Travel-related MERS-CoV cases: an assessment of exposures and risk factors in a group of Dutch travellers returning from the Kingdom of Saudi Arabia, May 2014
Identifieur interne : 000F36 ( Ncbi/Curation ); précédent : 000F35; suivant : 000F37Travel-related MERS-CoV cases: an assessment of exposures and risk factors in a group of Dutch travellers returning from the Kingdom of Saudi Arabia, May 2014
Auteurs : Ewout B. Fanoy [Pays-Bas, Suède] ; Marianne Ab Van Der Sande [Pays-Bas] ; Marleen Kraaij-Dirkzwager [Pays-Bas] ; Kees Dirksen [Pays-Bas] ; Marcel Jonges [Pays-Bas] ; Wim Van Der Hoek [Pays-Bas] ; Marion Pg Koopmans [Pays-Bas] ; Douwe Van Der Werf [Pays-Bas] ; Gerard Sonder [Pays-Bas] ; Charlie Van Der Weijden [Pays-Bas] ; Jet Van Der Heuvel [Pays-Bas] ; Luc Gelinck [Pays-Bas] ; Jolande W. Bouwhuis [Pays-Bas] ; Arianne B. Van Gageldonk-Lafeber [Pays-Bas]Source :
- Emerging Themes in Epidemiology [ 1742-7622 ] ; 2014.
Abstract
In May 2014, Middle East respiratory syndrome coronavirus (MERS-CoV) infection, with closely related viral genomes, was diagnosed in two Dutch residents, returning from a pilgrimage to Medina and Mecca, Kingdom of Saudi Arabia (KSA). These patients travelled with a group of 29 other Dutch travellers. We conducted an epidemiological assessment of the travel group to identify likely source(s) of infection and presence of potential risk factors.
All travellers, including the two cases, completed a questionnaire focussing on potential human, animal and food exposures to MERS-CoV. The questionnaire was modified from the WHO MERS-CoV questionnaire, taking into account the specific route and activities of the travel group.
Twelve non-cases drank unpasteurized camel milk and had contact with camels. Most travellers, including one of the two patients (Case 1), visited local markets, where six of them consumed fruits. Two travellers, including Case 1, were exposed to coughing patients when visiting a hospital in Medina. Four travellers, including Case 1, visited two hospitals in Mecca. All travellers had been in contact with Case 1 while he was sick, with initially non-respiratory complaints. The cases were found to be older than the other travellers and both had co-morbidities.
This epidemiological study revealed the complexity of MERS-CoV outbreak investigations with multiple potential exposures to MERS-CoV reported such as healthcare visits, camel exposure, and exposure to untreated food products. Exposure to MERS-CoV during a hospital visit is considered a likely source of infection for Case 1 but not for Case 2. For Case 2, the most likely source could not be determined. Exposure to MERS-CoV via direct contact with animals or dairy products seems unlikely for the two Dutch cases. Furthermore, exposure to a common but still unidentified source cannot be ruled out. More comprehensive research into sources of infection in the Arabian Peninsula is needed to strengthen and specify the prevention of MERS-CoV infections.
The online version of this article (doi:10.1186/1742-7622-11-16) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/1742-7622-11-16
PubMed: 25328533
PubMed Central: 4200475
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Rotterdam, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Rotterdam</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Van Der Werf, Douwe" sort="Van Der Werf, Douwe" uniqKey="Van Der Werf D" first="Douwe" last="Van Der Werf">Douwe Van Der Werf</name>
<affiliation wicri:level="1"><nlm:aff id="Aff7">Public Health Service IJsselland, Zwolle, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Public Health Service IJsselland, Zwolle</wicri:regionArea>
<wicri:noRegion>Zwolle</wicri:noRegion>
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</author>
<author><name sortKey="Sonder, Gerard" sort="Sonder, Gerard" uniqKey="Sonder G" first="Gerard" last="Sonder">Gerard Sonder</name>
<affiliation wicri:level="1"><nlm:aff id="Aff8"><institution-wrap><institution-id institution-id-type="GRID">grid.413928.5</institution-id>
<institution-id institution-id-type="ISNI">0000 0000 9418 9094</institution-id>
<institution>Public Health Service Amsterdam,</institution>
</institution-wrap>
Amsterdam, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Amsterdam</wicri:regionArea>
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<author><name sortKey="Van Der Weijden, Charlie" sort="Van Der Weijden, Charlie" uniqKey="Van Der Weijden C" first="Charlie" last="Van Der Weijden">Charlie Van Der Weijden</name>
<affiliation wicri:level="1"><nlm:aff id="Aff9"><institution-wrap><institution-id institution-id-type="GRID">grid.413928.5</institution-id>
<institution-id institution-id-type="ISNI">0000 0000 9418 9094</institution-id>
<institution>Public Health Service Flevoland,</institution>
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Lelystad, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Lelystad</wicri:regionArea>
