BACKGROUND: Identifying and testing patients who meet criteria for Middle East Respiratory Syndrome (MERS) patients under investigation (PUIs) is critical to ensure rapid case detection. Since January 2013, CDC has deployed MERS Coronavirus (MERS-CoV) real-time PCR assays to 47 states. CDC requires reporting of MERS PUI test results in accordance with FDA Emergency Use Authorization requirements. We describe the PUIs reported since 2013.
METHODS: We evaluated all available PUI reports using descriptive statistics and calculated descriptive statistics on data quality.
RESULTS: 889 MERS PUIs including 2 MERS-CoV positive cases (May 2014) were reported during January 1, 2013–November 16, 2016 across 47 states and the District of Columbia. PUI reports declined in 2016, from 232 during January 1-October 31 2015 to 114 during January 1-October 31 2016. Among PUIs, 794 (89%) had traveled to countries in or near the Arabian Peninsula (or South Korea during the South Korea outbreak) in the 14 days before symptom onset. The most commonly reported countries visited by PUIs include Saudi Arabia (389 PUIs [44%]), United Arab Emirates (154 PUIs [17%]), and Jordan (174 PUIs [8%]). Cough (82%), fever (81%), and shortness of breath (49%) were the most common symptoms reported. Hospitalization was reported for 584 (66%) PUIs; of those hospitalized 196 (34%) were admitted to the ICU, and 13 (2%) died. Median age of PUIs was 50 years (range, 2 months–95 years) and 553 (62%) were male. The most commonly reported non-MERS-CoV positive laboratory results were rhinovirus and/or enterovirus (8%), and influenza A (7%). However clinical data (3%–40% missing) and laboratory results for other respiratory pathogens (31%–55% missing or pending) were often unavailable.
CONCLUSIONS: MERS PUI surveillance facilitated rapid reporting of 2 MERS-CoV cases, and PUIs continue to be tested and reported. MERS PUI reports declined during 2016, consistent with the global decrease in reported MERS cases. Continued MERS PUI surveillance is essential for rapid identification of MERS-CoV cases, and continued monitoring of test use, but data quality could be improved.