This guideline is intended for health care workers (HCW) to assist in the management of a person who may be infected with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) or avian influenza A(H7N9) virus. This guideline includes Screening, Assessment, Treatment, Testing and Reporting phases. Each of the phases has key questions or indicators that determine whether the HCW should move on to the next phase, and considerations for infection control.
Screening is conducted upon arrival to the healthcare setting. The following are key components that staff should screen for, upon receiving an individual into the healthcare setting:
Does the patient have a new or worsening cough or shortness of breath and fever Footnote 1?
A more detailed assessment of risk and exposure should be conducted by a designated HCW, if the screening indicates a possible risk of infection.
Exposure risk assessment:
Within 14 days of illness onset, has the patient:
NOTE: Unusual severe acute respiratory illness (SARI) clusters in community or facility settings (and notably involving health care workers) should be appropriately investigated under the direction of local and provincial health authorities.
A close contact is defined as a person who provided care for the patient, including health care workers (except those wearing appropriate PPE), family members or other caregivers, or who had other similarly close physical contact OR who stayed at the same place (e.g. lived with or otherwise had close prolonged contact within two metres) as a probable or confirmed case while the case was ill. For additional details refer to the case definitions Footnote 5.
If ‘yes’ to any exposure question in Assessment:
If ‘no’ to any exposure question in Assessment:
If there a patient is positive for A(H7N9) or MERS-CoV, or there is a strong clinical suspicion that they will be, the following are recommended resources to aid clinicians:
Test for pathogen(s) according to Protocol for Microbiological Investigations of Severe Acute Respiratory Infections (SARI) Footnote 8. Follow infection prevention and control guidelines when collecting respiratory specimens Footnote 2. Be aware of approaches in your jurisdiction. For additional details on laboratory testing, refer to the surveillance guidelines Footnote 9.
Reporting patients under investigation to public health authorities, in a timely manner, is essential to ensuring a rapid response in the community, if required (e.g. investigating possible contacts and other cases). The following are the recommended steps for HCWs and local public health officials:
Elderly people and people who are immunocompromised may not have a febrile response to a respiratory infection, so the presence of new onset cough/shortness of breath may be enough to trigger further precautions.
Interim Guidance - Avian Influenza A (H7N9) Virus - Infection Prevention and Control Guidance for Acute Care Settings
Interim Guidance - Middle East respiratory syndrome coronavirus (MERS-CoV) - Infection Prevention and Control Guidance for Acute Care Settings
Laboratory Guidelines - Protocol for Microbiological Investigations of Severe Acute Respiratory Infections (SARI)