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Description of a Hospital Outbreak of Middle East Respiratory Syndrome in a Large Tertiary Care Hospital in Saudi Arabia.
Infect Control Hosp Epidemiol. 2016 10; 37(10):1147-55.IC

Abstract

BACKGROUND

Since the first isolation of Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia in 2012, sporadic cases, clusters, and sometimes large outbreaks have been reported.

OBJECTIVE

To describe the recent (2015) MERS-CoV outbreak at a large tertiary care hospital in Riyadh, Saudi Arabia.

METHODS

We conducted an epidemiologic outbreak investigation, including case finding and contact tracing and screening. MERS-CoV cases were categorized as suspected, probable, and confirmed. A confirmed case was defined as positive reverse transcription polymerase chain reaction test for MERS-CoV.

RESULTS

Of the 130 suspected cases, 81 (62%) were confirmed and 49 (38%) were probable. These included 87 patients (67%) and 43 healthcare workers (33%). Older age (mean [SD], 64.4 [18.3] vs 40.1 [11.3] years, P<.001), symptoms (97% vs 58%, P<.001), and comorbidity (99% vs 42%, P<.001) were more common in patients than healthcare workers. Almost all patients (97%) were hospitalized whereas most healthcare workers (72%) were home isolated. Among 96 hospitalized cases, 63 (66%) required intensive care unit management and 60 (63%) required mechanical ventilation. Among all 130 cases, 51 (39%) died; all were patients (51 [59%]) with no deaths among healthcare workers. More than half (54%) of infections were believed to be caught at the emergency department. Strict infection control measures, including isolation and closure of the emergency department, were implemented to interrupt the chain of transmission and end the outbreak.

CONCLUSION

MERS-CoV remains a major healthcare threat. Early recognition of cases and rapid implementation of infection control measures are necessary. Infect Control Hosp Epidemiol 2016;1-9.

Authors+Show Affiliations

1King Saud bin Abdulaziz University for Health Sciences,Riyadh Saudi Arabia.1King Saud bin Abdulaziz University for Health Sciences,Riyadh Saudi Arabia.4Infection Prevention and Control Department,King Abdulaziz Medical City,Jeddah,Saudi Arabia.1King Saud bin Abdulaziz University for Health Sciences,Riyadh Saudi Arabia.1King Saud bin Abdulaziz University for Health Sciences,Riyadh Saudi Arabia.1King Saud bin Abdulaziz University for Health Sciences,Riyadh Saudi Arabia.7Ministry of Health,Riyadh,Saudi Arabia.1King Saud bin Abdulaziz University for Health Sciences,Riyadh Saudi Arabia.8Pathology and Laboratory Medicine Department,King Abdulaziz Medical City,Riyadh,Saudi Arabia.7Ministry of Health,Riyadh,Saudi Arabia.7Ministry of Health,Riyadh,Saudi Arabia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27426423

Citation

Balkhy, Hanan H., et al. "Description of a Hospital Outbreak of Middle East Respiratory Syndrome in a Large Tertiary Care Hospital in Saudi Arabia." Infection Control and Hospital Epidemiology, vol. 37, no. 10, 2016, pp. 1147-55.
Balkhy HH, Alenazi TH, Alshamrani MM, et al. Description of a Hospital Outbreak of Middle East Respiratory Syndrome in a Large Tertiary Care Hospital in Saudi Arabia. Infect Control Hosp Epidemiol. 2016;37(10):1147-55.
Balkhy, H. H., Alenazi, T. H., Alshamrani, M. M., Baffoe-Bonnie, H., Arabi, Y., Hijazi, R., Al-Abdely, H. M., El-Saed, A., Al Johani, S., Assiri, A. M., & Bin Saeed, A. (2016). Description of a Hospital Outbreak of Middle East Respiratory Syndrome in a Large Tertiary Care Hospital in Saudi Arabia. Infection Control and Hospital Epidemiology, 37(10), 1147-55. https://doi.org/10.1017/ice.2016.132
Balkhy HH, et al. Description of a Hospital Outbreak of Middle East Respiratory Syndrome in a Large Tertiary Care Hospital in Saudi Arabia. Infect Control Hosp Epidemiol. 2016;37(10):1147-55. PubMed PMID: 27426423.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Description of a Hospital Outbreak of Middle East Respiratory Syndrome in a Large Tertiary Care Hospital in Saudi Arabia. AU - Balkhy,Hanan H, AU - Alenazi,Thamer H, AU - Alshamrani,Majid M, AU - Baffoe-Bonnie,Henry, AU - Arabi,Yaseen, AU - Hijazi,Raed, AU - Al-Abdely,Hail M, AU - El-Saed,Aiman, AU - Al Johani,Sameera, AU - Assiri,Abdullah M, AU - Bin Saeed,Abdulaziz, Y1 - 2016/07/18/ PY - 2016/7/19/entrez PY - 2016/7/19/pubmed PY - 2018/2/6/medline SP - 1147 EP - 55 JF - Infection control and hospital epidemiology JO - Infect Control Hosp Epidemiol VL - 37 IS - 10 N2 - BACKGROUND Since the first isolation of Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia in 2012, sporadic cases, clusters, and sometimes large outbreaks have been reported. OBJECTIVE To describe the recent (2015) MERS-CoV outbreak at a large tertiary care hospital in Riyadh, Saudi Arabia. METHODS We conducted an epidemiologic outbreak investigation, including case finding and contact tracing and screening. MERS-CoV cases were categorized as suspected, probable, and confirmed. A confirmed case was defined as positive reverse transcription polymerase chain reaction test for MERS-CoV. RESULTS Of the 130 suspected cases, 81 (62%) were confirmed and 49 (38%) were probable. These included 87 patients (67%) and 43 healthcare workers (33%). Older age (mean [SD], 64.4 [18.3] vs 40.1 [11.3] years, P<.001), symptoms (97% vs 58%, P<.001), and comorbidity (99% vs 42%, P<.001) were more common in patients than healthcare workers. Almost all patients (97%) were hospitalized whereas most healthcare workers (72%) were home isolated. Among 96 hospitalized cases, 63 (66%) required intensive care unit management and 60 (63%) required mechanical ventilation. Among all 130 cases, 51 (39%) died; all were patients (51 [59%]) with no deaths among healthcare workers. More than half (54%) of infections were believed to be caught at the emergency department. Strict infection control measures, including isolation and closure of the emergency department, were implemented to interrupt the chain of transmission and end the outbreak. CONCLUSION MERS-CoV remains a major healthcare threat. Early recognition of cases and rapid implementation of infection control measures are necessary. Infect Control Hosp Epidemiol 2016;1-9. SN - 1559-6834 UR - https://www.unboundmedicine.com/medline/citation/27426423/Description_of_a_Hospital_Outbreak_of_Middle_East_Respiratory_Syndrome_in_a_Large_Tertiary_Care_Hospital_in_Saudi_Arabia_ L2 - https://www.cambridge.org/core/product/identifier/S0899823X1600132X/type/journal_article DB - PRIME DP - Unbound Medicine ER -