CDC Cites Authorization For MERS Isolation & Quarantine

Sunday, September 29, 2013
By Paul Martin
September 27, 2013

CDC has determined that federal isolation and quarantine are authorized for MERS-CoV under Executive Order 13295

The above comments are from today’s CDC update in the week 38 MMWR. The above executive order was put in place for the control of SARS-CoV in 2003, which is listed on the CDC page of quarantinable diseases. The determination that MERS-CoV falls under the order for SARS-CoV recognizes the similarities between the two virus and its clinical effects. SARS and MERS are beta coronaviruses (2b and 2c, respectively) and produce similar clinical presentation in older cases, especially those with underlying conditions. WHO had initially maintained that MERS was unique because of the high frequency of renal failure in initial cases. However, SARS also caused renal failure in approximately 5% of confirmed cases, which was associated with a poor prognosis.

The high frequency of renal failure in MERS was largely based on surveillance. Probable cases in Jordan were identified epidemiologically and/or via lab confirmation of MERS antibodies and none of the probable cases developed renal failure and the milder cases did not develop pneumonia. Similarly, more aggressive testing of contacts (family and health care workers) has led to PCR confirmation of cases which did not develop pneumonia or renal failure. These milder cases recovered quickly without treatment and many were asymptomatic.

However, the cases identified because of severe pneumonia with no known etiology have an case fatality rate that is higher than SARS and it is these more severe MERS cases that are likely to be subjected to the above executive order.

The latest MMWR reflects growing concerns that the upcoming Hajj may facilitate the spread of MERS to countries sending pilgrims to Saudi Arabia and many countries have increased surveillance of symptom travelers who arrive from the Middle East.

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