Nosocomial outbreak of the Middle East Respiratory Syndrome coronavirus: A phylogenetic, epidemiological, clinical and infection control analysis (original) (raw)
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Lancet, 2013
Background Since June, 2012, Middle East respiratory syndrome coronavirus (MERS-CoV) has, worldwide, caused 104 infections in people including 49 deaths, with 82 cases and 41 deaths reported from Saudi Arabia. In addition to confi rming diagnosis, we generated the MERS-CoV genomic sequences obtained directly from patient samples to provide important information on MERS-CoV transmission, evolution, and origin. Methods Full genome deep sequencing was done on nucleic acid extracted directly from PCR-confi rmed clinical samples. Viral genomes were obtained from 21 MERS cases of which 13 had 100%, four 85-95%, and four 30-50% genome coverage. Phylogenetic analysis of the 21 sequences, combined with nine published MERS-CoV genomes, was done.
2014 MERS-CoV outbreak in Jeddah--a link to health care facilities
The New England journal of medicine, 2015
A marked increase in the number of cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection occurred in Jeddah, Saudi Arabia, in early 2014. We evaluated patients with MERS-CoV infection in Jeddah to explore reasons for this increase and to assess the epidemiologic and clinical features of this disease. We identified all cases of laboratory-confirmed MERS-CoV infection in Jeddah that were reported to the Saudi Arabian Ministry of Health from January 1 through May 16, 2014. We conducted telephone interviews with symptomatic patients who were not health care personnel, and we reviewed hospital records. We identified patients who were reported as being asymptomatic and interviewed them regarding a history of symptoms in the month before testing. Descriptive analyses were performed. Of 255 patients with laboratory-confirmed MERS-CoV infection, 93 died (case fatality rate, 36.5%). The median age of all patients was 45 years (interquartile range, 30 to 59), and 174 patie...
Epidemiology of a Novel Recombinant MERS-CoV in Humans in Saudi Arabia
The Journal of infectious diseases, 2016
The Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe respiratory illness in humans. Fundamental questions about circulating viruses and transmission routes remain. We assessed routinely collected epidemiologic data for MERS-CoV cases reported in Saudi Arabia during January 01 - June 30, 2015, and conducted a more detailed investigation of cases reported during February 2015. Available respiratory specimens were obtained for sequencing. During the study period, 216 MERS-CoV cases were reported. Spike gene or full genome sequences (n=17) were obtained from 99 individuals. Most (72 of 99, 73%) sequences formed a discrete, novel recombinant clade (NRC-2015), which was detected in 6 regions and became predominant by June, 2015. No clinical differences were noted between clades. Among 87 cases reported during February 2015, 13 had no recognized risks for secondary acquisition; 12 of these 13 also denied camel contact. Most viruses (8 of 9) from these 13 individuals...
American Journal of Transplantation, 2014
Since mid-March 2014, the frequency with which cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported has increased, with the majority of recent cases reported from Saudi Arabia and United Arab Emirates (UAE). In addition, the frequency with which travel-associated MERS cases have been reported and the number of countries that have reported them to the World Health Organization (WHO) have also increased. The first case of MERS in the United States, identified in a traveler recently returned from Saudi Arabia, was reported to CDC by the Indiana State Department of Health on May 1, 2014, and confirmed by CDC on May 2. A second imported case of MERS in the United States, identified in a traveler from Saudi Arabia having no connection with the first case, was reported to CDC by the Florida Department of Health on May 11, 2014. The purpose of this report is to alert clinicians, health officials, and others to increase awareness of the need to consider MERS-CoV infection in persons who have recently traveled from countries in or near the Arabian Peninsula.* This report summarizes recent epidemiologic information, provides preliminary descriptions of the cases reported from Indiana and Florida, and updates CDC guidance about patient evaluation, home care and isolation, specimen collection, and travel as of May 13, 2014. MERS-CoV was first reported to cause human infection in September 2012. Since mid-March 2014, the frequency with which cases have been reported has increased. † As of May 12, 2014, 536 laboratory-confirmed § cases of MERS-CoV infection have been reported by WHO (Figure 1). This includes 145 deaths. All reported cases have been directly or indirectly linked through travel or residence to seven countries: Saudi Arabia, UAE, Qatar, Oman, Jordan, Kuwait, and Yemen (Figure 2). Public health investigations are ongoing to determine the reason for the increase in cases. The median age of persons with laboratory-confirmed MERS-CoV infection is 49 years (range = <1-94 years);
Outbreak of Middle East Respiratory Syndrome at Tertiary Care Hospital, Jeddah, Saudi Arabia, 2014
Emerging Infectious Diseases, 2016
, that included many persons who worked or received medical treatment at King Fahd General Hospital. We investigated 78 persons who had laboratory-confirmed MERS during March 2-May 10 and documented contact at this hospital. The 78 persons with MERS comprised 53 patients, 16 healthcare workers, and 9 visitors. Among the 53 patients, the most probable sites of acquisition were the emergency department (22 patients), inpatient areas (17), dialysis unit (11), and outpatient areas (3). Infection control deficiencies included limited separation of suspected MERS patients, patient crowding, and inconsistent use of infection control precautions; aggressive improvements in these deficiencies preceded a decline in cases. MERS coronavirus transmission probably was multifocal, occurring in multiple hospital settings. Continued vigilance and strict application of infection control precautions are necessary to prevent future MERS outbreaks. M iddle East respiratory syndrome (MERS) coronavirus (CoV) is a new group C betacoronavirus first reported in a man hospitalized in Jeddah, Saudi Arabia, in June 2012 (1). In retrospect, MERS-CoV was found to have caused a respiratory illness cluster in April 2012 in Zarqa, Jordan (2). As of January 4, 2016, a total of 1,625 laboratory-confirmed MERS cases, 586 fatal, have been reported from 26 countries; >85% have been reported from Saudi Arabia (3). MERS-CoV infection is characterized by fever, cough, and dyspnea, and severity ranges from mild illness to acute respiratory distress, organ failure, and death; the case-fatality rate is ≈36% (3-7). Most documented symptomatic infections have resulted from human-to-human transmission (6). Transmission among healthcare workers (HCWs), hospital inpatients, dialysis patients, and families has been implicated in previous clusters (2-5,8,9). MERS-CoV, like other CoVs, is thought to spread through respiratory secretions; however, the precise ways the virus spreads are not well understood (10). The role of contact with surfaces contaminated by respiratory secretions (5,11,12) is unclear. Modeling done during other outbreaks estimated the incubation period to be 5.2-6.8 days (5,13,14). During March 2014, the Saudi Arabia Ministry of Health (MOH) reported to the World Health Organization an increase in MERS cases in the Jeddah area (7). Genetic typing suggested this outbreak was caused by transmission of a single viral subtype (15); the reason for the increase in cases was unclear (3). Subsequent investigation showed that, among symptomatic patients, 21% were HCWs and 88% of evaluable non-HCWs had exposure to healthcare facilities in the 14 days before illness onset (9). King Fahd General Hospital (KFGH), an 815-bed public hospital, was the primarily affected facility (15). However, multiple MERS patients were treated in >1 healthcare facility, and the number of infections attributable to transmission at KFGH was uncertain. MERS-CoV spread at other healthcare facilities has been documented in dialysis units (5);