Scope and extent of healthcare-associated Middle East respiratory syndrome coronavirus transmission during two contemporaneous outbreaks in Riyadh, Saudi Arabia, 2017
Identifieur interne : 000815 ( Main/Exploration ); précédent : 000814; suivant : 000816Scope and extent of healthcare-associated Middle East respiratory syndrome coronavirus transmission during two contemporaneous outbreaks in Riyadh, Saudi Arabia, 2017
Auteurs : Khalid H. Alanazi [Arabie saoudite] ; Marie E. Killerby [États-Unis, Arabie saoudite] ; Holly M. Biggs [États-Unis] ; Glen R. Abedi [États-Unis] ; Hani Jokhdar [Arabie saoudite] ; Ali A. Alsharef [Arabie saoudite] ; Mutaz Mohammed [Arabie saoudite] ; Osman Abdalla [Arabie saoudite] ; Aref Almari [Arabie saoudite] ; Samar Bereagesh [Arabie saoudite] ; Sameh Tawfik [Arabie saoudite] ; Husain Alresheedi [Arabie saoudite] ; Raafat F. Alhakeem [Arabie saoudite] ; Ahmed Hakawi [Arabie saoudite] ; Haitham Alfalah [Arabie saoudite] ; Hala Amer [Arabie saoudite, Égypte] ; Natalie J. Thornburg [États-Unis] ; Azaibi Tamin [États-Unis] ; Suvang Trivedi [États-Unis] ; Suxiang Tong [États-Unis] ; Xiaoyan Lu [États-Unis] ; Krista Queen [États-Unis] ; Yan Li [États-Unis] ; Senthilkumar K. Sakthivel [États-Unis] ; Ying Tao [États-Unis] ; Jing Zhang [États-Unis] ; Clinton R. Paden [États-Unis] ; Hail M. Al-Abdely [Arabie saoudite] ; Abdullah M. Assiri [Arabie saoudite] ; Susan I. Gerber [États-Unis] ; John T. Watson [États-Unis]Source :
- Infection Control and Hospital Epidemiology [ 0899-823X ] ; 2018.
Descripteurs français
- KwdFr :
- ARN viral (génétique), Adulte, Adulte d'âge moyen, Arabie saoudite (épidémiologie), Coronavirus du syndrome respiratoire du Moyen-Orient (génétique), Coronavirus du syndrome respiratoire du Moyen-Orient (isolement et purification), Femelle, Flambées de maladies, Humains, Infection croisée (transmission), Infection croisée (virologie), Infection croisée (épidémiologie), Infections à coronavirus (transmission), Infections à coronavirus (épidémiologie), Lutte contre l'infection (), Mâle, Personnel de santé, Sujet âgé, Sujet âgé de 80 ans ou plus, Séquence nucléotidique, Traçage des contacts.
- MESH :
- génétique : ARN viral, Coronavirus du syndrome respiratoire du Moyen-Orient.
- isolement et purification : Coronavirus du syndrome respiratoire du Moyen-Orient.
- virologie : Infection croisée.
- épidémiologie : Arabie saoudite, Infection croisée, Infections à coronavirus.
- Adulte, Adulte d'âge moyen, Femelle, Flambées de maladies, Humains, Lutte contre l'infection, Mâle, Personnel de santé, Sujet âgé, Sujet âgé de 80 ans ou plus, Séquence nucléotidique, Traçage des contacts.
- Wicri :
- geographic : Arabie saoudite.
English descriptors
- KwdEn :
- Adult, Aged, Aged, 80 and over, Base Sequence, Contact Tracing, Coronavirus Infections (epidemiology), Coronavirus Infections (transmission), Cross Infection (epidemiology), Cross Infection (transmission), Cross Infection (virology), Disease Outbreaks, Female, Health Personnel, Humans, Infection Control (methods), Male, Middle Aged, Middle East Respiratory Syndrome Coronavirus (genetics), Middle East Respiratory Syndrome Coronavirus (isolation & purification), RNA, Viral (genetics), Saudi Arabia (epidemiology).
- MESH :
- chemical , genetics : RNA, Viral.
- geographic , epidemiology : Saudi Arabia.
- epidemiology : Coronavirus Infections, Cross Infection.
