Transmission of MERS-Coronavirus in Household Contacts

Drosten, Christian; Meyer, Benjamin; Müller, Marcel A.; Corman, Victor M.; Almasri, Malak; Hossain, Raheela; Madani, Hosam; Sieberg, Andrea; Bosch, Berend Jan; Lattwein, Erik; Alhakeem, Raafat F.; Assiri, Abdullah M.; Hajomar, Waleed H.; Albarrak, Ali; Al‐Tawfiq, Jaffar A.; Zumla, Alimuddin; Memish, Ziad A.

doi:10.1056/nejmoa1405858

Cited by 373 publications

(413 citation statements)

References 21 publications

(30 reference statements)

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“…The occurrence of large familial clusters of severe cases of MERS is relatively uncommon (16)(17)(18). The secondary attack rate in the family was much higher (23%) than those reported in previous studies (about 5%) (19)(20)(21). Factors that probably contributed to occurrence of many cases in the family were probably related to the crowded living to ensure sustained compliance to IPC guidelines using a scoring method; the audits monitor performance of HCFs, and implementation of immediate corrective actions as deemed necessary (30).…”

Section: Discussionmentioning

confidence: 90%

“…Increasing public awareness through risk communication is the core activity for reducing or preventing the emergence of primary cases; whereas efficient IPC programmes are required to prevent secondary infections (9,12,19,24,25). The occurrence of secondary cases of MERS in hospitals is an indicator of laxity and complacency in implementing IPC measures or shortage of human resources, equipment, supplies or supervision.…”

Section: The Epidemic Curvementioning

confidence: 99%

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An outbreak of Middle East Respiratory Syndrome (MERS) due to coronavirus in Al-Ahssa Region, Saudi Arabia, 2015

Bushra¹,

Abdalla²,

Arbash³

et al. 2016

East Mediterr Health J

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Between 19 April and 23 June 2015, 52 laboratory-confirmed cases of Middle East RespiratorySyndrome due to coronavirus (MERS) were reported from Al-Ahssa region, eastern Saudi Arabia. The first seven cases occurred in one family; these were followed by 45 cases in three public hospitals. The objectives of this investigation were to describe the epidemiological characteristic of the cluster and identify potential risk factors and control measures to be instituted to prevent further occurrence of MERS. We obtained the medical records of all confirmed cases, interviewed the members of the affected household and reviewed the actions taken by the health authorities. All the cases were connected. The index case was a 62-year-old man with a history of close contact with dromedary camels; three of the seven infected family members and 18 people in hospitals died (case-fatality rate, 40.4%). The median incubation period was about 6 days. The cluster of cases appeared to be due to high exposure to MERS, delayed diagnosis, inadequate risk communication and inadequate compliance of hospital health workers and visitors with infection prevention and control measures.

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Section: Discussionmentioning

confidence: 90%

Section: The Epidemic Curvementioning

confidence: 99%

An outbreak of Middle East Respiratory Syndrome (MERS) due to coronavirus in Al-Ahssa Region, Saudi Arabia, 2015

Bushra¹,

Abdalla²,

Arbash³

et al. 2016

East Mediterr Health J

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“…2 The rate of secondary transmission is low, ranging anywhere from 1-4%. 3,4 However, those individuals who con-tacted the Middle East Respiratory Syndrome coronavirus infection did get significantly ill, with case fatality rates varying from 36 to 70% based on the underlying comorbidities and severity of pneumonia. 2,4,5 As of August 21, 2015, 1,432 laboratory-confirmed cases of infection with Middle East Respiratory Syndrome coronavirus had been reported to the World Health Organization with cases from recent outbreaks in Korea and Saudi Arabia, including at least 507 related deaths, with no complete eradication of the virus in sight.…”

