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Middle East Respiratory Syndrome Coronavirus by PCR

MERS-CoV

Department

Send Outs

Instructions

• Prior approval for testing must be obtained from the Michigan Department of Health and Human Services (MDHHS) at 517-335-8165 (after hours phone number: 517-335-9030) before specimens are collected and transported. MDHHS will not approve testing unless the following criteria are fulfilled:
  1. The patient’s healthcare provider must complete the MERS Patient Under Investigation form. This form must be included with the specimen when it is sent to the Send Out Laboratory. The completed form must also be sent by fax to the Send Out Laboratory at 248-551-5365.
  2. The patient must have traveled to an endemic area or been in close contact with a person believed to be infected with MERS.
  3. The patient must have an illness with symptoms suggestive of that produced by the MERS virus.
• Specimens received without the appropriate forms and information will not be shipped to MDHHS.
• Once approved, order as a Miscellaneous Send Out (XMISC).

Specimen Collection Criteria

Collect all three specimen types but of the three specimen types, Lower Respiratory is the most important. All specimen types should be considered STAT. Arrange for transportation to the Laboratory immediately after collection.

Lower Respiratory

• Expectorated Sputum: Single productive cough specimen (not saliva) in a sterile collection container, preferably collected in the early morning. The patient should rinse his/her mouth with water prior to specimen collection.
• Bronchoalveolar Lavage: Submit in sterile, tightly capped collection container.
• Tracheal Aspirate: Submit in sterile, tightly capped collection container.

Upper Respiratory

• Nasopharyngeal (NP) Swab: Place in viral transport medium (i.e., UVT, UTM).
  • During collection, please remember to leave the NP swab in the patient's nasopharynx for 30 seconds and to gently rotate the swab to obtain an adequate specimen. Swab both nasopharyngeal areas. For more information, please refer to the Specimen Collection Manual for NP Swab Collection.
• Oropharyngeal Swab: Place in viral transport medium (i.e., UVT, UTM).
  • During collection, swab the posterior pharynx, avoiding the tonsils and tongue.

Blood

• Collect two Gold-top SST tubes. (Minimum Serum: 1.0 mL)
  • The first Gold-top SST tube should be collected within the first week of symptom onset (preferably within the first 10-12 days).
  • The second Gold-top SST tube should be collected during the acute phase of disease (14 or more days post onset).

NOTE: Prior approval for testing must be obtained from the Michigan Department of Health and Human Services (MDHHS) at 517-335-8165 (after hours phone number: 517-335-9030) before specimens are collected and transported.

Physician Office/Draw Specimen Preparation

Let SST specimens clot 30-60 minutes then immediately centrifuge to separate serum from cells. Refrigerate (2-8°C or 36-46°F) the centrifuged SST tube within two hours of collection. (Minimum: 1.0 mL)

Prior approval for testing must be obtained from the Michigan Department of Health and Human Services (MDHHS) at 517-335-8165 (after hours phone number: 517-335-9030) before specimens are collected and transported. Once approved, collect specimen and arrange for transport to the Laboratory immediately.

Preparation for Courier Transport

Transport: Refrigerated (2-8°C or 36-46°F), with the completed MERS Patient Under Investigation form

Rejection Criteria

• Specimens submitted without prior approval for testing from the Michigan Department of Health and Human Services (MDHHS).
• Specimens in bacterial transport systems.
• Specimens submitted on cotton or calcium alginate swabs or on wood shaft swabs.
• Specimens submitted on dry swabs.
• Specimens not collected and processed as indicated.

Inpatient Specimen Preparation

• Prior approval for testing must be obtained from the Michigan Department of Health and Human Services (MDHHS) at 517-335-8165 (after hours phone number: 517-335-9030) before specimens are collected and transported. MDHHS will not approve testing unless the following criteria are fulfilled:
  1. The patient’s healthcare provider must complete the MERS Patient Under Investigation form. This form must be included with the specimen when it is sent to the Send Out Laboratory. The completed form must also be sent by fax to the Send Out Laboratory at 248-551-5365.
  2. The patient must have traveled to an endemic area or been in close contact with a person believed to be infected with MERS.
  3. The patient must have an illness with symptoms suggestive of that produced by the MERS virus.
• Specimens received without the appropriate forms and information will not be shipped to MDHHS.
• Once approved, collect specimen and arrange for transport to the Laboratory immediately.

