Consider MERS in Returning Travelers from the Arabian Peninsula 1 : Reminder to Screen for International Travel in Persons with Acute, Possibly Infectious Illness
August 2, 2019
With the annual Hajj pilgrimage occurring from August 9 to 14, 2019, thousands of Americans will be joining approximately two million Muslims in Mecca, Saudi Arabia. Crowded conditions increase the risk of communicable diseases, including respiratory and diarrheal illnesses.  Orange County Health Care Agency (HCA) Communicable Disease Control (formerly known as Epidemiology and Assessment) reminds healthcare providers in hospitals, emergency departments and clinics that a best practice continues to be to routinely ask patients with acute and possibly infectious illness about recent international travel.

One disease of particular concern in the Arabian Peninsula is Middle East Respiratory Syndrome Coronavirus (MERS-CoV or MERS), which is associated with severe acute respiratory illness. Although MERS infections are rare, there is no vaccine or specific treatment, the case fatality rate for MERS is about 35%, and healthcare transmission, including to healthcare workers, has occurred on numerous occasions. Since the disease was first recognized in 2012, all cases have been linked through travel to, or residence in, countries in and near the Arabian Peninsula. However, limited transmission in other countries, including a large outbreak in the Republic of Korea, has occurred from travelers from the Arabian Peninsula. Cases continue to be identified in the Arabian Peninsula, 1 with the most recent cases reported in Saudi Arabia in the past few months.  
Recommendations before International Travel
Prepare your patients for international travel by consulting the CDC Travelers’ Health website for vaccine and medication recommendations by destination, based on their underlying risk factors, planned activities, and potential exposures. Additional health-related topics for discussion during the pre-travel consultation are provided in the Pre-Travel Quick Guide.
Provider Recommendations for Returning Travelers
  • Routinely ask patients with signs or symptoms of acute, possibly infectious illness about recent travel.
  • Consider MERS-CoV infection in persons under investigation (PUIs) who meet clinical and epidemiologic criteria for MERS (see box next page).
  • Immediately isolate suspect PUIs for MERS utilizing standard, contact and airborne precautions.
  • Place patient in an Airborne Infection Isolation Room (AIIR) and utilize personal protective equipment (PPE) upon entry into the patient room or care area, including at minimum gloves, gowns, respiratory protection at least as protective as a fit-tested N-95 respirator, and eye protection. 
  • See for more information.
  • Notify HCA Communicable Disease Control Division immediately by phone at 714-834-8180 of any PUIs for MERS. Guidance will be provided on specimen collection and contact management for PUIs meeting criteria.

1 Note: Arabian Peninsula and neighboring areas include Bahrain; Iraq; Iran; Israel, the West Bank and Gaza; Jordan; Kuwait; Lebanon; Oman; Qatar; Saudi Arabia; Syria; the United Arab Emirates (UAE); and Yemen; 
Contact Information
If you have any questions or concerns please contact Communicable Disease Control Program at (714) 834-8180.
If you do not currently receive our Provider Advisories you can add yourself to our email list via the button below.