Section: Introductionmentioning

confidence: 99%

Acute Management and Long-Term Survival Among Subjects With Severe Middle East Respiratory Syndrome Coronavirus Pneumonia and ARDS

et al. 2015

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outbreak were included. Their characteristics, ICU course, management, and outcome were evaluated. RESULTS: Fourteen subjects, including 3 health-care workers, met study criteria. Besides 2 health-care workers, all subjects had comorbidities. Predominant symptoms were fever, cough, and dyspnea. The worst median P aO 2 /F IO 2 ratio of 118 post-intubation was seen on the third day, and median APACHE II score was 27. All subjects received lung-protective ventilation and 1 mg/kg/d methylprednisolone infusion for ARDS. Eleven subjects received ribavirin and peginterferon ␣-2a. Subjects had a critical ICU course and required neuromuscular blockade (n ‫؍‬ 11; 79%), required rescue therapy for respiratory failure (n ‫؍‬ 8; 57%), developed shock (n ‫؍‬ 10; 71%), and required renal replacement therapy (n ‫؍‬ 8; 57%). Declining C-reactive protein levels correlated with clinical improvement despite continued positive real-time polymerase chain reaction results. Nine subjects died in ICU. Five subjects, including 3 health-care workers, were discharged from hospital and were alive after 1 y. CONCLUSIONS: Middle East Respiratory Syndrome coronavirus pneumonia with ARDS has high mortality in subjects with comorbidities. The mainstay of treatment is meticulous ARDS management. Those who survived the acute infection and its complications remained well after 1 y in our study. The role of ribavirin and interferon warrants urgent further evaluation.

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“…1 The rate of secondary transmission seems to be low; 2,3 however, those who contract the disease can get significantly sick. Studies have reported that the fatality rates range anywhere from 36% to 70% based on the underlying comorbidities and severity of pneumonia.…”

mentioning

confidence: 99%

Healthcare Workers Emotions, Perceived Stressors and Coping Strategies During a MERS-CoV Outbreak

Khalid

Qabajah

et al. 2016

Clinical Medicine & Research

634

721

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Objective: Healthcare workers (HCWs) are at high risk of contracting Middle East respiratory syndrome coronavirus (MERS-CoV) during an epidemic. We explored the emotions, perceived stressors, and coping strategies of healthcare workers who worked during a MERS-CoV outbreak in our hospital. Design:A cross-sectional descriptive survey design. Setting:A tertiary care hospital.Participants: HCWs (150) who worked in high risk areas during the April-May 2014 MERS-CoV outbreak that occurred in Jeddah, Saudi Arabia. Methods:We developed and administered a "MERS-CoV staff questionnaire" to study participants. The questionnaire consisted of 5 sections with 72 questions. The sections evaluated hospital staffs emotions, perceived stressors, factors that reduced their stress, coping strategies, and motivators to work during future outbreaks. Responses were scored on a scale from 0-3. The varying levels of stress or effectiveness of measures were reported as mean and standard deviation, as appropriate. Results:Completed questionnaires were returned by 117 (78%) of the participants. The results had many unique elements. HCWs ethical obligation to their profession pushed them to continue with their jobs. The main sentiments centered upon fear of personal safety and well-being of colleagues and family. Positive attitudes in the workplace, clinical improvement of infected colleagues, and stoppage of disease transmission among HCWs after adopting strict protective measures alleviated their fear and drove them through the epidemic. They appreciated recognition of their efforts by hospital management and expected similar acknowledgment, infection control guidance, and equipment would entice them to work during future epidemics. Conclusion:The MERS-CoV outbreak was a distressing time for our staff. Hospitals can enhance HCWs experiences during any future MERS-CoV outbreak by focusing on the above mentioned aspects.

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Transmission of MERS-Coronavirus in Household Contacts

Abstract: The rate of secondary transmission among household contacts of patients with MERS-CoV infection has been approximately 5%. Our data provide insight into the rate of subclinical transmission of MERS-CoV in the home.

Cited by 373 publications

References 21 publications

An outbreak of Middle East Respiratory Syndrome (MERS) due to coronavirus in Al-Ahssa Region, Saudi Arabia, 2015

An outbreak of Middle East Respiratory Syndrome (MERS) due to coronavirus in Al-Ahssa Region, Saudi Arabia, 2015

Acute Management and Long-Term Survival Among Subjects With Severe Middle East Respiratory Syndrome Coronavirus Pneumonia and ARDS

Healthcare Workers Emotions, Perceived Stressors and Coping Strategies During a MERS-CoV Outbreak

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