MersV1, Ncbi, Merge, bibRecord, 000F36

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/Merge ); précédent : 000F35; suivant : 000F37

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

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.

RBID : PMC:4200475

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Electronic supplementary material

The online version of this article (doi:10.1186/1742-7622-11-16) contains supplementary material, which is available to authorized users.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200475

DOI: 10.1186/1742-7622-11-16
PubMed: 25328533
PubMed Central: 4200475

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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>
<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>
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<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><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>
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<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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Bilthoven, The Netherlands</nlm:aff>
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Stockholm, Sweden</nlm:aff>
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Antonie van Leeuwenhoeklaan 9, Bilthoven, MA 3721 The Netherlands</nlm:aff>
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Bilthoven, The Netherlands</nlm:aff>
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Utrecht, The Netherlands</nlm:aff>
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</affiliation>
</author>
<author><name sortKey="Kraaij Dirkzwager, Marleen" sort="Kraaij Dirkzwager, Marleen" uniqKey="Kraaij Dirkzwager M" first="Marleen" last="Kraaij-Dirkzwager">Marleen Kraaij-Dirkzwager</name>
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</institution-wrap>
Bilthoven, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Bilthoven</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Dirksen, Kees" sort="Dirksen, Kees" uniqKey="Dirksen K" first="Kees" last="Dirksen">Kees Dirksen</name>
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<wicri:regionArea>Public Health Service Haaglanden, Den Haag</wicri:regionArea>
<placeName><settlement type="city">La Haye</settlement>
<region nuts="2" type="province">Hollande-Méridionale</region>
</placeName>
</affiliation>
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<author><name sortKey="Jonges, Marcel" sort="Jonges, Marcel" uniqKey="Jonges M" first="Marcel" last="Jonges">Marcel Jonges</name>
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Bilthoven, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Bilthoven</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Van Der Hoek, Wim" sort="Van Der Hoek, Wim" uniqKey="Van Der Hoek W" first="Wim" last="Van Der Hoek">Wim Van Der Hoek</name>
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Bilthoven, The Netherlands</nlm:aff>
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<wicri:regionArea>Bilthoven</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Koopmans, Marion Pg" sort="Koopmans, Marion Pg" uniqKey="Koopmans M" first="Marion Pg" last="Koopmans">Marion Pg Koopmans</name>
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</institution-wrap>
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>
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<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Public Health Service IJsselland, Zwolle</wicri:regionArea>
<wicri:noRegion>Zwolle</wicri:noRegion>
</affiliation>
</author>
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</institution-wrap>
Amsterdam, The Netherlands</nlm:aff>
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<wicri:regionArea>Amsterdam</wicri:regionArea>
</affiliation>
</author>
<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>
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</institution-wrap>
Lelystad, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Lelystad</wicri:regionArea>
</affiliation>
</author>
<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>
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<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Public Health Service Hart voor Brabant’s, Hertogenbosch</wicri:regionArea>
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</affiliation>
</author>
<author><name sortKey="Gelinck, Luc" sort="Gelinck, Luc" uniqKey="Gelinck L" first="Luc" last="Gelinck">Luc Gelinck</name>
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</institution-wrap>
The Hague, The Netherlands</nlm:aff>
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<wicri:regionArea>The Hague</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Bouwhuis, Jolande W" sort="Bouwhuis, Jolande W" uniqKey="Bouwhuis J" first="Jolande W" last="Bouwhuis">Jolande W. Bouwhuis</name>
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<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Isalaklinieken, Zwolle</wicri:regionArea>
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</affiliation>
</author>
<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>
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</institution-wrap>
Bilthoven, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Bilthoven</wicri:regionArea>
</affiliation>
</author>
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<idno type="pmid">25328533</idno>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">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</title>
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Bilthoven, The Netherlands</nlm:aff>
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</affiliation>
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<institution-id institution-id-type="ISNI">0000000417918889</institution-id>
<institution>European Programme for Intervention Epidemiology Training (EPIET),</institution>
<institution>European Centre for Disease Prevention and Control (ECDC),</institution>
</institution-wrap>
Stockholm, Sweden</nlm:aff>
<country xml:lang="fr">Suède</country>
<wicri:regionArea>Stockholm</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="Aff3"><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 region of Utrecht,</institution>
</institution-wrap>