In-Lab Processing

• Blood: Let SST specimens clot 30-60 minutes then immediately centrifuge to separate serum from cells. Refrigerate (2-8°C or 36-46°F) the centrifuged SST tube within two hours of collection. (Min: 1.0 mL)
• Respiratory Specimens: Maintain all other specimens refrigerated (2-8°C or 36-46°F) prior to transport.

Prior approval for testing must be obtained from the Michigan Department of Health and Human Services (MDHHS) at 517-335-8165 (after hours phone number: 517-335-9030) before specimens are collected and transported.

Transport: Refrigerated (2-8°C or 36-46°F), with the completed MERS Patient Under Investigation form

Storage

Specimen Stability for Testing:

Room Temperature (20-26°C or 68-78.8°F): Unacceptable
Refrigerated (2-8°C or 36-46°F): 72 hours
Frozen (-20°C/-4°F or below): 1 month

Specimen Storage in Department Prior to Disposal:

No specimens will be stored in the Laboratory.

Laboratory

All testing is performed by the Michigan Department of Health and Human Services following acquisition of approval for testing from that institution.

Performed

Monday – Friday.
Results available in 1-3 days.

Reference Range

Negative.

Test Methodology

Nucleic Acid Amplification (real-time PCR, CDC methodology)/Serology (IgM).

Interpretation

This assay determines the presence of nucleic acid (RNA) from the Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) in clinical specimens from patients in the first two weeks of their illness and who have been exposed to persons or animals with the disease. The serologic assay determines the presence of antibodies to MERS-CoV after the first four days of their illness.

Clinical Disease

MERS-CoV causes both upper and lower respiratory disease. Pneumonia due to MERS-CoV ranges from mild to severe and may require hospitalization including ICU management. In some cases, kidney failure has developed. There may be gastrointestinal symptoms including nausea, vomiting and diarrhea and these may precede the respiratory disease. Asymptomatic infections have been noted through contact investigations. As of June 10, 2015, the World Health Organization has reported the fatality rate of laboratory confirmed cases was approximately 37%.

Epidemiology

In 2012, a novel human coronavirus was reported as the etiology of severe community-acquired pneumonia. This virus is now known as the Middle Eastern Respiratory Syndrome Coronavirus. Since that time, cases have continued to be detected in the Arabian Peninsula with a few travel-related cases detected elsewhere. In the spring of 2014, there has been a remarkable increase in the number of cases of MERS-CoV infection as well as an increase in the number of countries reporting cases. The World Health Organization Emergency Committee reviewed the situation and found “no sustained chains of human-to-human transmission” but stated concern about the trend.

Incubation Period

The incubation period is unknown. However for secondary cases of human-to-human transmission, the median incubation period is 5 days (range 3-12 days).

Transmission

Little is known about the transmission of this virus. The virus does not seem to pass easily from person to person unless there is close contact, such as occurs when providing unprotected care to a patient. There have been clusters of cases in health-care facilities, where human-to-human transmission appears to be more efficient, especially when infection prevention and control practices are inadequate. Thus far, no sustained community transmission has been documented. The MERS virus has been isolated from camels in Egypt, Qatar, and Saudi Arabia and other reservoirs may exist.

Reference

1. http://www.cdc.gov/coronavirus/mers/index.html
2. http://www.asm.org/images/MERSGuidance.pdf
3. http://www.idsociety.org/Breaking_News_and_Alerts/CDC_HAN/Updated_Information_and_Guidelines_for_Evaluation_of_Patients_for_Middle_East_Respiratory_Syndrome_Coronavirus_(MERS-CoV)_Infection_(content)/

Contacts

Last Updated

4/8/2024