A person was considered to have a probable case of MERS-CoV infection if he or she was a household, family, or health care contact of a person with a confirmed case and if pneumonia developed without another confirmed cause and either laboratory testing for MERS-CoV was not performed or a single test was negative and no other specimens were available for testing. The date of onset was defined among febrile patients as the first day of fever that persisted for more than 48 hours and among afebrile patients as the first day of new cough or shortness of breath. A person was considered to have been exposed if he or she had had any faceto-face contact with a symptomatic patient who had a confirmed or probable case, was in the same hospital room or ward as a symptomatic case patient for more than 1 hour, moved into a bed vacated by a symptomatic case patient, was being cared for by a health care worker who was also caring for a symptomatic case patient, or was sharing hospital equipment with a symptomatic
case patient.
Laboratory Surveillance
Beginning in September 2012, the Saudi Arabian Ministry of Health requested that all patients with pneumonia requiring admission to the ICU be tested for MERS-CoV. Throat-swab (Eurotubo,Deltalab), sputum, tracheal-aspirate, or bronchoalveolar-lavage specimens were obtained and were placed in viral transport medium (Vircell),stored at 28°C, and transported within 72 hours to the Ministry of Health regional reference laboratory in Jeddah,Saudi Arabia,where they were subjected to real-time reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assays to test for MERS-CoV.n engl j med 369;5 nejm.org august 1, 2013 20 For all patients, the results of RT-PCR tests were confirmed by measuring cycle-threshold values for viral load.