2014 Middle East respiratory syndrome coronavirus_ Implications for health care facilities

5 Pages·2014·0.22 MB·English

State of the Science Review

Middle East respiratory syndrome coronavirus: Implications
for health care facilities

Helena C. Maltezou MD, PhD a,*, Sotirios Tsiodras MD, PhD b

a Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
b Fourth Department of Internal Medicine, University of Athens Medical School, Attikon University Hospital, Athens, Greece

Key Words:
Middle East respiratory syndrome
coronavirus
Middle East respiratory syndrome
Hospital
Health care associated
Outbreak
Health care workers

Background: Middle East respiratory syndrome coronavirus (MERS-CoV) is a novel coronavirus that
causes a severe respiratory disease with high case fatality rate. Starting in March 2014, a dramatic in-
crease of cases has occurred in the Arabian Peninsula, many of which were acquired in health care
settings. As of May 9, 2014, 536 laboratory-confirmed cases and 145 deaths have been reported globally.
Methods: Review of publicly available data about MERS-CoV health careeassociated transmission.
Results: We identified 11 events of possible or confirmed health careeassociated transmission with high
morbidity and mortality, mainly among patients with comorbidities. Health care workers are also
frequently affected; however, they tend to have milder symptoms and better prognosis. Gaps in infection
control were noted in all events. Currently, health careeassociated outbreaks are playing a pivotal role in
the evolution of the MERS-CoV epidemic in countries in the Arabian Peninsula.
Conclusion: There is a need to increase infection control capacity in affected areas and areas at increased
risk of being affected to prevent transmission in health care settings. Vaccines and antiviral agents are
urgently needed. Overall, our knowledge about the epidemiologic characteristics of MERS-CoV that
impact health care transmission is very limited. As the MERS-CoV epidemic continues to evolve, issues
concerning best infection control measures will arise, and studies to better define their effectiveness in
real life are needed.
Copyright � 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc.
Published by Elsevier Inc. All rights reserved.

Middle East respiratory syndrome coronavirus (MERS-CoV) is a
novel betacoronavirus of the Coronaviridae family that causes a
severe respiratory disease with a high case fatality rate.1-4 The virus
was isolated for the first time in September 2012 from a 60-year-old
patient with fatal pneumonia in Saudi Arabia.5 However, the
earliest identified human cases were traced back to March 2012, to
a cluster of severe respiratory infections in a hospital in Jordan.6 Up
until now, all MERS-CoV infected cases are directly or indirectly
linked to the Middle East; therefore, the name MERS-CoV was
established.4 Over the first 2 years after the emergence of MERS-
CoV, the World Health Organization (WHO) has been notified of
191 laboratory-confirmed cases, of which 82 were fatal.7 However,

starting in mid- to late March 2014, a dramatic increase of cases has
been recorded, many which were acquired in health care settings
and concerned health care workers (HCWs).8 As of May 9, 2014, 536
laboratory-confirmed cases and 145 deaths have been reported to
the WHO globally.8 As a result, concerns have been expressed about
the possibility of a virus genetic change conferring increased
transmissibility, and the novel virus received media attention
globally. In the context of uncertainties about its epidemiology, the
high case fatality rate, the urgent need for a specific antiviral
treatment, and the unavailability of a vaccine, MERS-CoV has been a
major public health concern of global dimensions. Given the cur-
rent local epidemiologic trends of MERS-CoV8 and the large
numbers of travelers that fly out of the Arabian Peninsula,9 it is
almost certain that an increasing number of cases will be exported
to other countries; these cases, especially when that patient is
seriously ill, will require medical attention and hospitalization.
Herein, we review publicly available data about MERS-CoV focusing
on health careeassociated transmission. Aspects relevant to infec-
tion control are also discussed.

*
Address correspondence to Helena C. Maltezou, MD, PhD, Department for
Interventions in Health-Care Facilities, Hellenic Center for Disease Control and
Prevention, 3-5 Agrafon St, Athens, 15123 Greece.
E-mail address: