Skip to main content Accessibility help
×
Home

Description of a Hospital Outbreak of Middle East Respiratory Syndrome in a Large Tertiary Care Hospital in Saudi Arabia

  • Hanan H. Balkhy (a1) (a2) (a3), Thamer H. Alenazi (a1) (a3), Majid M. Alshamrani (a4), Henry Baffoe-Bonnie (a1) (a3), Yaseen Arabi (a1) (a5), Raed Hijazi (a1) (a6), Hail M. Al-Abdely (a7), Aiman El-Saed (a1) (a3), Sameera Al Johani (a8), Abdullah M. Assiri (a7) (a9) and Abdulaziz bin Saeed (a7) (a10)...

Abstract

BACKGROUND

Since the first isolation of Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia in 2012, sporadic cases, clusters, and sometimes large outbreaks have been reported.

OBJECTIVE

To describe the recent (2015) MERS-CoV outbreak at a large tertiary care hospital in Riyadh, Saudi Arabia.

METHODS

We conducted an epidemiologic outbreak investigation, including case finding and contact tracing and screening. MERS-CoV cases were categorized as suspected, probable, and confirmed. A confirmed case was defined as positive reverse transcription polymerase chain reaction test for MERS-CoV.

RESULTS

Of the 130 suspected cases, 81 (62%) were confirmed and 49 (38%) were probable. These included 87 patients (67%) and 43 healthcare workers (33%). Older age (mean [SD], 64.4 [18.3] vs 40.1 [11.3] years, P<.001), symptoms (97% vs 58%, P<.001), and comorbidity (99% vs 42%, P<.001) were more common in patients than healthcare workers. Almost all patients (97%) were hospitalized whereas most healthcare workers (72%) were home isolated. Among 96 hospitalized cases, 63 (66%) required intensive care unit management and 60 (63%) required mechanical ventilation. Among all 130 cases, 51 (39%) died; all were patients (51 [59%]) with no deaths among healthcare workers. More than half (54%) of infections were believed to be caught at the emergency department. Strict infection control measures, including isolation and closure of the emergency department, were implemented to interrupt the chain of transmission and end the outbreak.

CONCLUSION

MERS-CoV remains a major healthcare threat. Early recognition of cases and rapid implementation of infection control measures are necessary.

Infect Control Hosp Epidemiol 2016;1–9

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Description of a Hospital Outbreak of Middle East Respiratory Syndrome in a Large Tertiary Care Hospital in Saudi Arabia
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Description of a Hospital Outbreak of Middle East Respiratory Syndrome in a Large Tertiary Care Hospital in Saudi Arabia
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Description of a Hospital Outbreak of Middle East Respiratory Syndrome in a Large Tertiary Care Hospital in Saudi Arabia
      Available formats
      ×

Copyright

Corresponding author

Address correspondence to Hanan Balkhy, MD, Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, PO Box 22490, Riyadh 11426 Kingdom of Saudi Arabia (balkhyh@ngha.med.sa).

