MERS outbreak in Saudi Arabia hospital linked to single patient

Issue: July 2016

An outbreak of Middle East respiratory syndrome that has potentially sickened dozens of people at a Saudi Arabia hospital has been linked to one patient.

According to WHO, the ongoing outbreak at King Khalid University Hospital in Riyadh city can be traced to a woman who was admitted on June 10 with unrelated symptoms and was not suspected of having MERS.

The woman, aged 49 years, was treated in the ED and then admitted to the vascular surgery ward, where she was not isolated and was managed in a room with multiple beds. In that time, more than 49 health care workers and patients became exposed to infection, according to WHO. After her infection was confirmed, a rapid response team was dispatched, and extensive contract tracing was initiated, WHO said.

However, as of June 22, 24 other MERS cases had been linked to the index patient, including 14 infected health care workers who either cared for her directly or worked in the same hospital. Of the 14 health care workers, 13 were asymptomatic.

According to Peter K. Ben Embarek, PhD, MERS-CoV task force manager in the WHO department of food safety and zoonoses, it can be difficult to recognize MERS patients when they are admitted to the hospital.

Peter K. Ben Embarek

“They can have unspecific or unusual symptoms or they can be admitted for another illness with different symptoms, and MERS is then only detected later on,” Ben Embarek told Infectious Disease News. “This has led to and will probably continue to be a reason for initial transmission within a hospital environment.”

Overall, 34 MERS cases in Saudi Arabia were reported to WHO between May 15 and June 20. Among the nine patients unconnected to the outbreak, five had a history of frequently drinking raw camel milk — a risk factor for MERS — and four were still being investigated to determine their exposure.

In the past, hospital outbreaks of MERS have been linked to inconsistent infection control in Saudi Arabia and contaminated surfaces in South Korea, whose MERS outbreak last year was the biggest outside of the Arabian Peninsula. During the outbreak, a hospital dialysis unit in South Korea may have staved off the spread of MERS by implementing infection control measures, according to a recent presentation at ASM Microbe 2016 in Boston.

Notably, in contrast to the current hospital outbreak in Saudi Arabia, the South Korean dialysis unit isolated patients by eliminating beds and moving the remaining beds father apart so they were separated by around 2 meters.

Ben Embarek said the spread and amplification of a MERS outbreak depends on factors such as the quality of management in the admissions area, how well infection control procedures are introduced and implemented, and how quickly and efficiently cases are identified and isolated.

“It will continue to be challenging for hospitals to properly identify MERS cases on admission —not only for Saudi Arabia, but for all countries in the world,” he said. “However, we know how to ensure that an initial outbreak in a hospital does not spread further and become a large event.” – by Gerard Gallagher

Reference:

Moon S, et al. Middle East respiratory syndrome coronavirus transmission in dialysis patients and infection control interventions. Presented at: ASM Microbe; June 16-20, 2016; Boston.

Disclosure: Ben Embarek reports no relevant financial disclosures.