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<author><name sortKey="Van Der Heuvel, Jet" sort="Van Der Heuvel, Jet" uniqKey="Van Der Heuvel J" first="Jet" last="Van Der Heuvel">Jet Van Der Heuvel</name>
<affiliation wicri:level="1"><nlm:aff id="Aff10">Public Health Service Hart voor Brabant’s, Hertogenbosch, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Public Health Service Hart voor Brabant’s, Hertogenbosch</wicri:regionArea>
<wicri:noRegion>Hertogenbosch</wicri:noRegion>
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<author><name sortKey="Gelinck, Luc" sort="Gelinck, Luc" uniqKey="Gelinck L" first="Luc" last="Gelinck">Luc Gelinck</name>
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<institution-id institution-id-type="ISNI">0000000403956796</institution-id>
<institution>Medical Centre Haaglanden,</institution>
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The Hague, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>The Hague</wicri:regionArea>
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</author>
<author><name sortKey="Bouwhuis, Jolande W" sort="Bouwhuis, Jolande W" uniqKey="Bouwhuis J" first="Jolande W" last="Bouwhuis">Jolande W. Bouwhuis</name>
<affiliation wicri:level="1"><nlm:aff id="Aff12">Isalaklinieken, Zwolle, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Isalaklinieken, Zwolle</wicri:regionArea>
<wicri:noRegion>Zwolle</wicri:noRegion>
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<author><name sortKey="Van Gageldonk Lafeber, Arianne B" sort="Van Gageldonk Lafeber, Arianne B" uniqKey="Van Gageldonk Lafeber A" first="Arianne B" last="Van Gageldonk-Lafeber">Arianne B. Van Gageldonk-Lafeber</name>
<affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.31147.30</institution-id>
<institution-id institution-id-type="ISNI">0000 0001 2208 0118</institution-id>
<institution>National Institute for Public Health and the Environment,</institution>
<institution>Centre for Infectious Disease Control,</institution>
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Bilthoven, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Bilthoven</wicri:regionArea>
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</analytic>
<series><title level="j">Emerging Themes in Epidemiology</title>
<idno type="eISSN">1742-7622</idno>
<imprint><date when="2014">2014</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>In May 2014, Middle East respiratory syndrome coronavirus (MERS-CoV) infection, with closely related viral genomes, was diagnosed in two Dutch residents, returning from a pilgrimage to Medina and Mecca, Kingdom of Saudi Arabia (KSA). These patients travelled with a group of 29 other Dutch travellers. We conducted an epidemiological assessment of the travel group to identify likely source(s) of infection and presence of potential risk factors.</p>
</sec>
<sec><title>Methods</title>
<p>All travellers, including the two cases, completed a questionnaire focussing on potential human, animal and food exposures to MERS-CoV. The questionnaire was modified from the WHO MERS-CoV questionnaire, taking into account the specific route and activities of the travel group.</p>
</sec>
<sec><title>Results</title>
<p>Twelve non-cases drank unpasteurized camel milk and had contact with camels. Most travellers, including one of the two patients (Case 1), visited local markets, where six of them consumed fruits. Two travellers, including Case 1, were exposed to coughing patients when visiting a hospital in Medina. Four travellers, including Case 1, visited two hospitals in Mecca. All travellers had been in contact with Case 1 while he was sick, with initially non-respiratory complaints. The cases were found to be older than the other travellers and both had co-morbidities.</p>
</sec>
<sec><title>Conclusions</title>
<p>This epidemiological study revealed the complexity of MERS-CoV outbreak investigations with multiple potential exposures to MERS-CoV reported such as healthcare visits, camel exposure, and exposure to untreated food products. Exposure to MERS-CoV during a hospital visit is considered a likely source of infection for Case 1 but not for Case 2. For Case 2, the most likely source could not be determined. Exposure to MERS-CoV via direct contact with animals or dairy products seems unlikely for the two Dutch cases. Furthermore, exposure to a common but still unidentified source cannot be ruled out. More comprehensive research into sources of infection in the Arabian Peninsula is needed to strengthen and specify the prevention of MERS-CoV infections.</p>
</sec>
<sec><title>Electronic supplementary material</title>
<p>The online version of this article (doi:10.1186/1742-7622-11-16) contains supplementary material, which is available to authorized users.</p>
</sec>
</div>
</front>
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</TEI>
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