- genetics : Middle East Respiratory Syndrome Coronavirus.
- isolation & purification : Middle East Respiratory Syndrome Coronavirus.
- methods : Infection Control.
- transmission : Coronavirus Infections, Cross Infection.
- virology : Cross Infection.
- Adult, Aged, Aged, 80 and over, Base Sequence, Contact Tracing, Disease Outbreaks, Female, Health Personnel, Humans, Male, Middle Aged.
Abstract
To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.
Outbreak investigation.
Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.
Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.
In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.
We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.
Url:
DOI: 10.1017/ice.2018.290
PubMed: 30595141
PubMed Central: 7108661
Affiliations:
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Le document en format XML
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Alhakeem</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Hakawi, Ahmed" sort="Hakawi, Ahmed" uniqKey="Hakawi A" first="Ahmed" last="Hakawi">Ahmed Hakawi</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Alfalah, Haitham" sort="Alfalah, Haitham" uniqKey="Alfalah H" first="Haitham" last="Alfalah">Haitham Alfalah</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>King Saud Medical City</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Amer, Hala" sort="Amer, Hala" uniqKey="Amer H" first="Hala" last="Amer">Hala Amer</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>King Saud Medical City</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Department of Community Medicine</addr-line>,<addr-line>National Research Center</addr-line>,<addr-line>Cairo</addr-line>,<country>Egypt</country></nlm:aff><country xml:lang="fr">Égypte</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Thornburg, Natalie J" sort="Thornburg, Natalie J" uniqKey="Thornburg N" first="Natalie J." last="Thornburg">Natalie J. Thornburg</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Tamin, Azaibi" sort="Tamin, Azaibi" uniqKey="Tamin A" first="Azaibi" last="Tamin">Azaibi Tamin</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Trivedi, Suvang" sort="Trivedi, Suvang" uniqKey="Trivedi S" first="Suvang" last="Trivedi">Suvang Trivedi</name><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>IHRC</addr-line>,<addr-line>contractor to National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Tong, Suxiang" sort="Tong, Suxiang" uniqKey="Tong S" first="Suxiang" last="Tong">Suxiang Tong</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Lu, Xiaoyan" sort="Lu, Xiaoyan" uniqKey="Lu X" first="Xiaoyan" last="Lu">Xiaoyan Lu</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Queen, Krista" sort="Queen, Krista" uniqKey="Queen K" first="Krista" last="Queen">Krista Queen</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Li, Yan" sort="Li, Yan" uniqKey="Li Y" first="Yan" last="Li">Yan Li</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Sakthivel, Senthilkumar K" sort="Sakthivel, Senthilkumar K" uniqKey="Sakthivel S" first="Senthilkumar K." last="Sakthivel">Senthilkumar K. Sakthivel</name><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Batelle, contractor to National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA</addr-line>,<country>USA</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Tao, Ying" sort="Tao, Ying" uniqKey="Tao Y" first="Ying" last="Tao">Ying Tao</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Zhang, Jing" sort="Zhang, Jing" uniqKey="Zhang J" first="Jing" last="Zhang">Jing Zhang</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Paden, Clinton R" sort="Paden, Clinton R" uniqKey="Paden C" first="Clinton R." last="Paden">Clinton R. Paden</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Al Abdely, Hail M" sort="Al Abdely, Hail M" uniqKey="Al Abdely H" first="Hail M." last="Al-Abdely">Hail M. Al-Abdely</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Assiri, Abdullah M" sort="Assiri, Abdullah M" uniqKey="Assiri A" first="Abdullah M." last="Assiri">Abdullah M. Assiri</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Gerber, Susan I" sort="Gerber, Susan I" uniqKey="Gerber S" first="Susan