Middle East respiratory syndrome coronavirus transmission among health care workers: Implication for infection control
Identifieur interne : 000C84 ( Main/Exploration ); précédent : 000C83; suivant : 000C85Middle East respiratory syndrome coronavirus transmission among health care workers: Implication for infection control
Auteurs : Sarah H. Alfaraj [Arabie saoudite, Canada] ; Jaffar A. Al-Tawfiq [États-Unis, Arabie saoudite] ; Talal A. Altuwaijri [Arabie saoudite] ; Marzouqa Alanazi [Arabie saoudite] ; Nojoom Alzahrani [Arabie saoudite] ; Ziad A. Memish [Arabie saoudite, États-Unis]Source :
- American Journal of Infection Control [ 0196-6553 ] ; 2017.
Descripteurs français
- KwdFr :
- MESH :
- isolement et purification : Coronavirus du syndrome respiratoire du Moyen-Orient.
- virologie : Infections à coronavirus.
- Adulte, Arabie saoudite, Femelle, Humains, Infections à coronavirus, Lutte contre l'infection, Mâle, Personnel de santé, Philippines, Traçage des contacts.
- Wicri :
- geographic : Philippines, Arabie saoudite.
English descriptors
- KwdEn :
- MESH :
- geographic : Philippines, Saudi Arabia.
- isolation & purification : Middle East Respiratory Syndrome Coronavirus.
- methods : Infection Control.
- transmission : Coronavirus Infections.
- virology : Coronavirus Infections.
- Adult, Contact Tracing, Female, Health Personnel, Humans, Male.
Abstract
Many outbreaks of Middle East respiratory syndrome coronavirus (MERS-CoV) have occurred in health care settings and involved health care workers (HCWs). We describe the occurrence of an outbreak among HCWs and attempt to characterize at-risk exposures to improve future infection control interventions.
This study included an index case and all HCW contacts. All contacts were screened for MERS-CoV using polymerase chain reaction.
During the study period in 2015, the index case was a 30-year-old Filipino nurse who had a history of unprotected exposure to a MERS-CoV–positive case on May 15, 2015, and had multiple negative tests for MERS-CoV. Weeks later, she was diagnosed with pulmonary tuberculosis and MERS-CoV infection. A total of 73 staff were quarantined for 14 days, and nasopharyngeal swabs were taken on days 2, 5, and 12 postexposure. Of those contacts, 3 (4%) were confirmed positive for MERS-CoV. An additional 18 staff were quarantined and had MERS-CoV swabs. A fourth case was confirmed positive on day 12. Subsequent contact investigations revealed a fourth-generation transmission. Only 7 (4.5%) of the total 153 contacts were positive for MERS-CoV.
The role of HCWs in MERS-CoV transmission is complex. Although most MERS-CoV–infected HCWs are asymptomatic or have mild disease, fatal infections can occur and HCWs can play a major role in propagating health care facility outbreaks. This investigation highlights the need to continuously review infection control guidance relating to the role of HCWs in MERS-CoV transmission in health care outbreaks, especially as it relates to the complex questions on definition of risky exposures, who to test, and the frequency of MERS-CoV testing; criteria for who to quarantine and for how long; and clearance and return to active duty criteria.
Url:
DOI: 10.1016/j.ajic.2017.08.010
PubMed: 28958446
PubMed Central: 7115310
Affiliations:
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Memish</name><affiliation wicri:level="1"><nlm:aff id="af0040">College of Medicine, Alfaisal University, Riyadh, Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>College of Medicine, Alfaisal University, Riyadh</wicri:regionArea><wicri:noRegion>Riyadh</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="af0045">Infectious Diseases Division, Department of Medicine, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Infectious Diseases Division, Department of Medicine, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh</wicri:regionArea><wicri:noRegion>Riyadh</wicri:noRegion></affiliation><affiliation wicri:level="2"><nlm:aff id="af0050">Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName><wicri:cityArea>Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta</wicri:cityArea></affiliation></author></analytic><series><title level="j">American Journal of Infection Control</title><idno type="ISSN">0196-6553</idno><idno type="eISSN">1527-3296</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Contact Tracing</term><term>Coronavirus Infections (transmission)</term><term>Coronavirus Infections (virology)</term><term>Female</term><term>Health Personnel</term><term>Humans</term><term>Infection Control (methods)</term><term>Male</term><term>Middle East Respiratory Syndrome Coronavirus (isolation & purification)</term><term>Philippines</term><term>Saudi Arabia</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Arabie saoudite</term><term>Coronavirus du syndrome respiratoire du Moyen-Orient (isolement et purification)</term><term>Femelle</term><term>Humains</term><term>Infections à coronavirus (transmission)</term><term>Infections à coronavirus (virologie)</term><term>Lutte contre l'infection ()</term><term>Mâle</term><term>Personnel de santé</term><term>Philippines</term><term>Traçage des contacts</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>Philippines</term><term>Saudi Arabia</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></keywords><keywords scheme="MESH" qualifier="virologie" xml:lang="fr"><term>Infections à