1. MERS-CoV: case definition Republic of Lebanon Ministry of Public Health Epidemiological Surveillance Program May 2014

2. Confirmed case Any person with positive laboratory confirmation of infection with novel coronavirus

3. Probable case Any possible case with close contact during the last 10 days before onset of illness with a symptomatic confirmed case of novel coronavirus infection. Close contact is defined as:  Anyone who provided care for a nCoV patient  Or anyone who stayed at the same place while a nCoV patient was ill.

4. Suspected case Current case definition for suspected case: – Any person with severe acute respiratory infection, with: 1.Fever, cough, and evidence of pulmonary parenchymal disease 2.And not already explained by any other infection or etiology 3.And admitted to hospital 4.And one of the following: – With history travel within 14 days before onset in a country who reported local cases – Or contact history with a person with ARI who traveled in a country who reported local cases – Or HCW caring for patients with severe ARI – Or the case occurs as part of a cluster.

5. Cases On Sunday 4 th May, several patients were waiting at ER waiting room. Some of them are coughing, other have epistaxis, other show abdominal pain…

6. Case 1 At ER, Mrs Nour Nour, 35 years old, Lebanese has fever and cough. The cough is productive. No dyspnea is observed. She is a teacher in public school. She has no travel history, neither her close family. At physical exam, she is stable, some rhonchus are detected at auscultation. No signs of respiratory failure.

7. Case 2 At ER, Mr Kamel Kamel, 45 years old, Lebanese has fever and some watery diarrhea. He is an engineer working in KSA. He came back to Lebanon 4 days ago. He is afraid to have infection with MERS-CoV. At physical exam, he has no abnormal signs. The temperature was 37.8°C.

8. Case 3 At ER, Mr Jad Jad, 55 years old, Syrian, resident in Lebanon since 6 years, has fever and dyspnea. He came back from Tunis 3 days before, where he was in vacation. At physical exam, he has high grade fever (40°C), inspiratory dyspnea (RR=25), some crepitates are detected at auscultation. The chest X Rays showed localized condensation at left upper lobe. The CBC counted 12000 WBC (90% PN). The patient is admitted to hospital.

9. Case 4 At ER, Mrs Layla Abou Layla, 20 years old, Lebanese has fever and cough. The cough is productive. She is a nursing student actually at Intensive Care Unit. She has no travel history, neither her close family. At physical exam, the temperature is 39°C, some crepitates are detected at auscultation. The chest X Rays showed some infiltrates at right side. She is admitted to hospital.

10. Case 5 At ER, Mrs Alia Alia, 66 years old, Lebanese has fever and cough No dyspnea is observed. She lives between KSA and Lebanon. She came back from Jeddah 6 days before. At physical exam, she has fever (38.5°C), blood pressure is 130/80 mmHg, respiratory rate at 25/mn. The Chest X ray showed several infiltrates in both right and left lungs. The patient is admitted to hospital.

11. Case 6 At ER, Mr Anwar Anwar, 70 years old, Lebanese has fever, cough and dyspnea. The cough is productive. He is retired since 2 years after being working as medical doctor in a private cabinet. He reported that his son had also fever and some acute respiratory infection 5 days ago, his son works in KSA and came for a week end in Lebanon. At physical exam, there was fever, dyspnea and crepitents. The Chest X Ray showed patchy infiltrates. The patient was admitted.

12. Case 7 At ER, the child Nader Nader, 12 years old, Lebanese has fever and cough. The cough is productive. No dyspnea is observed. He is a student in a public school in Fnaydek (Akkar caza). He has no travel history, neither his close family. The family reported several similar cases among siblings and cousins. At physical exam, he is stable, rhonchus are detected at auscultation. Some dyspnea is noted. Saturation O2 was 75%. The child is admitted to hospital.

13. Case 8 At ER, Mr Nadim Nadim, 27 years old, Palestinian has fever and cough. No dyspnea is observed. He is bank employee. He has no travel history, neither his close family. At physical exam, he is stable, the lung are clear at auscultation. The chest X Ray is normal. He reported to be close contact of confirmed MERS case.

14. Case 9 At ER, Mrs Jamale Jamal, 55 years old, Lebanese has fever and dyspnea. She is a nurse in hospital in KSA. She went back to Lebanon 2 days before. Two cases of MERS were confirmed in her hospital. At physical exam, she has fever (38.5°C). Several infiltrates were observed at the chest X Ray. The PCR test was done, it is positive.

15. CaseClassification 1Not a suspected case 2 3 4Suspected case 5 6 7 8Probable case 9Confirmed case