I." last="Gerber">Susan I. Gerber</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Watson, John T" sort="Watson, John T" uniqKey="Watson J" first="John T." last="Watson">John T. Watson</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">30595141</idno><idno type="pmc">7108661</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7108661</idno><idno type="RBID">PMC:7108661</idno><idno type="doi">10.1017/ice.2018.290</idno><date when="2018">2018</date><idno type="wicri:Area/Pmc/Corpus">000D19</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000D19</idno><idno type="wicri:Area/Pmc/Curation">000D19</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000D19</idno><idno type="wicri:Area/Pmc/Checkpoint">000469</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000469</idno><idno type="wicri:source">PubMed</idno><idno type="RBID">pubmed:30595141</idno><idno type="wicri:Area/PubMed/Corpus">000692</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000692</idno><idno type="wicri:Area/PubMed/Curation">000692</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">000692</idno><idno type="wicri:Area/PubMed/Checkpoint">000391</idno><idno type="wicri:explorRef" wicri:stream="Checkpoint" wicri:step="PubMed">000391</idno><idno type="wicri:Area/Ncbi/Merge">002054</idno><idno type="wicri:Area/Ncbi/Curation">002054</idno><idno type="wicri:Area/Ncbi/Checkpoint">002054</idno><idno type="wicri:doubleKey">0899-823X:2018:Alanazi K:scope:and:extent</idno><idno type="wicri:Area/Main/Merge">000818</idno><idno type="wicri:Area/Main/Curation">000815</idno><idno type="wicri:Area/Main/Exploration">000815</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Scope and extent of healthcare-associated Middle East respiratory syndrome coronavirus transmission during two contemporaneous outbreaks in Riyadh, Saudi Arabia, 2017</title><author><name sortKey="Alanazi, Khalid H" sort="Alanazi, Khalid H" uniqKey="Alanazi K" first="Khalid H." last="Alanazi">Khalid H. Alanazi</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Killerby, Marie E" sort="Killerby, Marie E" uniqKey="Killerby M" first="Marie E." last="Killerby">Marie E. Killerby</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>King Saud Medical City</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Biggs, Holly M" sort="Biggs, Holly M" uniqKey="Biggs H" first="Holly M." last="Biggs">Holly M. Biggs</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Abedi, Glen R" sort="Abedi, Glen R" uniqKey="Abedi G" first="Glen R." last="Abedi">Glen R. Abedi</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Jokhdar, Hani" sort="Jokhdar, Hani" uniqKey="Jokhdar H" first="Hani" last="Jokhdar">Hani Jokhdar</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Alsharef, Ali A" sort="Alsharef, Ali A" uniqKey="Alsharef A" first="Ali A." last="Alsharef">Ali A. Alsharef</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Mohammed, Mutaz" sort="Mohammed, Mutaz" uniqKey="Mohammed M" first="Mutaz" last="Mohammed">Mutaz Mohammed</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Abdalla, Osman" sort="Abdalla, Osman" uniqKey="Abdalla O" first="Osman" last="Abdalla">Osman Abdalla</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Almari, Aref" sort="Almari, Aref" uniqKey="Almari A" first="Aref" last="Almari">Aref Almari</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Bereagesh, Samar" sort="Bereagesh, Samar" uniqKey="Bereagesh S" first="Samar" last="Bereagesh">Samar Bereagesh</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Tawfik, Sameh" sort="Tawfik, Sameh" uniqKey="Tawfik S" first="Sameh" last="Tawfik">Sameh Tawfik</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Alresheedi, Husain" sort="Alresheedi, Husain" uniqKey="Alresheedi H" first="Husain" last="Alresheedi">Husain Alresheedi</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Alhakeem, Raafat F" sort="Alhakeem, Raafat F" uniqKey="Alhakeem R" first="Raafat F." last="Alhakeem">Raafat F. Alhakeem</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Hakawi, Ahmed" sort="Hakawi, Ahmed" uniqKey="Hakawi A" first="Ahmed" last="Hakawi">Ahmed Hakawi</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Alfalah, Haitham" sort="Alfalah, Haitham" uniqKey="Alfalah