coronavirus</term></keywords><keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>Coronavirus Infections</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Contact Tracing</term><term>Female</term><term>Health Personnel</term><term>Humans</term><term>Male</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Arabie saoudite</term><term>Femelle</term><term>Humains</term><term>Infections à coronavirus</term><term>Lutte contre l'infection</term><term>Mâle</term><term>Personnel de santé</term><term>Philippines</term><term>Traçage des contacts</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Philippines</term><term>Arabie saoudite</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Many outbreaks of Middle East respiratory syndrome coronavirus (MERS-CoV) have occurred in health care settings and involved health care workers (HCWs). We describe the occurrence of an outbreak among HCWs and attempt to characterize at-risk exposures to improve future infection control interventions.</p></sec><sec><title>Methods</title><p>This study included an index case and all HCW contacts. All contacts were screened for MERS-CoV using polymerase chain reaction.</p></sec><sec><title>Results</title><p>During the study period in 2015, the index case was a 30-year-old Filipino nurse who had a history of unprotected exposure to a MERS-CoV–positive case on May 15, 2015, and had multiple negative tests for MERS-CoV. Weeks later, she was diagnosed with pulmonary tuberculosis and MERS-CoV infection. A total of 73 staff were quarantined for 14 days, and nasopharyngeal swabs were taken on days 2, 5, and 12 postexposure. Of those contacts, 3 (4%) were confirmed positive for MERS-CoV. An additional 18 staff were quarantined and had MERS-CoV swabs. A fourth case was confirmed positive on day 12. Subsequent contact investigations revealed a fourth-generation transmission. Only 7 (4.5%) of the total 153 contacts were positive for MERS-CoV.</p></sec><sec><title>Conclusions</title><p>The role of HCWs in MERS-CoV transmission is complex. Although most MERS-CoV–infected HCWs are asymptomatic or have mild disease, fatal infections can occur and HCWs can play a major role in propagating health care facility outbreaks. This investigation highlights the need to continuously review infection control guidance relating to the role of HCWs in MERS-CoV transmission in health care outbreaks, especially as it relates to the complex questions on definition of risky exposures, who to test, and the frequency of MERS-CoV testing; criteria for who to quarantine and for how long; and clearance and return to active duty criteria.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Al Tawfiq, J A" uniqKey="Al Tawfiq J">J.A. Al-Tawfiq</name></author><author><name sortKey="Assiri, A" uniqKey="Assiri A">A. Assiri</name></author><author><name sortKey="Memish, Z A" uniqKey="Memish Z">Z.A. Memish</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Guery, B" uniqKey="Guery B">B. Guery</name></author><author><name sortKey="Poissy, J" uniqKey="Poissy J">J. Poissy</name></author><author><name sortKey="El Mansouf, L" uniqKey="El Mansouf L">L. el Mansouf</name></author><author><name sortKey="Sejourne, C" uniqKey="Sejourne C">C. Séjourné</name></author><author><name sortKey="Ettahar, N" uniqKey="Ettahar N">N. Ettahar</name></author><author><name sortKey="Lemaire, X" uniqKey="Lemaire X">X. Lemaire</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Omrani, A S" uniqKey="Omrani A">A.S. Omrani</name></author><author><name sortKey="Matin, M A" uniqKey="Matin M">M.A. Matin</name></author><author><name sortKey="Haddad, Q" uniqKey="Haddad Q">Q. 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Kong</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Arabie saoudite</li><li>Canada</li><li>États-Unis</li></country><region><li>Géorgie (États-Unis)</li><li>Indiana</li></region></list><tree><country name="Arabie saoudite"><noRegion><name sortKey="Alfaraj, Sarah H" sort="Alfaraj, Sarah H" uniqKey="Alfaraj S" first="Sarah H." last="Alfaraj">Sarah H. Alfaraj</name></noRegion><name sortKey="Al Tawfiq, Jaffar A" sort="Al Tawfiq, Jaffar A" uniqKey="Al Tawfiq J" first="Jaffar A." last="Al-Tawfiq">Jaffar A. Al-Tawfiq</name><name sortKey="Alanazi, Marzouqa" sort="Alanazi, Marzouqa" uniqKey="Alanazi M" first="Marzouqa" last="Alanazi">Marzouqa Alanazi</name><name sortKey="Altuwaijri, Talal A" sort="Altuwaijri, Talal A" uniqKey="Altuwaijri T" first="Talal A." last="Altuwaijri">Talal A. Altuwaijri</name><name sortKey="Alzahrani, Nojoom" sort="Alzahrani, Nojoom" uniqKey="Alzahrani N" first="Nojoom" last="Alzahrani">Nojoom Alzahrani</name><name sortKey="Memish, Ziad A" sort="Memish, Ziad A" uniqKey="Memish Z" first="Ziad A." last="Memish">Ziad A. Memish</name><name sortKey="Memish, Ziad A" sort="Memish, Ziad A" uniqKey="Memish Z" first="Ziad A." last="Memish">Ziad A. Memish</name></country><country name="Canada"><noRegion><name sortKey="Alfaraj, Sarah H" sort="Alfaraj, Sarah H" uniqKey="Alfaraj S" first="Sarah H." last="Alfaraj">Sarah H. Alfaraj</name></noRegion></country><country name="États-Unis"><region name="Indiana"><name sortKey="Al Tawfiq, Jaffar A" sort="Al Tawfiq, Jaffar A" uniqKey="Al Tawfiq J" first="Jaffar A." last="Al-Tawfiq">Jaffar A. Al-Tawfiq</name></region><name sortKey="Memish, Ziad A" sort="Memish, Ziad A" uniqKey="Memish Z" first="Ziad A." last="Memish">Ziad A. 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