Zeist, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Zeist</wicri:regionArea>
</affiliation>
<affiliation><nlm:aff id="Aff13"><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>Epidemiology and Surveillance Unit,</institution>
</institution-wrap>
Antonie van Leeuwenhoeklaan 9, Bilthoven, MA 3721 The Netherlands</nlm:aff>
<wicri:noCountry code="subfield">MA 3721 The Netherlands</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Van Der Sande, Marianne Ab" sort="Van Der Sande, Marianne Ab" uniqKey="Van Der Sande M" first="Marianne Ab" last="Van Der Sande">Marianne Ab Van Der Sande</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>
</institution-wrap>
Bilthoven, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Bilthoven</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="Aff4"><institution-wrap><institution-id institution-id-type="GRID">grid.7692.a</institution-id>
<institution-id institution-id-type="ISNI">0000000090126352</institution-id>
<institution>Julius Center,</institution>
<institution>University Medical Center Utrecht,</institution>
</institution-wrap>
Utrecht, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Utrecht</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Kraaij Dirkzwager, Marleen" sort="Kraaij Dirkzwager, Marleen" uniqKey="Kraaij Dirkzwager M" first="Marleen" last="Kraaij-Dirkzwager">Marleen Kraaij-Dirkzwager</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>
</institution-wrap>
Bilthoven, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Bilthoven</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Dirksen, Kees" sort="Dirksen, Kees" uniqKey="Dirksen K" first="Kees" last="Dirksen">Kees Dirksen</name>
<affiliation wicri:level="3"><nlm:aff id="Aff5">Public Health Service Haaglanden, Den Haag, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Public Health Service Haaglanden, Den Haag</wicri:regionArea>
<placeName><settlement type="city">La Haye</settlement>
<region nuts="2" type="province">Hollande-Méridionale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Jonges, Marcel" sort="Jonges, Marcel" uniqKey="Jonges M" first="Marcel" last="Jonges">Marcel Jonges</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>
</institution-wrap>
Bilthoven, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Bilthoven</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Van Der Hoek, Wim" sort="Van Der Hoek, Wim" uniqKey="Van Der Hoek W" first="Wim" last="Van Der Hoek">Wim Van Der Hoek</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>
</institution-wrap>
Bilthoven, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Bilthoven</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Koopmans, Marion Pg" sort="Koopmans, Marion Pg" uniqKey="Koopmans M" first="Marion Pg" last="Koopmans">Marion Pg Koopmans</name>
<affiliation wicri:level="1"><nlm:aff id="Aff6"><institution-wrap><institution-id institution-id-type="GRID">grid.5645.2</institution-id>
<institution-id institution-id-type="ISNI">000000040459992X</institution-id>
<institution>Erasmus Medical Center,</institution>
</institution-wrap>
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>
</affiliation>
</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>
</affiliation>
</author>
<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>
</institution-wrap>
Lelystad, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Lelystad</wicri:regionArea>
</affiliation>
</author>
<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>
</affiliation>
</author>
<author><name sortKey="Gelinck, Luc" sort="Gelinck, Luc" uniqKey="Gelinck L" first="Luc" last="Gelinck">Luc Gelinck</name>
<affiliation wicri:level="1"><nlm:aff id="Aff11"><institution-wrap><institution-id institution-id-type="GRID">grid.414842.f</institution-id>
<institution-id institution-id-type="ISNI">0000000403956796</institution-id>
<institution>Medical Centre Haaglanden,</institution>
</institution-wrap>
The Hague, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>The Hague</wicri:regionArea>
</affiliation>
</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>
</affiliation>
</author>
<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>
</institution-wrap>
Bilthoven, The Netherlands</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Bilthoven</wicri:regionArea>
</affiliation>
</author>
</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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<pubmed><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">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.</title>
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<affiliation wicri:level="3"><nlm:affiliation>National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands ; Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands.</nlm:affiliation>
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<placeName><settlement type="city">La Haye</settlement>
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<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Public Health Service Amsterdam, Amsterdam</wicri:regionArea>
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</affiliation>
</author>
<author><name sortKey="Gelinck, Luc" sort="Gelinck, Luc" uniqKey="Gelinck L" first="Luc" last="Gelinck">Luc Gelinck</name>
<affiliation wicri:level="1"><nlm:affiliation>Medical Centre Haaglanden, The Hague, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Medical Centre Haaglanden, The Hague</wicri:regionArea>
<wicri:noRegion>The Hague</wicri:noRegion>
</affiliation>
</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:affiliation>Isalaklinieken, Zwolle, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Isalaklinieken, Zwolle</wicri:regionArea>
<wicri:noRegion>Zwolle</wicri:noRegion>
</affiliation>
</author>
<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:affiliation>National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven</wicri:regionArea>
<wicri:noRegion>Bilthoven</wicri:noRegion>
</affiliation>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PubMed</idno>
<date when="2014">2014</date>
<idno type="RBID">pubmed:25328533</idno>
<idno type="pmid">25328533</idno>
<idno type="doi">10.1186/1742-7622-11-16</idno>
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</publicationStmt>
