(1 p

art b

leac

h to

9 p

arts

wat

er).

Clot

hes,

bed

clot

hes,

bat

h an

d ha

nd to

wel

s, e

tc.,

of th

e ill

per

son

can

be c

lean

ed u

sing

regu

lar

laun

dry

soap

and

wat

er,

and

drie

d th

orou

ghly

. Pl

ace

cont

amin

ated

lin

en i

nto

a la

undr

y ba

g. s

oile

d la

undr

y sh

ould

not

be

shak

en a

nd d

irect

con

tact

of t

he s

kin

and

clot

hes

with

the

cont

amin

ated

mat

eria

ls fr

om th

e ill

per

son

shou

ld b

e av

oide

d.

Was

te m

anag

emen

tG

love

s, t

issu

es, m

asks

, and

oth

er w

aste

gen

erat

ed b

y th

e ill

per

son

or in

the

car

e of

the

ill

pers

on s

houl

d be

bag

ged

(pla

ced

in a

line

d co

ntai

ner i

n th

e ill

per

son’

s ro

om) b

efor

e di

spos

al w

ith o

ther

hou

seho

ld w

aste

.

19 s

ee “R

apid

adv

ice

note

on

hom

e ca

re fo

r pat

ient

s w

ith M

iddl

e ea

st re

spira

tory

syn

drom

e co

rona

viru

s (M

eRs-

CoV

) inf

ectio

n pr

esen

ting

with

mild

sym

ptom

s an

d m

anag

emen

t of c

onta

cts.

Wh

o, 2

013.

” 20

see

“Inf

ectio

n co

ntro

l str

ateg

ies

for s

peci

fic p

roce

dure

s in

hea

lth-c

are

faci

litie

s : a

qui

ck re

fere

nce

guid

e : e

pide

mic

-pro

ne a

nd p

ande

mic

-pro

ne a

cute

resp

irato

ry d

isea

ses.

Wh

o, 2

008.

” 21

see

“Clin

ical

man

agem

ent o

f sev

ere

acut

e re

spira

tory

infe

ctio

n w

hen

Mid

dle

east

resp

irato

ry s

yndr

ome

coro

navi

rus

(MeR

s-Co

V) i

nfec

tion

is s

uspe

cted

. Wh

o, 2

015.

” 22

Mos

t hou

seho

ld b

leac

h so

lutio

ns c

onta

in 5

% s

odiu

m h

ypoc

hlor

ite.

18

deC

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Rt

ANNEX 7. TRANSFER TO CHU SAINT-PIERRE

• Confirmed and probable symptomatic cases should be admitted to hospital whenever possible.9,10

• for the benefit of the patient, it is preferable to decide upon the transfer of the patient asaP. In case of clinical deterioration, the transfer becomes more risky for the patient and more difficult to organise.

• When the decision to transfer the patient is taken, it should be to the reference hospital for infec-tious pathogens (Chu saint-Pierre)

• transport of patient to Chu saint-Pierre needs to be discussed with health inspector in agreement with Chu saint-Pierre. (during working hours: 02/535.50.09; outside working hours: 0479/83.80.13 or 02/535.31.11)

• a dedicated ambulance should be used. Public transportation to the health care facility should be avoided.

• While traveling to seek care, the ill individual should wear a medical mask, perform appropriate hand hygiene and respiratory hygiene and should stand or sit as far away from others as possible. open the windows of the vehicle if possible.

• surfaces soiled during transport should be cleaned with regular household cleaners or a diluted bleach solution.

9 see “Rapid advice note on home care for patients with Middle east respiratory syndrome coronavirus (MeRs-CoV) infec-tion presenting with mild symptoms and management of contacts. Who, 2013.”

10 https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/Middle-east-respiratory-syndrome-coronavirus-risk-assessment-25-april-2014.pdf

https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/Middle-East-respiratory-syndrome-coronavirus-risk-assessment-25-April-2014.pdf


19

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oW

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ANNEX 8. SAMPLING INSTRUCTIONS FOR RESPIRATORY SAMPLES

8.1. TYPE OF SAMPLE

• bronchoalveolar lavage fluid (preferably) (minimum volume: 0,5 ml)

• nasopharyngeal aspirate (volume minimal : 0,5 ml)

• nasopharyngeal swab (see procedure)

8.2. COMPLETE QUESTIONNAIRE, PARTS A AND B

20

PRo

Céd

uRe

de

PRél

èVeM

ent

Pou

R le

s fR

otI

Is n

aso

Pha

Ryn

Gés

PROCÉDURE DE PRÉLÈVEMENT POUR LES FROTIIS NASOPHARYNGÉS

• Matériel: coton, dracon ou de préférence “flocked swabs” dans un milieu de transport universel ou de virus

• a laide d’un premier écouvillon préléver le plus possible de cellules en introduisant l’écouvillon profondément dans une narine. effectuer quelques mouvements de rotation. Procéder de même au niveau de l’autre narine.

• Mettre l’écouvillon dans le tube de transport et casser l’extrémité de la tige. Puis à l’aide d’un deuxième écouvillon, procéder de même au niveau des zones inflammatoires au fond de la gorge (amydales). Mettre l’écouvillon dans le tube contenant le milieu de transport et casser l’extrémité de la tige. fermer de tube hermétiquement.

• Identifier l’échantillon: o Référence du patient: il doit s’agir d’un code

o la date de pélèvement

o Médecin: coordonnées du médecin qui a réalisé le prélèvement.

