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Middle East respiratory syndrome coronavirus transmission among health care workers: Implication for infection control.
Am J Infect Control. 2018 Feb; 46(2):165-168.AJ

Abstract

BACKGROUND

Many outbreaks of Middle East respiratory syndrome coronavirus (MERS-CoV) have occurred in health care settings and involved health care workers (HCWs). We describe the occurrence of an outbreak among HCWs and attempt to characterize at-risk exposures to improve future infection control interventions.

METHODS

This study included an index case and all HCW contacts. All contacts were screened for MERS-CoV using polymerase chain reaction.

RESULTS

During the study period in 2015, the index case was a 30-year-old Filipino nurse who had a history of unprotected exposure to a MERS-CoV-positive case on May 15, 2015, and had multiple negative tests for MERS-CoV. Weeks later, she was diagnosed with pulmonary tuberculosis and MERS-CoV infection. A total of 73 staff were quarantined for 14 days, and nasopharyngeal swabs were taken on days 2, 5, and 12 postexposure. Of those contacts, 3 (4%) were confirmed positive for MERS-CoV. An additional 18 staff were quarantined and had MERS-CoV swabs. A fourth case was confirmed positive on day 12. Subsequent contact investigations revealed a fourth-generation transmission. Only 7 (4.5%) of the total 153 contacts were positive for MERS-CoV.

CONCLUSIONS

The role of HCWs in MERS-CoV transmission is complex. Although most MERS-CoV-infected HCWs are asymptomatic or have mild disease, fatal infections can occur and HCWs can play a major role in propagating health care facility outbreaks. This investigation highlights the need to continuously review infection control guidance relating to the role of HCWs in MERS-CoV transmission in health care outbreaks, especially as it relates to the complex questions on definition of risky exposures, who to test, and the frequency of MERS-CoV testing; criteria for who to quarantine and for how long; and clearance and return to active duty criteria.

Authors+Show Affiliations

Corona Center, Infectious Diseases Division, Department of Pediatric, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia; University of British Columbia, Vancouver, BC, Canada.Indiana University School of Medicine, Indianapolis, IN; Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.Department of Surgery, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia.Department of Emergency, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia.Corona Center, Infectious Diseases Division, Department of Pediatric, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia.College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Infectious Diseases Division, Department of Medicine, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA. Electronic address: zmemish@yahoo.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28958446

Citation

Alfaraj, Sarah H., et al. "Middle East Respiratory Syndrome Coronavirus Transmission Among Health Care Workers: Implication for Infection Control." American Journal of Infection Control, vol. 46, no. 2, 2018, pp. 165-168.
Alfaraj SH, Al-Tawfiq JA, Altuwaijri TA, et al. Middle East respiratory syndrome coronavirus transmission among health care workers: Implication for infection control. Am J Infect Control. 2018;46(2):165-168.
Alfaraj, S. H., Al-Tawfiq, J. A., Altuwaijri, T. A., Alanazi, M., Alzahrani, N., & Memish, Z. A. (2018). Middle East respiratory syndrome coronavirus transmission among health care workers: Implication for infection control. American Journal of Infection Control, 46(2), 165-168. https://doi.org/10.1016/j.ajic.2017.08.010
Alfaraj SH, et al. Middle East Respiratory Syndrome Coronavirus Transmission Among Health Care Workers: Implication for Infection Control. Am J Infect Control. 2018;46(2):165-168. PubMed PMID: 28958446.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Middle East respiratory syndrome coronavirus transmission among health care workers: Implication for infection control. AU - Alfaraj,Sarah H, AU - Al-Tawfiq,Jaffar A, AU - Altuwaijri,Talal A, AU - Alanazi,Marzouqa, AU - Alzahrani,Nojoom, AU - Memish,Ziad A, Y1 - 2017/09/25/ PY - 2017/07/10/received PY - 2017/08/11/revised PY - 2017/08/11/accepted PY - 2017/9/30/pubmed PY - 2019/2/26/medline PY - 2017/9/30/entrez KW - Infection control KW - MERS-CoV KW - Middle East respiratory syndrome coronavirus KW - Outbreak SP - 165 EP - 168 JF - American journal of infection control JO - Am J Infect Control VL - 46 IS - 2 N2 - BACKGROUND: Many outbreaks of Middle East respiratory syndrome coronavirus (MERS-CoV) have occurred in health care settings and involved health care workers (HCWs). We describe the occurrence of an outbreak among HCWs and attempt to characterize at-risk exposures to improve future infection control interventions. METHODS: This study included an index case and all HCW contacts. All contacts were screened for MERS-CoV using polymerase chain reaction. RESULTS: During the study period in 2015, the index case was a 30-year-old Filipino nurse who had a history of unprotected exposure to a MERS-CoV-positive case on May 15, 2015, and had multiple negative tests for MERS-CoV. Weeks later, she was diagnosed with pulmonary tuberculosis and MERS-CoV infection. A total of 73 staff were quarantined for 14 days, and nasopharyngeal swabs were taken on days 2, 5, and 12 postexposure. Of those contacts, 3 (4%) were confirmed positive for MERS-CoV. An additional 18 staff were quarantined and had MERS-CoV swabs. A fourth case was confirmed positive on day 12. Subsequent contact investigations revealed a fourth-generation transmission. Only 7 (4.5%) of the total 153 contacts were positive for MERS-CoV. CONCLUSIONS: The role of HCWs in MERS-CoV transmission is complex. Although most MERS-CoV-infected HCWs are asymptomatic or have mild disease, fatal infections can occur and HCWs can play a major role in propagating health care facility outbreaks. This investigation highlights the need to continuously review infection control guidance relating to the role of HCWs in MERS-CoV transmission in health care outbreaks, especially as it relates to the complex questions on definition of risky exposures, who to test, and the frequency of MERS-CoV testing; criteria for who to quarantine and for how long; and clearance and return to active duty criteria. SN - 1527-3296 UR - https://www.unboundmedicine.com/medline/citation/28958446/Middle_East_respiratory_syndrome_coronavirus_transmission_among_health_care_workers:_Implication_for_infection_control_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-6553(17)30957-4 DB - PRIME DP - Unbound Medicine ER -