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Clin Infect Dis. Hospital-associated outbreak of Middle East Respiratory Syndrome Coronavirus: A serologic, epidemiologic, and clinical description
[Source: Clinical Infectious Diseases, full page: (LINK). Abstract, edited.]
Hospital-associated outbreak of Middle East Respiratory Syndrome Coronavirus: A serologic, epidemiologic, and clinical description
Mohammad Mousa Al-Abdallat*,1, Daniel C. Payne*,2, Sultan Alqasrawi 1, Brian Rha 2,3, Rania A. Tohme 4, Glen R. Abedi 2, Mohannad Al Nsour 5, Ibrahim Iblan 6, Najwa Jarour 1, Noha H. Farag 7, Aktham Haddadin 8, Tarek Al-Sanouri 8, Azaibi Tamin 2, Jennifer L. Harcourt 2, David T. Kuhar 9, David L. Swerdlow 2, Dean D. Erdman 2, Mark A. Pallansch 2, Lia M. Haynes 2, Susan I. Gerber 2, the Jordan MERS-CoV Investigation Team
Author Affiliations: <SUP>1</SUP>Communicable Diseases Directorate, Jordan Ministry of Health, Amman, Jordan <SUP>2</SUP>Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA <SUP>3</SUP>Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA <SUP>4</SUP>Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA <SUP>5</SUP>Eastern Mediterranean Public Health Network (EMPHNET), Amman, Jordan <SUP>6</SUP>Field Epidemiology Training Program, Jordan Ministry of Health, Amman, Jordan <SUP>7</SUP>Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA <SUP>8</SUP>Directorate of Laboratories, Jordan Ministry of Health, Amman, Jordan <SUP>9</SUP>Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Correspondence: Daniel C. Payne, PhD, MSPH (Tele) 404-639-2784 DVP6@CDC.GOV, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop A34, Atlanta, Georgia, 30333 U.S.A.
* contributed equally to the study
<CITE><ABBR>Clin Infect Dis.</ABBR> (2014) doi: 10.1093/cid/ciu359 </CITE>First published online: May 14, 2014
Abstract
Background.
In April 2012, the Jordan Ministry of Health (JMoH) investigated an outbreak of lower respiratory illnesses at a hospital in Jordan; two fatal cases were retrospectively confirmed by rRT-PCR to be the first detected cases of Middle East Respiratory Syndrome (MERS-CoV).
Methods.
Epidemiologic and clinical characteristics of selected potential cases were assessed through serum blood specimens, medical chart reviews and interviews with surviving outbreak members, household contacts, and healthcare personnel. Cases of MERS-CoV infection were identified using three U.S. Centers for Disease Control and Prevention (CDC) serologic tests for detection of anti-MERS-CoV antibodies.
Results.
Specimens and interviews were obtained from 124 subjects. Seven previously unconfirmed individuals tested positive for anti-MERS-CoV antibodies by at least two of three serologic tests, in addition to two fatal cases identified by rRT-PCR. The case fatality rate among the nine total cases was 22%. Six cases were healthcare workers at the outbreak hospital, yielding an attack rate of 10% among potentially exposed outbreak hospital personnel. There was no evidence of MERS-CoV transmission at two transfer hospitals having acceptable infection control practices.
Conclusion.
Novel serological tests allowed for the detection of otherwise unrecognized cases of MERS-CoV infection among contacts of a Jordan hospital-associated respiratory illness outbreak in April 2012, resulting in a total of nine test-positive cases. Serologic results suggest that further spread of this outbreak to transfer hospitals did not occur. Most cases had no major, underlying medical conditions; none were on hemodialysis. Our observed case fatality was lower than has been reported from outbreaks elsewhere.
Received March 27, 2014. Accepted May 7, 2014.
Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.
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Hospital-associated outbreak of Middle East Respiratory Syndrome Coronavirus: A serologic, epidemiologic, and clinical description
Mohammad Mousa Al-Abdallat*,1, Daniel C. Payne*,2, Sultan Alqasrawi 1, Brian Rha 2,3, Rania A. Tohme 4, Glen R. Abedi 2, Mohannad Al Nsour 5, Ibrahim Iblan 6, Najwa Jarour 1, Noha H. Farag 7, Aktham Haddadin 8, Tarek Al-Sanouri 8, Azaibi Tamin 2, Jennifer L. Harcourt 2, David T. Kuhar 9, David L. Swerdlow 2, Dean D. Erdman 2, Mark A. Pallansch 2, Lia M. Haynes 2, Susan I. Gerber 2, the Jordan MERS-CoV Investigation Team
Author Affiliations: <SUP>1</SUP>Communicable Diseases Directorate, Jordan Ministry of Health, Amman, Jordan <SUP>2</SUP>Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA <SUP>3</SUP>Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA <SUP>4</SUP>Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA <SUP>5</SUP>Eastern Mediterranean Public Health Network (EMPHNET), Amman, Jordan <SUP>6</SUP>Field Epidemiology Training Program, Jordan Ministry of Health, Amman, Jordan <SUP>7</SUP>Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA <SUP>8</SUP>Directorate of Laboratories, Jordan Ministry of Health, Amman, Jordan <SUP>9</SUP>Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Correspondence: Daniel C. Payne, PhD, MSPH (Tele) 404-639-2784 DVP6@CDC.GOV, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop A34, Atlanta, Georgia, 30333 U.S.A.
* contributed equally to the study
<CITE><ABBR>Clin Infect Dis.</ABBR> (2014) doi: 10.1093/cid/ciu359 </CITE>First published online: May 14, 2014
Abstract
Background.
In April 2012, the Jordan Ministry of Health (JMoH) investigated an outbreak of lower respiratory illnesses at a hospital in Jordan; two fatal cases were retrospectively confirmed by rRT-PCR to be the first detected cases of Middle East Respiratory Syndrome (MERS-CoV).
Methods.
Epidemiologic and clinical characteristics of selected potential cases were assessed through serum blood specimens, medical chart reviews and interviews with surviving outbreak members, household contacts, and healthcare personnel. Cases of MERS-CoV infection were identified using three U.S. Centers for Disease Control and Prevention (CDC) serologic tests for detection of anti-MERS-CoV antibodies.
Results.
Specimens and interviews were obtained from 124 subjects. Seven previously unconfirmed individuals tested positive for anti-MERS-CoV antibodies by at least two of three serologic tests, in addition to two fatal cases identified by rRT-PCR. The case fatality rate among the nine total cases was 22%. Six cases were healthcare workers at the outbreak hospital, yielding an attack rate of 10% among potentially exposed outbreak hospital personnel. There was no evidence of MERS-CoV transmission at two transfer hospitals having acceptable infection control practices.
Conclusion.
Novel serological tests allowed for the detection of otherwise unrecognized cases of MERS-CoV infection among contacts of a Jordan hospital-associated respiratory illness outbreak in April 2012, resulting in a total of nine test-positive cases. Serologic results suggest that further spread of this outbreak to transfer hospitals did not occur. Most cases had no major, underlying medical conditions; none were on hemodialysis. Our observed case fatality was lower than has been reported from outbreaks elsewhere.
Received March 27, 2014. Accepted May 7, 2014.
Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.
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