<sourceDesc><biblStruct><analytic><title xml:lang="en">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.</title>
<author><name sortKey="Fanoy, Ewout B" sort="Fanoy, Ewout B" uniqKey="Fanoy E" first="Ewout B" last="Fanoy">Ewout B. Fanoy</name>
<affiliation wicri:level="1"><nlm:affiliation>National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands ; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden ; Public Health Service region of Utrecht, Zeist, The Netherlands ; National Institute for Public Health and the Environment, Epidemiology and Surveillance Unit, Antonie van Leeuwenhoeklaan 9, Bilthoven, MA 3721, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands ; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden ; Public Health Service region of Utrecht, Zeist, The Netherlands ; National Institute for Public Health and the Environment, Epidemiology and Surveillance Unit, Antonie van Leeuwenhoeklaan 9, Bilthoven, MA 3721</wicri:regionArea>
<wicri:noRegion>MA 3721</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Van Der Sande, Marianne Ab" sort="Van Der Sande, Marianne Ab" uniqKey="Van Der Sande M" first="Marianne Ab" last="Van Der Sande">Marianne Ab Van Der Sande</name>
<affiliation wicri:level="3"><nlm:affiliation>National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands ; Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands ; Julius Center, University Medical Center Utrecht, Utrecht</wicri:regionArea>
<placeName><settlement type="city">Utrecht</settlement>
<region nuts="2" type="province">Utrecht (province)</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Kraaij Dirkzwager, Marleen" sort="Kraaij Dirkzwager, Marleen" uniqKey="Kraaij Dirkzwager M" first="Marleen" last="Kraaij-Dirkzwager">Marleen Kraaij-Dirkzwager</name>
<affiliation wicri:level="1"><nlm:affiliation>National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven</wicri:regionArea>
<wicri:noRegion>Bilthoven</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Dirksen, Kees" sort="Dirksen, Kees" uniqKey="Dirksen K" first="Kees" last="Dirksen">Kees Dirksen</name>
<affiliation wicri:level="3"><nlm:affiliation>Public Health Service Haaglanden, Den Haag, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Public Health Service Haaglanden, Den Haag</wicri:regionArea>
<placeName><settlement type="city">La Haye</settlement>
<region nuts="2" type="province">Hollande-Méridionale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Jonges, Marcel" sort="Jonges, Marcel" uniqKey="Jonges M" first="Marcel" last="Jonges">Marcel Jonges</name>
<affiliation wicri:level="1"><nlm:affiliation>National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven</wicri:regionArea>
<wicri:noRegion>Bilthoven</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Van Der Hoek, Wim" sort="Van Der Hoek, Wim" uniqKey="Van Der Hoek W" first="Wim" last="Van Der Hoek">Wim Van Der Hoek</name>
<affiliation wicri:level="1"><nlm:affiliation>National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven</wicri:regionArea>
<wicri:noRegion>Bilthoven</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Koopmans, Marion Pg" sort="Koopmans, Marion Pg" uniqKey="Koopmans M" first="Marion Pg" last="Koopmans">Marion Pg Koopmans</name>
<affiliation wicri:level="3"><nlm:affiliation>Erasmus Medical Center, Rotterdam, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Erasmus Medical Center, Rotterdam</wicri:regionArea>
<placeName><settlement type="city">Rotterdam</settlement>
<region nuts="2" type="province">Hollande-Méridionale</region>
</placeName>
</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:affiliation>Public Health Service IJsselland, Zwolle, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Public Health Service IJsselland, Zwolle</wicri:regionArea>
<wicri:noRegion>Zwolle</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Sonder, Gerard" sort="Sonder, Gerard" uniqKey="Sonder G" first="Gerard" last="Sonder">Gerard Sonder</name>
<affiliation wicri:level="3"><nlm:affiliation>Public Health Service Amsterdam, Amsterdam, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Public Health Service Amsterdam, Amsterdam</wicri:regionArea>
<placeName><settlement type="city">Amsterdam</settlement>
<region nuts="2" type="province">Hollande-Septentrionale</region>
</placeName>
</affiliation>
</author>
<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:affiliation>Public Health Service Flevoland, Lelystad, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Public Health Service Flevoland, Lelystad</wicri:regionArea>
<wicri:noRegion>Lelystad</wicri:noRegion>
</affiliation>
</author>
<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:affiliation>Public Health Service Hart voor Brabant's, Hertogenbosch, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Public Health Service Hart voor Brabant's, Hertogenbosch</wicri:regionArea>
<wicri:noRegion>Hertogenbosch</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Gelinck, Luc" sort="Gelinck, Luc" uniqKey="Gelinck L" first="Luc" last="Gelinck">Luc Gelinck</name>
<affiliation wicri:level="1"><nlm:affiliation>Medical Centre Haaglanden, The Hague, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Medical Centre Haaglanden, The Hague</wicri:regionArea>
<wicri:noRegion>The Hague</wicri:noRegion>
</affiliation>
</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:affiliation>Isalaklinieken, Zwolle, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Isalaklinieken, Zwolle</wicri:regionArea>
<wicri:noRegion>Zwolle</wicri:noRegion>
</affiliation>
</author>
<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:affiliation>National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven</wicri:regionArea>
<wicri:noRegion>Bilthoven</wicri:noRegion>
</affiliation>
</author>
</analytic>
<series><title level="j">Emerging themes in epidemiology</title>
<idno type="ISSN">1742-7622</idno>
<imprint><date when="2014" type="published">2014</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en">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.</div>
</front>
</TEI>
</pubmed>
</double>
</record>

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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

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

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