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Nosocomial MERS outbreak shows more ‘intense transmission’ of disease
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An investigation of a large outbreak of Middle East respiratory syndrome, or MERS, coronavirus at a hospital in Saudi Arabia revealed a more “intense transmission” of the infection than previously recorded in other outbreaks, researchers reported in MMWR.
“Since the first diagnosis of [MERS] ... in the Kingdom of Saudi Arabia in 2012, sporadic cases and clusters have occurred throughout the country,” the researchers said. “This large MERS outbreak in a major tertiary-care hospital in Riyadh was thought to be related to emergency department overcrowding, uncontrolled patient movement and high visitor traffic. The outbreak required institution of multiple measures to interrupt transmission, including almost complete shutdown of the hospital.”
A man aged 67 years was admitted to the 1,200-bed hospital in June 2015 with a history of fever and cough. Despite no identified exposure to camels, reverse transcription PCR of a nasopharyngeal swab revealed the presence of MERS coronavirus (MERS-CoV). The patient died 31 days after admittance, and had no contact with any subsequent cases, according to the researchers.
Three weeks after the index patient was admitted to care, a second case of MERS was confirmed. After the hospital’s infection control program initiated an outbreak investigation to identify risk factors and exposures, 81 confirmed and 49 probable cases of MERS were identified at the hospital over approximately 2 months. One-third of these cases occurred among health care workers (HCWs), and the majority of all cases were linked to the hospital’s ED. Nearly three-quarters of patients required hospitalization, 16% were asymptomatic and 53% died.
During the outbreak, the hospital initiated a pre-existing Infectious Disease Epidemic Plan developed from CDC and WHO guidelines. Despite strict enforcement of infection control practices, including hand hygiene and isolation of cases, more patients and HCWs continued to be infected, leading the hospital to close its ED, postpone elective surgical procedures and suspend all outpatient appointments and visits. These measures were associated with a rapid decline in new cases, and eventually led to the outbreak’s conclusion.
“Although data are still limited, this occurrence is considered a more intense transmission than has been previously described in similar outbreaks,” the researchers wrote. “Early recognition of cases and rapid implementation of infection control guidance is necessary to prevent health care facility-associated outbreaks of MERS-CoV.” – by Dave Muoio
- Reference:
- Balkhy HH, et al. MMWR Morb Mortal Wkly Rep. 2016;doi:10.15585/mmwr.mm6506a5.
Disclosure: The researchers report no relevant financial disclosures.