Response and measures following identification of a case of MERS-CoV infection in Norway. Fagseminar om MERS-CoV 25.

Transcription

1 Response and measures following identification of a case of MERS-CoV infection in Norway Fagseminar om MERS-CoV 25. September 2013

2 A patient with MERS-CoV infection is identified in Norway Investigating a case of MERS-CoV infection Contact tracing Contact monitoring Roles and responsibilities Examples from Italy and France

3 Where would a case be identified? Most likely in tertiary care Primary care Notified internationally (contact tracing) All HCW should consider: Norwegian travelers/patients transferred from abroad With pneumonia of unknown etiology/ards Within 14 days of travel to the Middle East

4 Notification in Norway HCW that suspect or have confirmed MERS-CoV in a patient must immediately notify the municipal health authority (kommuneoverlege) The municipal health authority must immediately notify FHI (Smittevernvakta) and fylkesmannen If it not possible to notify kommuneoverlegen, FHI should be contacted directly. Norway is required to report probable/confirmed cases to WHO within hours of identification Notification required by IHR-forskriften and MSIS-forskriften

5 Investigation An investigation should be initiated: With laboratory confirmation of a MERS-CoV case If a patient is strongly suspected to have a MERS-CoV infection Multidisciplinary team Frontline healthcare workers Municipal health authority (Kommuneoverlege) Folkehelseinstituttet Others?

6 Why investigate? Source/vector still unknown Need for up-to-date information Contact tracing: resource intensive but critical for containment Necessary for communication between frontline healthcare workers, local, national and international public health authorities

7 How did the case become infected? Exposures CASE OF MERS-COV Contact tracing Who could the case have infected?

8 How did the case become infected? Exposures CASE OF MERS-COV Contact tracing Who could the case have infected?

9 Case interviews Patient and/or family members should be interviewed within hours of identification Collection of demographic, clinical and epidemiological information WHO has developed a sample questionnaire (should be adapted to local context) Interview should be conducted by local personnel in collaboration with FHI May require collaboration of family or translators

10 Information to be collected: The following basic information should be collected: Date of symptom onset Date of admission/visit to healthcare facility Date of WHO notification Patient contact information Demographic information Occupation Date of sample collection, laboratory testing and specimen type

11 Exposure information Animal exposures Human exposures Food exposures Travel history

12 How did the case become infected? Exposures CASE OF MERS-COV Contact tracing Who could the case have infected?

13 Goals of contact tracing Promptly identify, evaluate and monitor close contacts of probable and confirmed cases Prevent spread from contact by monitoring for evidence of infection and the need for isolation Prioritize contacts to be monitored?

14 Who are close contacts? Any person who provided care for the patient, including a healthcare worker or family member, or had similarly close physical contact Any person who stayed at the same place (e.g. lived with, visited) as the patient while the patient was ill. Prolonged face-to-face contact (> 15 minutes) in any other enclosed setting

15 Settings in which contact tracing may be necessary Households Workplace Schools Social settings Healthcare facilities Transportation

16 Contact tracing after air travel Follow RAGIDA guidelines for SARS No time limit for flight Priority to: Passengers in the same row as the case Passengers three rows in front or behind the case All crew members Passengers providing care to the case Passengers having at least 15 minutes of face-to-face contact Passengers having had contact with respiratory secretions Passengers living in the same household

17 Contact monitoring Close contacts of confirmed or probable cases should be identified and monitored for 14 days after last exposure to case Information collected from close contacts: Date and setting of contact with case Any respiratory symptoms in 14-day period Use of PPE (healthcare workers) Consider active monitoring (daily visits or telephone calls) of contacts for development of symptoms

18 Symptomatic contacts Any contact that becomes ill during the 14-day period should be tested for MERS-CoV While under investigation, symptomatic contacts should limit interaction with others Contacts who develop mild symptoms should self-isolate at home (or be isolated in hospital if admitted) Neither quarantine or isolation of asymptomatic contacts seems necessary at this time

19 Survey of healthcare workers In order to detect person-to-person transmission Should be conducted among staff directly involved in care, staff working on the same ward and staff who provide intermittent care (e.g. radiologists, physical therapists) Collect information on: Timing, duration and intensity of contact Type of contact Use of PPE

20 Roles and responsibilities: Frontline healthcare workers Clinical management of suspected/confirmed cases Maintain appropriate infection control strategies/use of PPE among patients and staff Notify municipal health authorities (or FHI) of suspected/confirmed cases Conduct interview with patient/patient s family Identify close contacts in cooperation with municipal health authorities Monitor healthcare staff for development of symptoms Contribute to communication strategy

21 Roles and responsibilities: Municipal health authorities Notify Folkehelseinstituttet of suspected/confirmed cases Identify close contacts in cooperation with frontline healthcare workers Contact, advise and coordinate monitoring of close contacts in cooperation with FHI Contribute to communication strategy

22 Roles and responsibilities: Folkehelseinstituttet Notify WHO of suspected/confirmed cases Prepare interview materials for cases/contacts Contact, advise and coordinate monitoring of close contacts in cooperation with municipal health authorities Identify and contact potential close contacts related to air travel Advise healthcare facilities and municipal health authorities Viral testing (National Reference Laboratory) Contribute to communication strategy

23 Index case (May 2013) developed symptoms following holiday in Jordan 115 close contacts identified: 90 contacts from healthcare setting 44 HCW from two hospitals and the local health authority, 1 patient sharing a room, 5 cleaners and 3 ambulance drivers 37 patients attending same ER 4 family members 9 passengers on the same airplane 12 work colleagues Case 2 and 3 among family member and colleague of index case 5 and 24 additional contacts identified

24 Index case (April 2013) developed symptoms after travel to UAE 123 close contacts identified 117 contacts from healthcare setting Including 5 patients 6 family members One additional case identified Patient who shared hospital room with index case 39 close contacts identified

25 Links to WHO guidance documents WHO website: Coronavirus infections Guidelines for investigation of cases Initial interview questionnaire Guidance for infection prevention and control during health care Rapid advice note on home care for patients with mild symptoms and management of contacts