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Scope and extent of healthcare-associated Middle East respiratory syndrome coronavirus transmission during two contemporaneous outbreaks in Riyadh, Saudi Arabia, 2017.
Infect Control Hosp Epidemiol. 2019 01; 40(1):79-88.IC

Abstract

OBJECTIVE

To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.

DESIGN

Outbreak investigation.

SETTING

Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.

METHODS

Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.

RESULTS

In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.

CONCLUSIONS

We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.

Authors+Show Affiliations

1Ministry of Health,Riyadh,Saudi Arabia.2Division of Viral Diseases,National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia,United States.2Division of Viral Diseases,National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia,United States.2Division of Viral Diseases,National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia,United States.1Ministry of Health,Riyadh,Saudi Arabia.1Ministry of Health,Riyadh,Saudi Arabia.1Ministry of Health,Riyadh,Saudi Arabia.1Ministry of Health,Riyadh,Saudi Arabia.1Ministry of Health,Riyadh,Saudi Arabia.1Ministry of Health,Riyadh,Saudi Arabia.1Ministry of Health,Riyadh,Saudi Arabia.1Ministry of Health,Riyadh,Saudi Arabia.1Ministry of Health,Riyadh,Saudi Arabia.1Ministry of Health,Riyadh,Saudi Arabia.3King Saud Medical City,Riyadh,Saudi Arabia.3King Saud Medical City,Riyadh,Saudi Arabia.2Division of Viral Diseases,National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia,United States.2Division of Viral Diseases,National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia,United States.5IHRC,contractor to National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia,United States.2Division of Viral Diseases,National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia,United States.2Division of Viral Diseases,National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia,United States.2Division of Viral Diseases,National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia,United States.2Division of Viral Diseases,National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia,United States.6Batelle, contractor to National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA,USA.2Division of Viral Diseases,National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia,United States.2Division of Viral Diseases,National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia,United States.2Division of Viral Diseases,National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia,United States.1Ministry of Health,Riyadh,Saudi Arabia.1Ministry of Health,Riyadh,Saudi Arabia.2Division of Viral Diseases,National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia,United States.2Division of Viral Diseases,National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia,United States.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

30595141

Citation

Alanazi, Khalid H., et al. "Scope and Extent of Healthcare-associated Middle East Respiratory Syndrome Coronavirus Transmission During Two Contemporaneous Outbreaks in Riyadh, Saudi Arabia, 2017." Infection Control and Hospital Epidemiology, vol. 40, no. 1, 2019, pp. 79-88.
Alanazi KH, Killerby ME, Biggs HM, et al. Scope and extent of healthcare-associated Middle East respiratory syndrome coronavirus transmission during two contemporaneous outbreaks in Riyadh, Saudi Arabia, 2017. Infect Control Hosp Epidemiol. 2019;40(1):79-88.
Alanazi, K. H., Killerby, M. E., Biggs, H. M., Abedi, G. R., Jokhdar, H., Alsharef, A. A., Mohammed, M., Abdalla, O., Almari, A., Bereagesh, S., Tawfik, S., Alresheedi, H., Alhakeem, R. F., Hakawi, A., Alfalah, H., Amer, H., Thornburg, N. J., Tamin, A., Trivedi, S., ... Watson, J. T. (2019). Scope and extent of healthcare-associated Middle East respiratory syndrome coronavirus transmission during two contemporaneous outbreaks in Riyadh, Saudi Arabia, 2017. Infection Control and Hospital Epidemiology, 40(1), 79-88. https://doi.org/10.1017/ice.2018.290
Alanazi KH, et al. Scope and Extent of Healthcare-associated Middle East Respiratory Syndrome Coronavirus Transmission During Two Contemporaneous Outbreaks in Riyadh, Saudi Arabia, 2017. Infect Control Hosp Epidemiol. 2019;40(1):79-88. PubMed PMID: 30595141.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Scope and extent of healthcare-associated Middle East respiratory syndrome coronavirus transmission during two contemporaneous outbreaks in Riyadh, Saudi Arabia, 2017. AU - Alanazi,Khalid H, AU - Killerby,Marie E, AU - Biggs,Holly M, AU - Abedi,Glen R, AU - Jokhdar,Hani, AU - Alsharef,Ali A, AU - Mohammed,Mutaz, AU - Abdalla,Osman, AU - Almari,Aref, AU - Bereagesh,Samar, AU - Tawfik,Sameh, AU - Alresheedi,Husain, AU - Alhakeem,Raafat F, AU - Hakawi,Ahmed, AU - Alfalah,Haitham, AU - Amer,Hala, AU - Thornburg,Natalie J, AU - Tamin,Azaibi, AU - Trivedi,Suvang, AU - Tong,Suxiang, AU - Lu,Xiaoyan, AU - Queen,Krista, AU - Li,Yan, AU - Sakthivel,Senthilkumar K, AU - Tao,Ying, AU - Zhang,Jing, AU - Paden,Clinton R, AU - Al-Abdely,Hail M, AU - Assiri,Abdullah M, AU - Gerber,Susan I, AU - Watson,John T, PY - 2019/1/1/entrez PY - 2019/1/1/pubmed PY - 2019/12/18/medline SP - 79 EP - 88 JF - Infection control and hospital epidemiology JO - Infect Control Hosp Epidemiol VL - 40 IS - 1 N2 - OBJECTIVE: To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications. DESIGN: Outbreak investigation. SETTING: Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit. METHODS: Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases. RESULTS: In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive. CONCLUSIONS: We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission. SN - 1559-6834 UR - https://www.unboundmedicine.com/medline/citation/30595141/Scope_and_extent_of_healthcare_associated_Middle_East_respiratory_syndrome_coronavirus_transmission_during_two_contemporaneous_outbreaks_in_Riyadh_Saudi_Arabia_2017_ L2 - https://www.cambridge.org/core/product/identifier/S0899823X18002908/type/journal_article DB - PRIME DP - Unbound Medicine ER -