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Hospital-associated outbreak of Middle East respiratory syndrome coronavirus: a serologic, epidemiologic, and clinical description.
Clin Infect Dis. 2014 Nov 01; 59(9):1225-33.CI

Abstract

BACKGROUND

In April 2012, the Jordan Ministry of Health investigated an outbreak of lower respiratory illnesses at a hospital in Jordan; 2 fatal cases were retrospectively confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) to be the first detected cases of Middle East respiratory syndrome (MERS-CoV).

METHODS

Epidemiologic and clinical characteristics of selected potential cases were assessed through serum blood specimens, medical record reviews, and interviews with surviving outbreak members, household contacts, and healthcare personnel. Cases of MERS-CoV infection were identified using 3 US Centers for Disease Control and Prevention serologic tests for detection of anti-MERS-CoV antibodies.

RESULTS

Specimens and interviews were obtained from 124 subjects. Seven previously unconfirmed individuals tested positive for anti-MERS-CoV antibodies by at least 2 of 3 serologic tests, in addition to 2 fatal cases identified by rRT-PCR. The case-fatality rate among the 9 total cases was 22%. Six subjects were healthcare workers at the outbreak hospital, yielding an attack rate of 10% among potentially exposed outbreak hospital personnel. There was no evidence of MERS-CoV transmission at 2 transfer hospitals having acceptable infection control practices.

CONCLUSIONS

Novel serologic tests allowed for the detection of otherwise unrecognized cases of MERS-CoV infection among contacts in a Jordanian hospital-associated respiratory illness outbreak in April 2012, resulting in a total of 9 test-positive cases. Serologic results suggest that further spread of this outbreak to transfer hospitals did not occur. Most subjects had no major, underlying medical conditions; none were on hemodialysis. Our observed case-fatality rate was lower than has been reported from outbreaks elsewhere.

Authors+Show Affiliations

Communicable Diseases Directorate, Jordan Ministry of Health, Amman.Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.Communicable Diseases Directorate, Jordan Ministry of Health, Amman.Division of Viral Diseases, National Center for Immunization and Respiratory Diseases Epidemic Intelligence Service.Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.Eastern Mediterranean Public Health Network.Field Epidemiology Training Program, Jordan Ministry of Health, Amman.Communicable Diseases Directorate, Jordan Ministry of Health, Amman.Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.Directorate of Laboratories, Jordan Ministry of Health, Amman.Directorate of Laboratories, Jordan Ministry of Health, Amman.Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24829216

Citation

Al-Abdallat, Mohammad Mousa, et al. "Hospital-associated Outbreak of Middle East Respiratory Syndrome Coronavirus: a Serologic, Epidemiologic, and Clinical Description." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 59, no. 9, 2014, pp. 1225-33.
Al-Abdallat MM, Payne DC, Alqasrawi S, et al. Hospital-associated outbreak of Middle East respiratory syndrome coronavirus: a serologic, epidemiologic, and clinical description. Clin Infect Dis. 2014;59(9):1225-33.
Al-Abdallat, M. M., Payne, D. C., Alqasrawi, S., Rha, B., Tohme, R. A., Abedi, G. R., Al Nsour, M., Iblan, I., Jarour, N., Farag, N. H., Haddadin, A., Al-Sanouri, T., Tamin, A., Harcourt, J. L., Kuhar, D. T., Swerdlow, D. L., Erdman, D. D., Pallansch, M. A., Haynes, L. M., & Gerber, S. I. (2014). Hospital-associated outbreak of Middle East respiratory syndrome coronavirus: a serologic, epidemiologic, and clinical description. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 59(9), 1225-33. https://doi.org/10.1093/cid/ciu359
Al-Abdallat MM, et al. Hospital-associated Outbreak of Middle East Respiratory Syndrome Coronavirus: a Serologic, Epidemiologic, and Clinical Description. Clin Infect Dis. 2014 Nov 1;59(9):1225-33. PubMed PMID: 24829216.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hospital-associated outbreak of Middle East respiratory syndrome coronavirus: a serologic, epidemiologic, and clinical description. AU - Al-Abdallat,Mohammad Mousa, AU - Payne,Daniel C, AU - Alqasrawi,Sultan, AU - Rha,Brian, AU - Tohme,Rania A, AU - Abedi,Glen R, AU - Al Nsour,Mohannad, AU - Iblan,Ibrahim, AU - Jarour,Najwa, AU - Farag,Noha H, AU - Haddadin,Aktham, AU - Al-Sanouri,Tarek, AU - Tamin,Azaibi, AU - Harcourt,Jennifer L, AU - Kuhar,David T, AU - Swerdlow,David L, AU - Erdman,Dean D, AU - Pallansch,Mark A, AU - Haynes,Lia M, AU - Gerber,Susan I, AU - ,, Y1 - 2014/05/14/ PY - 2014/5/16/entrez PY - 2014/5/16/pubmed PY - 2015/6/11/medline KW - Jordan KW - MERS-CoV KW - Middle East respiratory syndrome KW - novel coronavirus KW - seroepidemiology SP - 1225 EP - 33 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 59 IS - 9 N2 - BACKGROUND: In April 2012, the Jordan Ministry of Health investigated an outbreak of lower respiratory illnesses at a hospital in Jordan; 2 fatal cases were retrospectively confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) to be the first detected cases of Middle East respiratory syndrome (MERS-CoV). METHODS: Epidemiologic and clinical characteristics of selected potential cases were assessed through serum blood specimens, medical record reviews, and interviews with surviving outbreak members, household contacts, and healthcare personnel. Cases of MERS-CoV infection were identified using 3 US Centers for Disease Control and Prevention serologic tests for detection of anti-MERS-CoV antibodies. RESULTS: Specimens and interviews were obtained from 124 subjects. Seven previously unconfirmed individuals tested positive for anti-MERS-CoV antibodies by at least 2 of 3 serologic tests, in addition to 2 fatal cases identified by rRT-PCR. The case-fatality rate among the 9 total cases was 22%. Six subjects were healthcare workers at the outbreak hospital, yielding an attack rate of 10% among potentially exposed outbreak hospital personnel. There was no evidence of MERS-CoV transmission at 2 transfer hospitals having acceptable infection control practices. CONCLUSIONS: Novel serologic tests allowed for the detection of otherwise unrecognized cases of MERS-CoV infection among contacts in a Jordanian hospital-associated respiratory illness outbreak in April 2012, resulting in a total of 9 test-positive cases. Serologic results suggest that further spread of this outbreak to transfer hospitals did not occur. Most subjects had no major, underlying medical conditions; none were on hemodialysis. Our observed case-fatality rate was lower than has been reported from outbreaks elsewhere. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/24829216/Hospital_associated_outbreak_of_Middle_East_respiratory_syndrome_coronavirus:_a_serologic_epidemiologic_and_clinical_description_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciu359 DB - PRIME DP - Unbound Medicine ER -