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Middle East respiratory syndrome coronavirus intermittent positive cases: Implications for infection control.
Am J Infect Control. 2019 03; 47(3):290-293.AJ

Abstract

BACKGROUND

Middle East respiratory syndrome coronavirus (MERS-CoV) continues to be reported from the Kingdom of Saudi Arabia. Data on the phenomenon of intermittent positive results for MERS-CoV on reverse-transcription polymerase chain reaction (RT-PCR) with negative results in between are lacking. Here we describe cases with intermittent positive MERS-CoV test results and highlight the required number of tests to rule out or rule in MERS-CoV infection based on a large retrospective cohort of patients with confirmed MERS-CoV.

METHODS

This analysis included cases admitted between January 2014 and December 2017. The included patients had a minimum of 3 nasopharyngeal MERS-CoV RT-PCR tests for confirmation and needed 2 negative samples for MERS-CoV evaluated 48 hours apart with clinical improvement or stabilization apart to ensure clearance.

RESULTS

A total of 408 patients with positive MERS-CoV test results were treated at the referring hospital. We excluded 72 patients who had only 1 swab result available in the system and were treated in the initial years of the disease. Of the remaining 336 patients, 300 (89%) had a positive result after 1 swab, 324 (96.5%) had a positive result after 2 consecutive swabs, and 328 (97.6%) had a positive result after 3 consecutive swabs. Of the total cases, 46 (13.7%) had a positive MERS-CoV test then a negative test, followed by positive test results.

CONCLUSIONS

Our data indicate that 2 to 3 nasopharyngeal samples are needed to produce the highest yield of positive results for MERS-CoV. In addition, 2 negative results 48 hours apart with clinical improvement or stabilization are needed to clear patients from MERS-CoV. Evaluation of the yield of sputum samples is needed to assess the effectiveness against nasopharyngeal swabs.

Authors+Show Affiliations

Corona Center, Infectious Diseases Division, Department of Pediatrics, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia; University of British Columbia, Vancouver, BC, Canada.Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN; Johns Hopkins University School of Medicine, Baltimore, MD.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

30352694

Citation

Alfaraj, Sarah H., et al. "Middle East Respiratory Syndrome Coronavirus Intermittent Positive Cases: Implications for Infection Control." American Journal of Infection Control, vol. 47, no. 3, 2019, pp. 290-293.
Alfaraj SH, Al-Tawfiq JA, Memish ZA. Middle East respiratory syndrome coronavirus intermittent positive cases: Implications for infection control. Am J Infect Control. 2019;47(3):290-293.
Alfaraj, S. H., Al-Tawfiq, J. A., & Memish, Z. A. (2019). Middle East respiratory syndrome coronavirus intermittent positive cases: Implications for infection control. American Journal of Infection Control, 47(3), 290-293. https://doi.org/10.1016/j.ajic.2018.08.020
Alfaraj SH, Al-Tawfiq JA, Memish ZA. Middle East Respiratory Syndrome Coronavirus Intermittent Positive Cases: Implications for Infection Control. Am J Infect Control. 2019;47(3):290-293. PubMed PMID: 30352694.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Middle East respiratory syndrome coronavirus intermittent positive cases: Implications for infection control. AU - Alfaraj,Sarah H, AU - Al-Tawfiq,Jaffar A, AU - Memish,Ziad A, Y1 - 2018/10/21/ PY - 2018/07/08/received PY - 2018/08/15/revised PY - 2018/08/16/accepted PY - 2018/10/26/pubmed PY - 2020/4/9/medline PY - 2018/10/25/entrez KW - MERS-CoV KW - Middle East respiratory syndrome coronavirus KW - Outbreak Saudi Arabia SP - 290 EP - 293 JF - American journal of infection control JO - Am J Infect Control VL - 47 IS - 3 N2 - BACKGROUND: Middle East respiratory syndrome coronavirus (MERS-CoV) continues to be reported from the Kingdom of Saudi Arabia. Data on the phenomenon of intermittent positive results for MERS-CoV on reverse-transcription polymerase chain reaction (RT-PCR) with negative results in between are lacking. Here we describe cases with intermittent positive MERS-CoV test results and highlight the required number of tests to rule out or rule in MERS-CoV infection based on a large retrospective cohort of patients with confirmed MERS-CoV. METHODS: This analysis included cases admitted between January 2014 and December 2017. The included patients had a minimum of 3 nasopharyngeal MERS-CoV RT-PCR tests for confirmation and needed 2 negative samples for MERS-CoV evaluated 48 hours apart with clinical improvement or stabilization apart to ensure clearance. RESULTS: A total of 408 patients with positive MERS-CoV test results were treated at the referring hospital. We excluded 72 patients who had only 1 swab result available in the system and were treated in the initial years of the disease. Of the remaining 336 patients, 300 (89%) had a positive result after 1 swab, 324 (96.5%) had a positive result after 2 consecutive swabs, and 328 (97.6%) had a positive result after 3 consecutive swabs. Of the total cases, 46 (13.7%) had a positive MERS-CoV test then a negative test, followed by positive test results. CONCLUSIONS: Our data indicate that 2 to 3 nasopharyngeal samples are needed to produce the highest yield of positive results for MERS-CoV. In addition, 2 negative results 48 hours apart with clinical improvement or stabilization are needed to clear patients from MERS-CoV. Evaluation of the yield of sputum samples is needed to assess the effectiveness against nasopharyngeal swabs. SN - 1527-3296 UR - https://www.unboundmedicine.com/medline/citation/30352694/Middle_East_respiratory_syndrome_coronavirus_intermittent_positive_cases:_Implications_for_infection_control_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-6553(18)30871-X DB - PRIME DP - Unbound Medicine ER -