Infectivity of an Asymptomatic Patient With Middle East Respiratory Syndrome Coronavirus Infection

Moon, Soo-youn; Son, Jun Seong

doi:10.1093/cid/cix170

Cited by 28 publications

(33 citation statements)

References 10 publications

(11 reference statements)

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“…21 Using serology, none of 48 contacts were positive for MERS-CoV infection. 26 Although, the Ct value of the index case was high, the index case was able to infect an additional 4 cases. 23 Although MERS-CoV among HCWs is usually asymptomatic or presents as a mild disease, fatal cases had been reported.…”

Section: Discussionmentioning

confidence: 99%

Middle East respiratory syndrome coronavirus transmission among health care workers: Implication for infection control

Alfaraj

Al‐Tawfiq

Altuwaijri

et al. 2018

American Journal of Infection Control

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The role of HCWs in MERS-CoV transmission is complex. Although most MERS-CoV-infected HCWs are asymptomatic or have mild disease, fatal infections can occur and HCWs can play a major role in propagating health care facility outbreaks. This investigation highlights the need to continuously review infection control guidance relating to the role of HCWs in MERS-CoV transmission in health care outbreaks, especially as it relates to the complex questions on definition of risky exposures, who to test, and the frequency of MERS-CoV testing; criteria for who to quarantine and for how long; and clearance and return to active duty criteria.

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Section: Discussionmentioning

confidence: 99%

Middle East respiratory syndrome coronavirus transmission among health care workers: Implication for infection control

Alfaraj

Al‐Tawfiq

Altuwaijri

et al. 2018

American Journal of Infection Control

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“…The screening revealed that three (0·5%) health-care workers had acquired asymptomatic MERS-CoV infections. A followup study 65 of a nurse with an asymptomatic MERS-CoV infection in South Korea showed that she did not transmit the infection to the 82 people they had been in contact with, whereas another study 46 speculated that a family cluster of MERS-CoV infections in Saudi Arabia was probably related to exposure to an unrecognised individual with asymptomatic or subclinically mild MERS-CoV in a hospital setting. Four generations of transmission among health-care workers in hospital, shared housing, and home environments were observed in Saudi Arabia after investigation of an outbreak of MERS-CoV caused by an index patient (a nurse with MERS-CoV and pulmonary tuberculosis) who had contact with 73 people.…”

Section: Transmission Of Mers-cov By Asymptomatic Individualsmentioning

confidence: 99%

Middle East respiratory syndrome coronavirus: risk factors and determinants of primary, household, and nosocomial transmission

Hui

Azhar

Kim

et al. 2018

The Lancet Infectious Diseases

389

327

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Middle East respiratory syndrome coronavirus (MERS-CoV) is a lethal zoonosis that causes death in 35·7% of cases. As of Feb 28, 2018, 2182 cases of MERS-CoV infection (with 779 deaths) in 27 countries were reported to WHO worldwide, with most being reported in Saudi Arabia (1807 cases with 705 deaths). MERS-CoV features prominently in the WHO blueprint list of priority pathogens that threaten global health security. Although primary transmission of MERS-CoV to human beings is linked to exposure to dromedary camels (Camelus dromedarius), the exact mode by which MERS-CoV infection is acquired remains undefined. Up to 50% of MERS-CoV cases in Saudi Arabia have been classified as secondary, occurring from human-to-human transmission through contact with asymptomatic or symptomatic individuals infected with MERS-CoV. Hospital outbreaks of MERS-CoV are a hallmark of MERS-CoV infection. The clinical features associated with MERS-CoV infection are not MERS-specific and are similar to other respiratory tract infections. Thus, the diagnosis of MERS can easily be missed, unless the doctor or health-care worker has a high degree of clinical awareness and the patient undergoes specific testing for MERS-CoV. The largest outbreak of MERS-CoV outside the Arabian Peninsula occurred in South Korea in May, 2015, resulting in 186 cases with 38 deaths. This outbreak was caused by a traveller with undiagnosed MERS-CoV infection who became ill after returning to Seoul from a trip to the Middle East. The traveller visited several health facilities in South Korea, transmitting the virus to many other individuals long before a diagnosis was made. With 10 million pilgrims visiting Saudi Arabia each year from 182 countries, watchful surveillance by public health systems, and a high degree of clinical awareness of the possibility of MERS-CoV infection is essential. In this Review, we provide a comprehensive update and synthesis of the latest available data on the epidemiology, determinants, and risk factors of primary, household, and nosocomial transmission of MERS-CoV, and suggest measures to reduce risk of transmission.

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“…This is based on an incubation period of 7-10 days. In the South Korea outbreak, 82 contacts of an asymptomatic or mild MERS-CoV infection were tested by RT-PCR and serology and all of them were negative [51]. In a study from Abu Dhabi, of 34 casepatients, 91% were asymptomatic with no evidence of transmission [52].…”

Section: Role Of Asymptomatic Individuals In Mers-cov Infectionmentioning

confidence: 99%

Asymptomatic Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: Extent and implications for infection control: A systematic review

Al‐Tawfiq

Gautret

2019

Travel Medicine and Infectious Disease

101

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Background: The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) emerged in 2012 and attracted an international attention as the virus caused multiple healthcare associated outbreaks. There are reports of the role of asymptomatic individuals in the transmission of MERS-CoV, however, the exact role is not known. Method: The MEDLINE/PubMed and Scopus databases were searched for relevant papers published till August 2018 describing asymptomatic MERS-CoV infection.Results: A total of 10 papers were retrieved and included in the final analysis and review. The extent of asymptomatic MERS infection had increased with change in the policy of testing asymptomatic contacts. In early cases in April 2012-October 2013, 12.5% were asymptomatic among 144 PCR laboratory-confirmed MERS-CoV cases while in 2014 the proportion rose to 25.1% among 255 confirmed cases. The proportion of asymptomatic cases reported among pediatric confirmed MERS-CoV cases were higher (41.9%-81.8%). Overall, the detection rate of MERS infection among asymptomatic contacts was 1-3.9% in studies included in this review. Asymptomatic individuals were less likely to have underlying condition compared to fatal cases. Of particular interest is that most of the identified pediatric cases were asymptomatic with no clear explanation.Conclusions: The proportion of asymptomatic MERS cases were detected with increasing frequency as the disease progressed overtime. Those patients were less likely to have comorbid disease and may contribute to the transmission of the virus. * Corresponding author.

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Infectivity of an Asymptomatic Patient With Middle East Respiratory Syndrome Coronavirus Infection

Cited by 28 publications

References 10 publications

Middle East respiratory syndrome coronavirus transmission among health care workers: Implication for infection control

Middle East respiratory syndrome coronavirus transmission among health care workers: Implication for infection control

Middle East respiratory syndrome coronavirus: risk factors and determinants of primary, household, and nosocomial transmission

Asymptomatic Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: Extent and implications for infection control: A systematic review

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