H" first="Haitham" last="Alfalah">Haitham Alfalah</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>King Saud Medical City</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Amer, Hala" sort="Amer, Hala" uniqKey="Amer H" first="Hala" last="Amer">Hala Amer</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>King Saud Medical City</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Department of Community Medicine</addr-line>,<addr-line>National Research Center</addr-line>,<addr-line>Cairo</addr-line>,<country>Egypt</country></nlm:aff><country xml:lang="fr">Égypte</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Thornburg, Natalie J" sort="Thornburg, Natalie J" uniqKey="Thornburg N" first="Natalie J." last="Thornburg">Natalie J. Thornburg</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Tamin, Azaibi" sort="Tamin, Azaibi" uniqKey="Tamin A" first="Azaibi" last="Tamin">Azaibi Tamin</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Trivedi, Suvang" sort="Trivedi, Suvang" uniqKey="Trivedi S" first="Suvang" last="Trivedi">Suvang Trivedi</name><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>IHRC</addr-line>,<addr-line>contractor to National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Tong, Suxiang" sort="Tong, Suxiang" uniqKey="Tong S" first="Suxiang" last="Tong">Suxiang Tong</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Lu, Xiaoyan" sort="Lu, Xiaoyan" uniqKey="Lu X" first="Xiaoyan" last="Lu">Xiaoyan Lu</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Queen, Krista" sort="Queen, Krista" uniqKey="Queen K" first="Krista" last="Queen">Krista Queen</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Li, Yan" sort="Li, Yan" uniqKey="Li Y" first="Yan" last="Li">Yan Li</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Sakthivel, Senthilkumar K" sort="Sakthivel, Senthilkumar K" uniqKey="Sakthivel S" first="Senthilkumar K." last="Sakthivel">Senthilkumar K. Sakthivel</name><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Batelle, contractor to National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA</addr-line>,<country>USA</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Tao, Ying" sort="Tao, Ying" uniqKey="Tao Y" first="Ying" last="Tao">Ying Tao</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Zhang, Jing" sort="Zhang, Jing" uniqKey="Zhang J" first="Jing" last="Zhang">Jing Zhang</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Paden, Clinton R" sort="Paden, Clinton R" uniqKey="Paden C" first="Clinton R." last="Paden">Clinton R. Paden</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Al Abdely, Hail M" sort="Al Abdely, Hail M" uniqKey="Al Abdely H" first="Hail M." last="Al-Abdely">Hail M. Al-Abdely</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Assiri, Abdullah M" sort="Assiri, Abdullah M" uniqKey="Assiri A" first="Abdullah M." last="Assiri">Abdullah M. Assiri</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Gerber, Susan I" sort="Gerber, Susan I" uniqKey="Gerber S" first="Susan I." last="Gerber">Susan I. Gerber</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Watson, John T" sort="Watson, John T" uniqKey="Watson J" first="John T." last="Watson">John T. Watson</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">Infection Control and Hospital Epidemiology</title><idno type="ISSN">0899-823X</idno><idno type="eISSN">1559-6834</idno><imprint><date when="2018">2018</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Base Sequence</term><term>Contact Tracing</term><term>Coronavirus Infections (epidemiology)</term><term>Coronavirus Infections (transmission)</term><term>Cross Infection (epidemiology)</term><term>Cross Infection (transmission)</term><term>Cross Infection (virology)</term><term>Disease Outbreaks</term><term>Female</term><term>Health Personnel</term><term>Humans</term><term>Infection Control (methods)</term><term>Male</term><term>Middle Aged</term><term>Middle East Respiratory Syndrome Coronavirus (genetics)</term><term>Middle East Respiratory Syndrome Coronavirus (isolation & purification)</term><term>RNA, Viral (genetics)</term><term>Saudi Arabia (epidemiology)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>ARN