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Nosocomial outbreak of the Middle East Respiratory Syndrome coronavirus: A phylogenetic, epidemiological, clinical and infection control analysis.
Travel Med Infect Dis. 2020 Sep - Oct; 37:101807.TM

Abstract

BACKGROUND

Middle East Respiratory Syndrome coronavirus (MERS-CoV) continues to cause intermittent community and nosocomial outbreaks. Obtaining data on specific source(s) and transmission dynamics of MERS-CoV during nosocomial outbreaks has been challenging. We performed a clinical, epidemiological and phylogenetic investigation of an outbreak of MERS-CoV at a University Hospital in Riyadh, Kingdom of Saudi Arabia.

METHODS

Clinical, epidemiological and infection control data were obtained from patients and Healthcare workers (HCWs). Full genome sequencing was conducted on nucleic acid extracted directly from MERS-CoV PCR-confirmed clinical samples and phylogenetic analysis performed. Phylogenetic analysis combined with published MERS-CoV genomes was performed. HCWs compliance with infection control practices was also assessed.

RESULTS

Of 235 persons investigated, there were 23 laboratory confirmed MERS cases, 10 were inpatients and 13 HCWs. Eight of 10 MERS inpatients died (80% mortality). There were no deaths among HCWs. The primary index case assumed from epidemiological investigation was not substantiated phylogenetically. 17/18 MERS cases were linked both phylogenetically and epidemiologically. One asymptomatic HCW yielded a MERS-CoV genome not directly linked to any other case in the investigation. Five HCWs with mild symptoms yielded >75% full MERS-CoV genome sequences. HCW compliance with use of gowns was 62.1%, gloves 69.7%, and masks 57.6%.

CONCLUSIONS

Several factors and sources, including a HCW MERS-CoV 'carrier phenomenon', occur during nosocomial MERS-CoV outbreaks. Phylogenetic analyses of MERS-CoV linked to clinical and epidemiological information is essential for outbreak investigation. The specific role of apparently healthy HCWs in causing nosocomial outbreaks requires further definition.

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Authors+Show Affiliations

Barry M
Infectious Diseases Division, Faculty of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. Electronic address: mbarry@ksu.edu.sa.
Phan MV
Virus Genomics, Wellcome Trust Sanger Institute, Hinxton, United Kingdom. Electronic address: mp21@sanger.ac.uk.
Akkielah L
Department of Internal Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia. Electronic address: layan.ak0@gmail.com.
Al-Majed F
Infectious Diseases Division, Faculty of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. Electronic address: almajid@ksu.edu.sa.
Alhetheel A
Division of Microbiology, Faculty of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. Electronic address: aalhetheel@ksu.edu.sa.
Somily A
Division of Microbiology, Faculty of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. Electronic address: ali.somily@gmail.com.
Alsubaie SS
Division of Pediatric Infectious Diseases, Faculty of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. Electronic address: salsubaie@ksu.edu.sa.
McNabb SJ
Emory University, Rollins School of Public Health, Atlanta, GA, USA. Electronic address: scottjnmcnabb@emory.edu.
Cotten M
MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda; MRC-University of Glasgow Centre for Virus Research, Glasgow, UK. Electronic address: Matthew.Cotten@lshtm.ac.uk.
Zumla A
Division of Infection and Immunity, Center for Clinical Microbiology, University College London, UK; National Institute of Health Research Biomedical Research Centre at UCL Hospitals, London, UK. Electronic address: a.i.zumla@gmail.com.
Memish ZA
Senior Infectious Diseases Consultant & Director Research & Innovation Center, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia; Faculty of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: zmemish@yahoo.com.

