Page 113 - Journal of Special Operations Medicine - Winter 2015

chloroquine, loperamide, and lopinavir, but the clinical
utility of these drugs is unknown. A single study tested
the combination of interferon-α2b and the antiviral
drug ribavirin in severely ill patients and demonstrated
improved survival at 14 days, but not at 28 days. The
7
recommendations for management of patients with
MERS-CoV at this time remains largely based upon
supportive care and meticulous use of personal protec-
tive equipment and infection control procedures.

Importance in a Deployed Setting
The overall threat of MERS-CoV infection remains low.
However, its prevalence in regions that house US Mili-
tary personnel, ongoing transmission in these countries,
unknown method of transmission, illness severity, and
mortality rate make it a formidable disease with which
healthcare providers should be familiar.

References
1. Al-Tawfiq JA, Memish ZA. Managing MERS-CoV in the
healthcare setting. Hosp Pract (1995). 2015;43:158–163.
2. Zumla A, Hui DS, Perlman S. Middle east respiratory syn-
drome. Lancet. 2015;386:995–1007.
3. World Health Organization. Middle east respiratory syndrome
coronavirus (MERS-CoV). http://www.who.int/emergencies/mers
-cov/en. Updated 2015. Accessed 23 October 2015.
4. World Health Organization. Clinical management of severe acute
respiratory infection when middle east respiratory syndrome
coronavirus (MERS-CoV) infection is suspected—interim guid-
ance. http://apps.who.int/iris/bitstream/10665/178529/1/WHO
_MERS_Clinical_15.1_eng.pdf. Updated 2 July 2015. Accessed
23 October 2015.
5. Department of Defense, Armed Forces Health Surveillance
Center. Detecting and reporting DoD cases of middle east re-
spiratory syndrome coronavirus (MERS-CoV) infection: guid-
ance as of 16 JUL 2015. http://afhsc.army.mil/documents/pubs
/documents/Detecting_and_Reporting_DoD_Cases_of_MERS
_CoV_Infection.pdf. Accessed 23 October 2015.
6. Centers for Disease Control and Prevention. Middle East respi-
ratory syndrome: interim guidance for healthcare profession-
als. http://www.cdc.gov/coronavirus/mers/interim-guidance.
html. Updated 11 June 2015. Accessed 23 October 2015.
7. Omrani AS, Saad MM, Baig K, et al. Ribavirin and interferon
alfa-2a for severe Middle East Respiratory Syndrome corona-
virus infection: A retrospective cohort study. Lancet Infect Dis.
2014;14:1090–1095.

CPT Shishido is with the Walter Reed National Military
Medical Center, Department of Internal Medicine, Bethesda,
Maryland. E-mail: akira.a.shishido.mil@mail.mil.

LCDR Letizia is with the Walter Reed National Military
Medical Center, Department of Infectious Disease, Bethesda,
Maryland.

Crimean-Congo Hemorrhagic Fever 101