viral (génétique)</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Arabie saoudite (épidémiologie)</term><term>Coronavirus du syndrome respiratoire du Moyen-Orient (génétique)</term><term>Coronavirus du syndrome respiratoire du Moyen-Orient (isolement et purification)</term><term>Femelle</term><term>Flambées de maladies</term><term>Humains</term><term>Infection croisée (transmission)</term><term>Infection croisée (virologie)</term><term>Infection croisée (épidémiologie)</term><term>Infections à coronavirus (transmission)</term><term>Infections à coronavirus (épidémiologie)</term><term>Lutte contre l'infection ()</term><term>Mâle</term><term>Personnel de santé</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Séquence nucléotidique</term><term>Traçage des contacts</term></keywords><keywords scheme="MESH" type="chemical" qualifier="genetics" xml:lang="en"><term>RNA, Viral</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Saudi Arabia</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Coronavirus Infections</term><term>Cross Infection</term></keywords><keywords scheme="MESH" qualifier="genetics" xml:lang="en"><term>Middle East Respiratory Syndrome Coronavirus</term></keywords><keywords scheme="MESH" qualifier="génétique" xml:lang="fr"><term>ARN viral</term><term>Coronavirus du syndrome respiratoire du Moyen-Orient</term></keywords><keywords scheme="MESH" qualifier="isolation & purification" xml:lang="en"><term>Middle East Respiratory Syndrome Coronavirus</term></keywords><keywords scheme="MESH" qualifier="isolement et purification" xml:lang="fr"><term>Coronavirus du syndrome respiratoire du Moyen-Orient</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Infection Control</term></keywords><keywords scheme="MESH" qualifier="transmission" xml:lang="en"><term>Coronavirus Infections</term><term>Cross Infection</term></keywords><keywords scheme="MESH" qualifier="virologie" xml:lang="fr"><term>Infection croisée</term></keywords><keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>Cross Infection</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Arabie saoudite</term><term>Infection croisée</term><term>Infections à coronavirus</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Base Sequence</term><term>Contact Tracing</term><term>Disease Outbreaks</term><term>Female</term><term>Health Personnel</term><term>Humans</term><term>Male</term><term>Middle Aged</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Femelle</term><term>Flambées de maladies</term><term>Humains</term><term>Lutte contre l'infection</term><term>Mâle</term><term>Personnel de santé</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Séquence nucléotidique</term><term>Traçage des contacts</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Arabie saoudite</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="abs1" sec-type="general"><title>Objective</title><p>To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.</p></sec><sec id="abs2" sec-type="general"><title>Design</title><p>Outbreak investigation.</p></sec><sec id="abs3" sec-type="general"><title>Setting</title><p>Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.</p></sec><sec id="abs4" sec-type="methods"><title>Methods</title><p>Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.</p></sec><sec id="abs5" sec-type="results"><title>Results</title><p>In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.</p></sec><sec id="abs6" sec-type="conclusions"><title>Conclusions</title><p>We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Zaki, Am" uniqKey="Zaki A">AM Zaki</name></author><author><name sortKey="Van Boheemen, S" uniqKey="Van Boheemen S">S van Boheemen</name></author><author><name sortKey="Bestebroer, Tm" uniqKey="Bestebroer T">TM Bestebroer</name></author><author><name sortKey="Osterhaus, Adme" uniqKey="Osterhaus A">ADME Osterhaus</name></author><author><name sortKey="Fouchier, Ram" uniqKey="Fouchier R">RAM Fouchier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Arabi, Ym" uniqKey="Arabi Y">YM Arabi</name></author><author><name sortKey="Balkhy, Hh" uniqKey="Balkhy H">HH Balkhy</name></author><author><name sortKey="Hayden, Fg" uniqKey="Hayden F">FG 