Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus

By A. Assiri, A. McGeer, Trish Perl, C. Price, Abdullah A. Al Rabeeah, Derek A. T. Cummings, Z. Alabdullatif, Maher Assad, Abdulmohsen Almulhim, H. Makhdoom and 8 more. New England Journal of Medicine, 2013

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BACKGROUND In September 2012, the World Health Organization reported the first cases of pneumonia caused by the novel Middle East respiratory syndrome coronavirus (MERS-CoV). We describe a cluster of health care–acquired MERS-CoV infections. METHODS Medical records were reviewed for clinical and demographic information and determination of potential contacts and exposures. Case patients and contacts were interviewed. The incubation period and serial interval (the time between the successive onset of symptoms in a chain of transmission) were estimated. Viral RNA was sequenced. RESULTS Between April 1 and May 23, 2013, a total of 23 cases of MERS-CoV infection were reported in the eastern province of Saudi Arabia. Symptoms included fever in 20 patients (87%), cough in 20 (87%), shortness of breath in 11 (48%), and gastrointestinal symptoms in 8 (35%); 20 patients (87%) presented with abnormal chest radiographs. As of June 12, a total of 15 patients (65%) had died, 6 (26%) had recovered, and 2 (9%) remained hospitalized. The median incubation period was 5.2 days (95% confidence interval [CI], 1.9 to 14.7), and the serial interval was 7.6 days (95% CI, 2.5 to 23.1). A total of 21 of the 23 cases were acquired by person-to-person transmission in hemodialysis units, intensive care units, or in-patient units in three different health care facilities. Sequencing data from four isolates revealed a single monophyletic clade. Among 217 household contacts and more than 200 health care worker contacts whom we identified, MERS-CoV infection developed in 5 family members (3 with laboratory-confirmed cases) and in 2 health care workers (both with laboratory-confirmed cases). CONCLUSIONS Person-to-person transmission of MERS-CoV can occur in health care settings and may be associated with considerable morbidity. Surveillance and infection-control measures are critical to a global public health response.

Subfields: Infectious Diseases, Modeling and Simulation, Pulmonary and Respiratory Medicine

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Citations in the corpus

Human Coronavirus HKU1 Spike Protein Uses O-Acetylated Sialic Acid as an Attachment Receptor Determinant and Employs Hemagglutinin-Esterase Protein as a Receptor-Destroying Enzyme (2015, background): “MERS-CoV (5, 6) are two highly virulent hCoVs causing severe”
Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis (2020, positive): “These results are also consistent with previous studies, [21] and are also frequently identified in MERS and SARS. [57] [58] [59] In this systematic review and meta-analysis, we found a CFR of 3.6%, which is closer to the estimate (2.3%) in a report by the Chinese Center for Disease In our analysis,”
Middle East respiratory syndrome coronavirus neutralising serum antibodies in dromedary camels: a comparative serological study (2013, background): “6, 8 Therefore, the primary reservoir of MERS-CoV is probably animals.”
Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20–28 January 2020 (2020, positive): “In absence of data on the 2019-nCoV incubation period, these studies have assumed incubation periods of SARS or MERS coronaviruses.”
Prevalence of comorbidities in the Middle East respiratory syndrome coronavirus (MERS-CoV): a systematic review and meta-analysis (2016, background): “Severe illnesses may subsequently manifest as pneumonia, acute respiratory distress syndrome, encephalitis, myocarditis, or other severe and life-threatening complications.(3,7)”
Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak (2020, background): “4 days for MERS [13], and mean of 8.”
Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths (2020, background): “Previous CoV epidemics include severe acute respiratory syndrome (SARS)-CoV, which started in China in 2002 [2], and the ongoing Middle East respiratory syndrome (MERS)-CoV in the Middle East, first reported in 2012 [3].”
A decade after SARS: Strategies to control emerging coronaviruses (2013, background): “Additionally, there is evidence that infection can cause less severe illness in cluster infections (such as those that occur among families and in hospitals) and can even be asymptomatic [32] [33] [34] .”
Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study (2013, background): “[11] [12] [13] ”
Clinical Characteristics of Coronavirus Disease 2019 in China (2020, neutral): “Fever and cough were the dominant symptoms and gastrointestinal symptoms were uncommon, which suggests a difference in viral tropism as compared with SARS-CoV, MERS-CoV, and seasonal influenza.(22,23) The absence of fever in Covid-19 is more frequent than in SARS-CoV (1%) and MERS-CoV infection (2%)”
Middle East Respiratory Syndrome Coronavirus: Another Zoonotic Betacoronavirus Causing SARS-Like Disease (2015, background): “In primary kidney epithelial cells and primary bronchial epithelial cells infected with either MERS-CoV or SARS-CoV, pronounced CPE with rounding, detachment, and death of the majority of cells occurs only in primary kidney epithelial cells infected with MERS-CoV, although viral replication was dete”