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Because of its high mortality rate, Middle East respiratory syndrome coronavirus (MERS-CoV) infection has received much attention since its identification in 2012. Extensive investigations into the epidemiology of this illness have yielded evidence of transmission from dromedary camels to humans (NEJM JW Infect Dis Jan 2015 and Emerg Infect Dis 2014; 20:1999) and of secondary human-to-human spread in households and healthcare facilities. Now, Saudi Arabian Ministry of Health and CDC researchers have investigated a MERS-CoV outbreak in early 2014 in Jeddah. All laboratory-confirmed cases were included.
Overall, 255 patients were identified (median age, 45 years; interquartile range, 30–59). Despite this relatively young age, 37% were admitted to an intensive care unit, and 37% died. Among the 191 symptomatic patients, 21% were healthcare employees. Of the remaining symptomatic patients who did not work in healthcare and who had information available (n=112), 97% reported recent contact with a healthcare facility or with a person who had confirmed MERS-CoV infection or a severe respiratory illness of unknown cause.
Of the 64 patients with reportedly asymptomatic infection, 64% were healthcare personnel. Among the 33 patients who could be contacted for additional information, 79% reported at least one symptom consistent with MERS-CoV infection; 36% had manifested signs and symptoms that prompted laboratory screening for MERS-CoV and were apparently misclassified as asymptomatic.
Oboho IK et al. 2014 MERS-CoV outbreak in Jeddah — a link to health care facilities. N Engl J Med 2015 Feb 26; 372:846. (http://dx.doi.org/10.1056/NEJMoa1408636)
Comment
The findings demonstrate the importance of healthcare exposure in transmitting this potentially lethal illness. As noted by the authors, they underscore the need to strengthen infection prevention and control practices in healthcare facilities — and to promptly recognize early or mild MERS-CoV infection in an effort to limit spread.