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Alanazi</name></noRegion><name sortKey="Abdalla, Osman" sort="Abdalla, Osman" uniqKey="Abdalla O" first="Osman" last="Abdalla">Osman Abdalla</name><name sortKey="Al Abdely, Hail M" sort="Al Abdely, Hail M" uniqKey="Al Abdely H" first="Hail M." last="Al-Abdely">Hail M. Al-Abdely</name><name sortKey="Alfalah, Haitham" sort="Alfalah, Haitham" uniqKey="Alfalah H" first="Haitham" last="Alfalah">Haitham Alfalah</name><name sortKey="Alhakeem, Raafat F" sort="Alhakeem, Raafat F" uniqKey="Alhakeem R" first="Raafat F." last="Alhakeem">Raafat F. Alhakeem</name><name sortKey="Almari, Aref" sort="Almari, Aref" uniqKey="Almari A" first="Aref" last="Almari">Aref Almari</name><name sortKey="Alresheedi, Husain" sort="Alresheedi, Husain" uniqKey="Alresheedi H" first="Husain" last="Alresheedi">Husain Alresheedi</name><name sortKey="Alsharef, Ali A" sort="Alsharef, Ali A" uniqKey="Alsharef A" first="Ali A." last="Alsharef">Ali A. Alsharef</name><name sortKey="Amer, Hala" sort="Amer, Hala" uniqKey="Amer H" first="Hala" last="Amer">Hala Amer</name><name sortKey="Assiri, Abdullah M" sort="Assiri, Abdullah M" uniqKey="Assiri A" first="Abdullah M." last="Assiri">Abdullah M. Assiri</name><name sortKey="Bereagesh, Samar" sort="Bereagesh, Samar" uniqKey="Bereagesh S" first="Samar" last="Bereagesh">Samar Bereagesh</name><name sortKey="Hakawi, Ahmed" sort="Hakawi, Ahmed" uniqKey="Hakawi A" first="Ahmed" last="Hakawi">Ahmed Hakawi</name><name sortKey="Jokhdar, Hani" sort="Jokhdar, Hani" uniqKey="Jokhdar H" first="Hani" last="Jokhdar">Hani Jokhdar</name><name sortKey="Killerby, Marie E" sort="Killerby, Marie E" uniqKey="Killerby M" first="Marie E." last="Killerby">Marie E. Killerby</name><name sortKey="Mohammed, Mutaz" sort="Mohammed, Mutaz" uniqKey="Mohammed M" first="Mutaz" last="Mohammed">Mutaz Mohammed</name><name sortKey="Tawfik, Sameh" sort="Tawfik, Sameh" uniqKey="Tawfik S" first="Sameh" last="Tawfik">Sameh Tawfik</name></country><country name="États-Unis"><noRegion><name sortKey="Killerby, Marie E" sort="Killerby, Marie E" uniqKey="Killerby M" first="Marie E." last="Killerby">Marie E. Killerby</name></noRegion><name sortKey="Abedi, Glen R" sort="Abedi, Glen R" uniqKey="Abedi G" first="Glen R." last="Abedi">Glen R. Abedi</name><name sortKey="Biggs, Holly M" sort="Biggs, Holly M" uniqKey="Biggs H" first="Holly M." last="Biggs">Holly M. Biggs</name><name sortKey="Gerber, Susan I" sort="Gerber, Susan I" uniqKey="Gerber S" first="Susan I." last="Gerber">Susan I. Gerber</name><name sortKey="Li, Yan" sort="Li, Yan" uniqKey="Li Y" first="Yan" last="Li">Yan Li</name><name sortKey="Lu, Xiaoyan" sort="Lu, Xiaoyan" uniqKey="Lu X" first="Xiaoyan" last="Lu">Xiaoyan Lu</name><name sortKey="Paden, Clinton R" sort="Paden, Clinton R" uniqKey="Paden C" first="Clinton R." last="Paden">Clinton R. Paden</name><name sortKey="Queen, Krista" sort="Queen, Krista" uniqKey="Queen K" first="Krista" last="Queen">Krista Queen</name><name sortKey="Sakthivel, Senthilkumar K" sort="Sakthivel, Senthilkumar K" uniqKey="Sakthivel S" first="Senthilkumar K." last="Sakthivel">Senthilkumar K. Sakthivel</name><name sortKey="Tamin, Azaibi" sort="Tamin, Azaibi" uniqKey="Tamin A" first="Azaibi" last="Tamin">Azaibi Tamin</name><name sortKey="Tao, Ying" sort="Tao, Ying" uniqKey="Tao Y" first="Ying" last="Tao">Ying Tao</name><name sortKey="Thornburg, Natalie J" sort="Thornburg, Natalie J" uniqKey="Thornburg N" first="Natalie J." last="Thornburg">Natalie J. Thornburg</name><name sortKey="Tong, Suxiang" sort="Tong, Suxiang" uniqKey="Tong S" first="Suxiang" last="Tong">Suxiang Tong</name><name sortKey="Trivedi, Suvang" sort="Trivedi, Suvang" uniqKey="Trivedi S" first="Suvang" last="Trivedi">Suvang Trivedi</name><name sortKey="Watson, John T" sort="Watson, John T" uniqKey="Watson J" first="John T." last="Watson">John T. Watson</name><name sortKey="Zhang, Jing" sort="Zhang, Jing" uniqKey="Zhang J" first="Jing" last="Zhang">Jing Zhang</name></country><country name="Égypte"><noRegion><name sortKey="Amer, Hala" sort="Amer, Hala" uniqKey="Amer H" first="Hala" last="Amer">Hala Amer</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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