1. Screening of Human and Animal Sera from Egypt and Hong Kong Perera et al. Euro Surveill. 2013;18(36):pii=20574 Sampled 1343 Human, 625 animals

2. Treatment SARS: definitive treatment regimen was not clearly established MERS CoV: Interferon alpha 2b + ribavirin in vitro 1 Recent study in Macaque monkeys 2 No clear data on human treatment 1 Falzarano D et al. Sci Rep 3 2013:1686 2 Falzarano D et al. Nature Medicine 2013 pub online 9/8/13

3. Vaccines SARS vaccines were in development Possible MERS vaccines: – VLP/nanoparticles with S protein – Constitutive expression of S protein in cell culture Developmental stages

4. Domestic Activities Case definition and guidance developed and disseminated 5 MMWRs published 3 health advisories sent to state/local health departments Investigating persons with travel link, severe respiratory illness – 100 samples/31 states: all negative Serology developed – MERS-CoV ELISA, MERS-CoV IFA and MERS-CoV MNt PCR diagnostics developed and distributed

5. A person with the following characteristics: Fever (≥38°C, 100.4°F) and pneumonia or acute respiratory distress syndrome (based on clinical or radiological evidence); AND EITHER History of travel from countries in or near the Arabian Peninsula within 14 days before symptom onset; OR Close contact with a symptomatic traveler who developed fever and acute respiratory illness (not necessarily pneumonia) within 14 days after traveling from countries in or near the Arabian Peninsula; OR Is a member of a cluster of patients with severe acute respiratory illness (e.g. fever and pneumonia requiring hospitalization) of unknown etiology in which MERS-CoV is being evaluated, in consultation with state and local health departments. CDC Case Definition Patient Under Investigation (PUI) http://www.cdc.gov/coronavirus/mers/case-def.html

6. Epidemiology Tool Kit Patient Under Investigation Form

7. Surveillance Plan: Phasic Response Tiers TierDescriptionNational Surveillance Goals 0 No cases in the US, threat of importation, low risk of large-scale outbreak Utilize key public health networks and current relevant surveillance programs for other pathogens or similar clinical syndromes 1 Imported case(s) linked to exposure in an endemic country Geographically focused monitoring of routine surveillance networks Potential expanded testing from inpatient and outpatient settings in affected area 2 Secondary or tertiary cases linked to a primary case with known exposure in an endemic country Expanded testing from inpatient and outpatient settings in affected area Enhance non-local surveillance by expanding case finding efforts or testing in existing programs Possible modification of surveillance platforms and development of new surveillance 3 Index case in the US without endemic country exposure or efficient transmission of several generations from imported case Active inpatient, outpatient and community setting surveillance in affected and priority areas Passive, but broad case finding nationally

8. Domestic Deployment of CDC MERS-CoV rRT-PCR Assay by LRN

10. Infection Prevention and Control Recommendations Standard, Contact and Airborne Precautions – N95 respirators if available – Airborne infection isolation rooms Similar recommendations as SARS – High mortality – Human-to human transmission – Unknown modes of transmission – No vaccine or chemoprophylaxis

11. Infection Control: Checklists Prompt triage and testing of patients Prioritization of available isolation rooms Plans for appropriate cohorting of patients and personnel Training Sick leave policy