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Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Updates 
 
Note:  MERS-CoV used to be called “novel coronavirus,” or “nCoV”.
Coronavirus - MERS (CDC) - http://www.cdc.gov/coronavirus/
 
Testing for MERS-CoV at the Maryland State Lab:
 

Specimen Type and Priority To date, little is known about pathogenic potential and transmission dynamics of MERS-CoV. To increase the likelihood of detecting infection, it is recommended to collect specimens from different sites – for example a nasopharyngeal swab and a lower respiratory tract specimen such as sputum, bronchoalveolar lavage, bronchial wash, or tracheal aspirate. Specimens should be collected at different times after symptom onset, if possible. Consider lower respiratory tract, serum, and stool specimens a priority for collection and PCR testing. 

General Guidelines For short periods (≤ 72 hours), most specimens should be held at 2-8o C rather than frozen; for delays exceeding 72 hrs, freeze specimens at -70o C as soon as possible after collection (with exceptions noted below). Label each specimen container with the patient’s ID number, specimen type and the date the sample was collected. 

I. Collecting Respiratory Specimens 

A. Lower respiratory tract Broncheoalveolar lavage, tracheal aspirate, pleural fluid Collect 2-3 mL into a sterile, leak-proof, screw-cap sputum collection cup or sterile dry container. Refrigerate specimen at 2-8o C up to 72 hrs; if exceeding 72 hrs, freeze at -70o C and ship on dry ice. 

Sputum 

Have the patient rinse the mouth with water and then expectorate deep cough sputum directly into a sterile, leak-proof, screw-cap sputum collection cup or sterile dry container. Refrigerate specimen at 2-8o C up to 72 hrs; if exceeding 72 hrs, freeze at -70o C and ship on dry ice. 

B. Upper respiratory tract 

Use only synthetic fiber swabs with plastic shafts. Do not use calcium alginate swabs or swabs with wooden shafts, as they may contain substances that inactivate some viruses and inhibit PCR testing. Place swabs immediately into sterile tubes containing 2-3 ml of viral transport media. Refrigerate specimen at 2-8o C up to 72 hrs; if exceeding 72 hrs, freeze at -70o C and ship on dry ice. 

Nasopharyngeal swabs --Insert a swab into the nostril parallel to the palate. Leave the swab in place for a few seconds to absorb secretions. Swab both nostrils. Oropharyngeal swabs -- Swab the posterior pharynx, avoiding the tonsils and tongue. Collect 2-3 mL into a sterile, leak-proof, screw-cap sputum collection cup or sterile dry container. Refrigerate specimen at 2-8o C up to 72 hrs; if exceeding 72 hrs, freeze at -70o C and ship on dry ice. 

June 7, 2013 Page 1 of 3 Interim Guidelines for Collection, Processing and Transport of Clinical Specimens from Patients Under Investigation for Middle East

Respiratory Syndrome (MERS)

II. Blood Components 

Serum 

For eventual serum antibody testing: Serum specimens should be collected during the acute stage of the disease, preferably during the first week after onset of illness, and again during convalescence, ≥ 3 weeks later. 

Children and adults Collect 1 tube (5-10 mL) of whole blood in a serum separator tube. Allow the blood to clot, centrifuge briefly, and separate sera into sterile tube container. The minimum amount of serum required for testing is 200 µL. Refrigerate specimen at 2-8o C and ship on ice pack; freezing and shipment on dry ice is permissible. 

Infants A minimum of 1 cc of whole blood is needed for testing of pediatric patients. If possible, collect 1 cc in an EDTA tube and in a serum separator tube. If only 1cc can be obtained, use a serum separator tube. 

EDTA blood (plasma) Collect 1 tube (10 mL) of heparinized (green-top) or EDTA (purple-top) blood. Refrigerate specimen at 2-8o C and ship on ice-pack; do not freeze. 

III. Stool 

Collect 2-5 grams of stool specimen (formed or liquid) in sterile, leak-proof, screw-cap sputum collection cup or sterile dry container. Refrigerate specimen at 2-8o C up to 72 hrs; if exceeding 72 hrs, freeze at -70o C and ship on dry ice. 

Update, Case Definitions, and Guidance (CDC):

 
 
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