MERS-CoV: Reporting and Laboratory Testing

Republic of LebanonMinistry of Public Health

Epidemiological Surveillance ProgramMay 2014

Outline

• MOPH documents: MOPH website• Reporting• Specimen collection

www.moph.gov.lb

www.moph.gov.lb

Reporting

Reporting form

Reporting form

Hospital name:

Date of reporting: |___|___|_______|

A. Reporter

Physician name:

Mobile phone:

Reporting form

B. Patient information

Name:

Date of Birth:|___|___|_______|

Caza of residence:

Locality of residence:

Phone number:

Gender: M F

Nationality:

Residence:

Resident

Visitor

Refugee

Occupation:

Institution:

Reporting form

C. Signs and symptoms

Symptoms onset: |___|___|_______|

Fever (≥ 38°c ):

Cough:

If other, specify:

Dyspnea

Pathologic chest X-ray

Reporting form

D. Hospitalization

Hospitalized for this illness? Since |___|___|_______|

Patient admitted to ICU?

Since |___|___|_______|

Mechanical ventilation? Since |___|___|_______|

Reporting form

E. Clinical and paraclinical presentation

Cardiac arrest

Hypotension requiring vasopressors

Pregnancy

Other, specify

Diagnosis of pneumonia

Acute Respiratory Distress Syndrome (ARDS)

Acute Renal Failure

Multi-organ failure

Reporting form

F. Risk factors/Exposure in the 14 days prior to illness onset

Travel Where

Travel of Family member Where

Contact with confirmed MERS-CoV cases Who

Contact with non confirmed MERS-CoV Who

Contact with Severe Acute Respiratory Infection (SARI) Who

Health Care Worker Where

Reporting form

G. Comorbidities

Cancer

Diabetes

Chronic lung disease

Asthma

Hematogical disorder

H. Outcome

Remission Still Ill Death, date of death |____|____|_______|

Kidney failure

Chronic liver disease

Heart disease

Deficient immune system

Other, specify:

Reporting form

I. Specimens

Sputum date |____|____|_______|

Tracheal aspirate

date |____|____|_______|

Serum (paired sera)

date |____|____|_______|

J. Date and signature:

Broncholaveolar lavage

date |____|____|_______|

Nasal/throat swab

date |____|____|_______|

Blood EDTA date |____|____|_______|

Reporting to?

• Reporting to MOPH/ESUMOH central level–Fax: 01/610920

Specimen collection

Specimen type algorithmFirst choice:

Broncho alveolar lavage

Second choice: Tracheal aspirate (if intubated)

Third choice: Deep sputum

Fourth choice: Oropharyngeal or nasopharyngeal swab (in

VTM)

Specimen type: for intubated patient

Intubated patient

Tracheal aspirate: 2 specimens (with at least 24 h apart) preferably during the first 3 days of onset

Broncho alveolar lavage: if done

Acute serum (during the first week of onset)Convalescent sera: 3 or 4 weeks later

AND

AND

Specimen type: for non-intubated patient

Non-intubated patient

Sputum: 2 specimens (with at least 24 h apart) preferably during the first 3 days of onset

Broncho alveolar lavage: if done

Acute serum (during the first week of onset)Convalescent sera: 3 or 4 weeks later

AND

AND

Specimen type

Non-Intubated patient, with difficulty to

collect sputum

Oropharyngeal swab in VTM: 2 specimens (with at least 24 h) apart preferably during the first 3 days of onset

Broncho alveolar lavage: if done

Acute serum (during the first week of onset)Convalescent sera: 3 or 4 weeks later

AND

AND

Specimen recipient

In sterile recipient without additives

Tracheal aspirate

Broncho alveolar lavage: if done

Serum

In sterile recipient with Viral

Transport Media (VTM)

Oropharyngeal swab

Sputum

Nasopharyngeal swab

Specimen testing algorithmTest received at reference laboratory

Reporting form is filled for each suspected case, specifying all

variables. Form is sent by fax to MOPH, and sent with specimen.

Q2: Is the specimen adequately received?

Q1: Is there a reporting form?

Q3: Is there an approval from MOPH?

Specimen are kept at 4-8°C if transported within 48 h (other

wise minus 20°C), and transported in icebox with ice

packs, and well labeled.

Criteria for approval is to fulfil the MOPH case definition. Daily

list of approved request is shared between MOPH and

RHUH.

If 3 YES, the test is done.

YES

YES

YES

If no 3 YES, the test is not done.

NO

NO

NO

PPE during specimen collection

• Hand hygiene• Gloves• Long-sleeved gown• Eye protection• Mask:–Medical mask– If aerosol producing procedure: mask N95

Specimen referred to?

• Specimen sent to Rafic Hariri University Hospital–Dr Rita Feghaly–Reference test: RT-PCR

Specimen transportation

Labelling

• Patient name• Date of birth or age• Type of specimen• Date of collection

Local Packing

Local Transport

• In icebox• With ice packs