MERS- CoV : Reporting and Laboratory Testing

1. MERS-CoV: Reporting and Laboratory Testing Republic of Lebanon Ministry of Public Health Epidemiological Surveillance Program May 2014

2. Outline • MOPH documents: MOPH website • Reporting • Specimen collection

3. www.moph.gov.lb

4. www.moph.gov.lb

5. Reporting

6. Reportingform

7. Reporting form A. Reporter

8. Reporting form B. Patient information

9. Reporting form C. Signs and symptoms

10. Reporting form D. Hospitalization

11. Reporting form E. Clinical and paraclinical presentation

12. Reporting form F. Risk factors/Exposure in the 14 days prior to illness onset

13. Reporting form G. Comorbidities H. Outcome

14. Reporting form I. Specimens J. Date and signature:

15. Reporting to? • Reporting to MOPH/ESUMOH central level • Fax: 01/610920

16. Specimen collection

17. First choice: Broncho alveolar lavage Specimen type algorithm Second choice: Tracheal aspirate (if intubated) Third choice: Deep sputum Fourth choice: Oropharyngeal or nasopharyngeal swab (in VTM)

18. Intubated patient Tracheal aspirate: 2 specimens (with at least 24 h apart) preferably during the first 3 days of onset Specimen type: for intubated patient AND Broncho alveolar lavage: if done AND Acute serum (during the first week of onset) Convalescent sera: 3 or 4 weeks later

19. Non-intubated patient Sputum: 2 specimens (with at least 24 h apart) preferably during the first 3 days of onset Specimen type: for non-intubated patient AND Broncho alveolar lavage: if done AND Acute serum (during the first week of onset) Convalescent sera: 3 or 4 weeks later

20. Non-Intubated patient, with difficulty to collect sputum Oropharyngeal swab in VTM: 2 specimens (with at least 24 h) apart preferably during the first 3 days of onset Specimen type AND Broncho alveolar lavage: if done AND Acute serum (during the first week of onset) Convalescent sera: 3 or 4 weeks later

21. In sterile recipient without additives Broncho alveolar lavage: if done Specimen recipient Tracheal aspirate Sputum Serum In sterile recipient with Viral Transport Media (VTM) Oropharyngeal swab Nasopharyngeal swab

22. Test received at reference laboratory Reporting form is filled for each suspected case, specifying all variables. Form is sent by fax to MOPH, and sent with specimen. Q1: Is there a reporting form? NO Specimen testing algorithm YES Specimen are keptat 4-8°C if transported within 48 h (other wise minus 20°C), and transported in icebox with ice packs, and well labeled. NO Q2: Is the specimen adequately received? YES Q3: Is there an approval from MOPH? Criteria for approval is to fulfil the MOPH case definition. Daily list of approved request is shared between MOPH and RHUH. NO YES If 3 YES, the test is done. If no 3 YES, the test is not done.

23. PPE during specimen collection • Hand hygiene • Gloves • Long-sleeved gown • Eye protection • Mask: • Medical mask • If aerosol producing procedure: mask N95

24. Specimen referred to? • Specimen sent to Rafic Hariri University Hospital • Dr Rita Feghaly • Reference test: RT-PCR

25. Specimen transportation

26. Labelling • Patient name • Date of birth or age • Type of specimen • Date of collection

27. Local Packing

28. Local Transport • In icebox • With ice packs