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

5. Reporting

6. Reporting form

7. Hospital name: Date of reporting:|___|___|_______| A. Reporter Physician name: Mobile phone:

8. Reporting form B. Patient information Name: Date of Birth: |___|___|_______| Caza of residence: Locality of residence: Phone number: Gender:  M  F Nationality: Residence:  Resident  Visitor  Refugee Occupation: Institution:

9. Reporting form C. Signs and symptoms Symptoms onset:|___|___|_______| Fever (≥ 38°c ):  Cough:  If other, specify:  Dyspnea  Pathologic chest X-ray 

10. Reporting form D. Hospitalization Hospitalized for this illness?  Since |___|___|_______| Patient admitted to ICU?  Since |___|___|_______| Mechanical ventilation?  Since |___|___|_______|

11. Reporting form E. Clinical and paraclinical presentation Cardiac arrest  Hypotension requiring vasopressors  Pregnancy  Other, specify  Diagnosis of pneumonia  Acute Respiratory Distress Syndrome (ARDS)  Acute Renal Failure  Multi-organ failure 

12. Reporting form F. Risk factors/Exposure in the 14 days prior to illness onset Travel  Where Travel of Family member  Where Contact with confirmed MERS-CoV cases  Who Contact with non confirmed MERS-CoV  Who Contact with Severe Acute Respiratory Infection (SARI)  Who Health Care Worker  Where

13. Reporting form G. Comorbidities Cancer  Diabetes  Chronic lung disease  Asthma  Hematogical disorder  H. Outcome  Remission  Still Ill  Death, date of death |____|____|_______| Kidney failure  Chronic liver disease  Heart disease  Deficient immune system  Other, specify: 

14. Reporting form I. Specimens Sputum  date |____|____|_______| Tracheal aspirate  date |____|____|_______| Serum (paired sera)  date |____|____|_______| J. Date and signature: Broncholaveol ar lavage  date |____|____|_______| Nasal/throat swab  date |____|____|_______| Blood EDTA  date |____|____|_______|

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

16. Specimen collection

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

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

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

20. Specimen type 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 Broncho alveolar lavage: if done Acute serum (during the first week of onset) Convalescent sera: 3 or 4 weeks later AND

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

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

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