References

Hide All
1. Zaki, AM, van Boheemen, S, Bestebroer, TM, Osterhaus, AD, Fouchier, RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med 2012;367:18141820.
2. Saudi Ministry of Health. MERS-CoV daily updates. Saudi Ministry of Health website. http://www.moh.gov.sa/en/CCC/PressReleases/Pages/Statistics-2015-12-31-001.aspx. Published 2015. Accessed December 31, 2015.
3. World Health Organization (WHO). Middle East respiratory syndrome coronavirus (MERS-CoV)–Saudi Arabia. WHO website. http://www.who.int/csr/don/4-december-2015-mers-saudi-arabia/en/. Published December 4, 2015. Accessed December 31, 2015.
4. Al-Tawfiq, JA, Perl, TM. Middle East respiratory syndrome coronavirus in healthcare settings. Curr Opin Infect Dis 2015;28:392396.
5. Assiri, A, McGeer, A, Perl, TM, et al. Hospital outbreak of Middle East respiratory syndrome coronavirus. N Engl J Med 2013;369:407416.
6. Drosten, C, Muth, D, Corman, VM, et al. An observational, laboratory-based study of outbreaks of Middle East respiratory syndrome coronavirus in Jeddah and Riyadh, Kingdom of Saudi Arabia, 2014. Clin Infect Dis 2015;60:369377.
7. Korean Society of Infectious Diseases. An unexpected outbreak of Middle East respiratory syndrome coronavirus infection in the Republic of Korea, 2015. Infect Chemother 2015;47:120122.
8. Korea Centers for Disease Control and Prevention. Middle East respiratory syndrome coronavirus outbreak in the Republic of Korea, 2015. Osong Public Health Res Perspect 2015;6:269278.
9. Alameer, K, Abukhzam, B, Khan, W, El-Saed, A, Balkhy, H. Middle East respiratory syndrome coronavirus (MERS-Cov) screening of exposed healthcare workers in a tertiary care hospital in Saudi Arabia. Antimicrob Resist Infect Control 2015;4:O57O57.
10. Saudi Ministry of Health. Case definition and surveillance guidance—updated June 2015. Saudi Ministry of Health website. http://www.moh.gov.sa/en/CCC/Regulations/Case%20Definition.pdf. Published June 2015. Accessed December 31, 2015.
11. Centers for Disease Control and Prevention (CDC). Interim infection prevention and control recommendations for hospitalized patients with Middle East respiratory syndrome coronavirus (MERS-CoV). CDC website. http://www.cdc.gov/coronavirus/mers/infection-prevention-control.html#infection-prevention. Updated December 8, 2015. Accessed December 31, 2015.
12. World Health Organization (WHO). Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care. WHO website. http://apps.who.int/iris/bitstream/10665/69707/1/WHO_CDS_EPR_2007.6_eng.pdf?ua=1. Published June 2007. Accessed December 31, 2015.
13. Memish, ZA, Al-Tawfiq, JA, Makhdoom, HQ, et al. Screening for Middle East respiratory syndrome coronavirus infection in hospital patients and their healthcare worker and family contacts: a prospective descriptive study. Clin Microbiol Infect 2014;20:469474.
14. Oboho, IK, Tomczyk, SM, Al-Asmari, AM, et al. 2014 MERS-CoV outbreak in Jeddah—a link to health care facilities. N Engl J Med 2015;372:846854.
15. Das, KM, Lee, EY, Jawder, SE, et al. Acute Middle East respiratory syndrome coronavirus: temporal lung changes observed on the chest radiographs of 55 patients. AJR Am J Roentgenol 2015;205:W267S274.
16. World Health Organization (WHO). Middle East respiratory syndrome coronavirus (MERS-CoV): summary and risk assessment of current situation in the Republic of Korea and China, as of 19 June 2015. WHO website. http://www.who.int/entity/emergencies/mers-cov/mers-cov-republic-of-korea-and-china-risk-assessment-19-june-2015.pdf?ua=1. Published June 19, 2015. Accessed December 31, 2015.
17. Mizumoto, K, Saitoh, M, Chowell, G, Miyamatsu, Y, Nishiura, H. Estimating the risk of Middle East respiratory syndrome (MERS) death during the course of the outbreak in the Republic of Korea, 2015. Intl J Infect Dis 2015;39:79.
18. Balkhy, H. MERS CoV: a trigger for healthcare transformation. J Infect Public Health 2015;9:12.

Description of a Hospital Outbreak of Middle East Respiratory Syndrome in a Large Tertiary Care Hospital in Saudi Arabia

  • Hanan H. Balkhy (a1) (a2) (a3), Thamer H. Alenazi (a1) (a3), Majid M. Alshamrani (a4), Henry Baffoe-Bonnie (a1) (a3), Yaseen Arabi (a1) (a5), Raed Hijazi (a1) (a6), Hail M. Al-Abdely (a7), Aiman El-Saed (a1) (a3), Sameera Al Johani (a8), Abdullah M. Assiri (a7) (a9) and Abdulaziz bin Saeed (a7) (a10)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed