. 2020 Jul 28;66(9):101053. doi: 10.1016/j.disamonth.2020.101053

Table 2.

Persons under investigation PUI³⁴

CLINICAL FEATURES EPIDEMIOLOGICAL RISKS
Severe illness Fever¹and pneumonia or acute respiratory distress syndrome (based on clinical or radiological evidence)	and	A history of travel from countries in or near the Arabian Peninsula² within 14 days before symptom onset, or close contact³ with a symptomatic traveler who developed fever¹ and acute respiratory illness (not necessarily pneumonia) within 14 days after traveling from countries in or near the Arabian Peninsula².
		– or –
		A member of a cluster of patients with severe acute respiratory illness (e.g., fever¹ and pneumonia requiring hospitalization) of unknown etiology in which MERS-CoV is being evaluated, in consultation with state and local health departments in the US.
Milder illness Fever¹and symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath)	and	A history of being in a healthcare facility (as a patient, worker, or visitor) within 14 days before symptom onset in a country or territory in or near the Arabian Peninsula² in which recent healthcare-associated cases of MERS have been identified.
Fever¹or symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath)	and	Close contact³ with a confirmed MERS case while the case was ill.

Fever may not be present in some patients, such as those who are very young, elderly, immunosuppressed, or taking certain medications. Clinical judgement should be used to guide testing of patients in such situations.

Countries considered in the Arabian Peninsula and neighboring include: Bahrain; Iraq; Iran; Israel, the West Bank, and Gaza; Jordan; Kuwait; Lebanon; Oman; Qatar; Saudi Arabia; Syria; the United Arab Emirates (UAE); and Yemen.

Close contact is defined as a) being within approximately 6 feet (2 meters), or within the room or care area, of a confirmed MERS case for a prolonged period of time (such as caring for, living with, visiting, or sharing a healthcare waiting area or room with, a confirmed MERS case) while not wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection); or b) having direct contact with infectious secretions of a confirmed MERS case (e.g., being coughed on) while not wearing recommended personal protective equipment. See CDC's Interim Infection Prevention and Control Recommendations for Hospitalized Patients with MERS (https://www.cdc.gov/coronavirus/mers/infection-prevention-control.html). Data to inform the definition of close contact are limited; considerations when assessing close contact include the duration of exposure (e.g., longer exposure time likely increases exposure risk) and the clinical symptoms of the person with MERS (e.g., coughing likely increases exposure risk). Special consideration should be given to those exposed in healthcare settings. For detailed information regarding healthcare personnel (HCP) please review CDC Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Middle East Respiratory Syndrome (MERS-CoV) Exposure (https://www.cdc.gov/coronavirus/mers/hcp/monitoring-movement-guidance.html). Transient interactions, such as walking by a person with MERS, are not thought to constitute an exposure; however, final determination should be made in consultation with public health authorities.