MeSH

Coronavirus InfectionsCross InfectionDisease OutbreaksGenome, ViralHealth PersonnelHospitals, UniversityHumansInfection ControlMiddle East Respiratory Syndrome CoronavirusPhylogenySaudi Arabia

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32599173

Citation

Barry, Mazin, et al. "Nosocomial Outbreak of the Middle East Respiratory Syndrome Coronavirus: a Phylogenetic, Epidemiological, Clinical and Infection Control Analysis." Travel Medicine and Infectious Disease, vol. 37, 2020, p. 101807.
Barry M, Phan MV, Akkielah L, et al. Nosocomial outbreak of the Middle East Respiratory Syndrome coronavirus: A phylogenetic, epidemiological, clinical and infection control analysis. Travel Med Infect Dis. 2020;37:101807.
Barry, M., Phan, M. V., Akkielah, L., Al-Majed, F., Alhetheel, A., Somily, A., Alsubaie, S. S., McNabb, S. J., Cotten, M., Zumla, A., & Memish, Z. A. (2020). Nosocomial outbreak of the Middle East Respiratory Syndrome coronavirus: A phylogenetic, epidemiological, clinical and infection control analysis. Travel Medicine and Infectious Disease, 37, 101807. https://doi.org/10.1016/j.tmaid.2020.101807
Barry M, et al. Nosocomial Outbreak of the Middle East Respiratory Syndrome Coronavirus: a Phylogenetic, Epidemiological, Clinical and Infection Control Analysis. Travel Med Infect Dis. 2020 Sep - Oct;37:101807. PubMed PMID: 32599173.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nosocomial outbreak of the Middle East Respiratory Syndrome coronavirus: A phylogenetic, epidemiological, clinical and infection control analysis. AU - Barry,Mazin, AU - Phan,My Vt, AU - Akkielah,Layan, AU - Al-Majed,Fahad, AU - Alhetheel,Abdulkarim, AU - Somily,Ali, AU - Alsubaie,Sarah Suliman, AU - McNabb,Scott Jn, AU - Cotten,Matthew, AU - Zumla,Alimuddin, AU - Memish,Ziad A, Y1 - 2020/06/27/ PY - 2020/04/07/received PY - 2020/05/21/revised PY - 2020/06/22/accepted PY - 2020/7/1/pubmed PY - 2020/10/30/medline PY - 2020/6/30/entrez KW - Epidemiology KW - Healthcare workers KW - MERS-CoV carrier phenomenon KW - Middle east respiratory syndrome KW - Nosocomial KW - Outbreak KW - Phylogenetics SP - 101807 EP - 101807 JF - Travel medicine and infectious disease JO - Travel Med Infect Dis VL - 37 N2 - BACKGROUND: Middle East Respiratory Syndrome coronavirus (MERS-CoV) continues to cause intermittent community and nosocomial outbreaks. Obtaining data on specific source(s) and transmission dynamics of MERS-CoV during nosocomial outbreaks has been challenging. We performed a clinical, epidemiological and phylogenetic investigation of an outbreak of MERS-CoV at a University Hospital in Riyadh, Kingdom of Saudi Arabia. METHODS: Clinical, epidemiological and infection control data were obtained from patients and Healthcare workers (HCWs). Full genome sequencing was conducted on nucleic acid extracted directly from MERS-CoV PCR-confirmed clinical samples and phylogenetic analysis performed. Phylogenetic analysis combined with published MERS-CoV genomes was performed. HCWs compliance with infection control practices was also assessed. RESULTS: Of 235 persons investigated, there were 23 laboratory confirmed MERS cases, 10 were inpatients and 13 HCWs. Eight of 10 MERS inpatients died (80% mortality). There were no deaths among HCWs. The primary index case assumed from epidemiological investigation was not substantiated phylogenetically. 17/18 MERS cases were linked both phylogenetically and epidemiologically. One asymptomatic HCW yielded a MERS-CoV genome not directly linked to any other case in the investigation. Five HCWs with mild symptoms yielded >75% full MERS-CoV genome sequences. HCW compliance with use of gowns was 62.1%, gloves 69.7%, and masks 57.6%. CONCLUSIONS: Several factors and sources, including a HCW MERS-CoV 'carrier phenomenon', occur during nosocomial MERS-CoV outbreaks. Phylogenetic analyses of MERS-CoV linked to clinical and epidemiological information is essential for outbreak investigation. The specific role of apparently healthy HCWs in causing nosocomial outbreaks requires further definition. SN - 1873-0442 UR - https://www.unboundmedicine.com/medline/citation/32599173/Nosocomial_outbreak_of_the_Middle_East_Respiratory_Syndrome_coronavirus:_A_phylogenetic_epidemiological_clinical_and_infection_control_analysis_ DB - PRIME DP - Unbound Medicine ER -