Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus

Abstract

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.

Comparison between SARS CoV and MERS CoV Using Apriori Algorithm, Decision Tree, SVM

“…Viral RNA encapsidated in the N protein then buds into vesicles lined with the S, M, and E proteins. Vesicles are then transported to the cell surface before releasing [4]. …”

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

“…[3][4][5] Even people with no comorbidities can contract the disease and become critically ill. 6,7 A major source of disease transmission has been linked to health care facilities, and health care workers exposed to cases of MERSCoV can contract both symptomatic and asymptomatic infection. 4,8 A major outbreak of MERS-CoV occurred in the city of Jeddah, Saudi Arabia in the months of April to May 2014, almost 2 years after the first case of MERS-CoV was reported. 8 During this outbreak, a large number of cases occurred among health care workers (HCW), which were contracted within the health care facilities.…”

Emergence of new infections in the 21st century and identification of pathogens using next generation sequencing

“…Statistical reports reveal a 3-fold increase in disease prevalence over 4 months meaning that the epidemic is still raging. Mortality rates of up to 30 % are especially high in patients with comorbidities; patients with immunodeficiency or other primary diseases are also susceptible to the infection [21,22]. There is also a serious risk of nosocomial transmission [23].…”

“…Clinical manifestations of MERS are similar to those of the acute viral respiratory infection and include such common respiratory symptoms as cough, fever and gastrointestinal dysfunction [24] before the onset of pneumonia [21]. Patients with MERS also tend to develop acute respiratory syndrome (ARS), renal failure, pericarditis and disseminated intravascular coagulation [24].…”