• Placer le sachet “minigrip” dans un emballage parfaitement hermétique

• tous les échantillons doivent être conservés à 4°C avant l’envoi

21

ho

e n

aso

faRy

nG

eale

sta

len

neM

en?

HOE NASOFARYNGEALE STALEN NEMEN?

• Materiaal: katoen, dacron of liefst flocked swabs» in een universeel- of virustransportmilieu

• Breng een eerste wattenstaafje diep in het neusgat en maak zoveel mogelijk cellen los door langs de binnenkant van een neusgat te schrapen. Ga met hetzelfde wattenstaafje op dezelfde manier te werk om een staal te nemen van het andere neusgat.

• Plaats het wattenstaafje in de tube met transportmilieu en breek het uiteinde van de steel af.

• Ga met het tweede wattenstaafje op dezelfde manier te werk om een staal te nemen van de ontstoken zones in de keel (amandelen, keelwand, etc.). Plaats het wattenstaafje in de tube met transportmilieu en breek het uiteinde van de steel af.

• sluit het flesje hermetisch.

• het staal identificeren:o Referentie van de patiënt: onder de vorm van een code

o datum van staalname

o arts: Coördinaten van de behandelende arts die het staal heeft afgenomen.

• Plaats de transporttube in een “Minigrip” zakje en sluit hermetisch

• In afwachting van verzending, bewaar de stalen in de koelkast (+4°C).

22

ho

e n

aso

faRy

nG

eale

sta

len

neM

en?

ANNEX 9. QUESTIONNAIRE

Part A: Questionnaire to be completed at hospital admission

Hospital Reference: ______________________

date of the notification____/____/____ (dd/mm/yyyy)

Institution_______________________________________

Identification of the person notifying the case (name, function, e-mail, telephone)

________________________________________________________________________________

Identification of the patient

sex M f

date of birth (dd/mm/yyyy)____/____/____ or age (year if >=2, months if < 2years)

Country of residence: _____________________________________________________________

the patient is health professional yes no unknown

Hospitalisation

date of hospitalisation (dd/mm/yyyy) : ……/……../ ……….

Referred from other hospital/institution yes no

If referred, specify:

Signs and symptoms

date of onset (dd/mm/yyyy) ____/____/____

t° > 38°C yes no unknown

history of t° yes no unknown

Cough yes no unknown

dyspnoea yes no unknown

aRds yes no unknown

other significant: _________________________

X-ray

thoracic X-ray yes no

Infiltrate/pneumonia yes no

23

ho

e n

aso

faRy

nG

eale

sta

len

neM

en?

Severity at admission

ICu yes no

Mechanical ventilation yes no

Referred to other hospital yes no

If referred, specify:

Laboratory samples

date of the sample (dd/mm/yyyy) …./…./….

sent to reference laboratory uZ leuven WIV-IsP no

first serum taken (acute phase) yes no date (dd/mm/yyyy) …./…./….

second serum taken (convalescence) yes no date (dd/mm/yyyy) …./…./….

Exposure

Contact with a confirmed case in the 14 days before onset?

yes no unknown

If yes, specify (country, date, event):

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Contact with animals in a foreign country in the 14 days before onset?

yes no unknown

If yes, specify (country, date, event):

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

24

ho

e n

aso

faRy

nG

eale

sta

len

neM

en?

History of travel in a foreign country in the 14 days before onset No yes

If yes, fill in the following table:

Country Place from dd/mm/yyyy to dd/mm/yyyy

flight coordinates at departure (for any flight in the last 14 days)

airport Company flight nb seat nb date time

25

ho

e n

aso

faRy

nG

eale

sta

len

neM

en?

Part B: List of close contacts

Page ….. / ……. Date ……/………/………

Hospital Reference: ________________ WIV-ISP: ________________

name Cat.* Coordinates

1

2

3

4

5

6

7

8

9

10

11

12

h = household ; hW = health worker ; C = colleagues, classmate ; o = other

26

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e n

aso

faRy

nG

eale

sta

len

neM

en?

Part C: Laboratory results


Virology

Influenza neg

a B undetermined

h3 h1 h7 not sub-typable

MeRs Coronavirus neg pos undetermined

other coronavirus neg pos

RsV neg a B undetermined

adeno neg pos undetermined

Parainfluenza neg 1 2 3 4

hMPV neg pos und

enterovirus neg pos und

other important finding no yes If yes, specify

Bacteriology

27

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e n

aso

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nG

eale

sta

len

neM

en?

Part D: Outcome


Outcome

discharge status: alive death

date of discharge or death (dd/mum/yyyy): …../……/……..

Final classification : laboratory confirmed

laboratory negative

not a case or unclassified

28

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e n

aso

faRy

nG

eale

sta

len

neM

en?

ANNEX 10. (FOOTNOTES)

(1) see “Rapid advice note on home care for patients with Middle east respiratory syndrome coronavirus (MeRs-CoV) infection presenting with mild symptoms and management of contacts. Who, 2013.”

(2) https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/Middle-east-respiratory-syndrome-coronavirus-risk-assessment-25-april-2014.pdf

(3) see “laboratory testing for Middle east respiratory syndrome coronavirus (MeRs-CoV) Interim guidance updated June 2015”

(4) Immunocompromised, people with comorbidities, age > 65


(6) see “Infection control strategies for specific procedures in health-care facilities : a quick reference guide : epidemic-prone and pandemic-prone acute respiratory diseases. Who, 2008.”

(7) see “Clinical management of severe acute respiratory infection when Middle east respiratory syndrome coronavirus (MeRs-CoV) infection is suspected. Who, 2015.”







(14) Most household bleach solutions contain 5% sodium hypochlorite.



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