Active screening and surveillance in the United Kingdom for Middle East respiratory syndrome coronavirus in returning travellers and pilgrims from the Middle East: a prospective descriptive study for the period 2013–2015
Identifieur interne : 000D51 ( Pmc/Corpus ); précédent : 000D50; suivant : 000D52Active screening and surveillance in the United Kingdom for Middle East respiratory syndrome coronavirus in returning travellers and pilgrims from the Middle East: a prospective descriptive study for the period 2013–2015
Auteurs : Sowsan F. Atabani ; Steven Wilson ; Clare Overton-Lewis ; Judith Workman ; I. Michael Kidd ; Eskild Petersen ; Alimuddin Zumla ; Erasmus Smit ; Husam OsmanSource :
- International Journal of Infectious Diseases [ 1201-9712 ] ; 2016.
Abstract
The Middle East respiratory syndrome coronavirus (MERS-CoV) remains a threat to global health security, and continuous surveillance for the virus in returning pilgrims or travellers from the Middle East is required. The UK is home to over two million Muslims. Around 25 000 UK pilgrims visit Mecca and Medina each year for the Hajj and Umrah pilgrimages. During the years 2013–2015, 214 UK patients who had travelled to the Middle East fulfilled the criteria of the MERS-CoV case definition algorithm and were tested for MERS-CoV infection. No MERS-CoV cases were detected over the period of Hajj seasons 2013, 2014, and 2015. A viral aetiology was detected in 50% of cases. Rhinovirus and influenza A, detected in equal proportions, were the most common viruses detected. Heightened awareness and rapid screening are essential parts of sustained surveillance to prevent outbreaks of MERS-CoV.
Url:
DOI: 10.1016/j.ijid.2016.04.016
PubMed: 27117200
PubMed Central: 7110479
Links to Exploration step
PMC:7110479Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Active screening and surveillance in the United Kingdom for Middle East respiratory syndrome coronavirus in returning travellers and pilgrims from the Middle East: a prospective descriptive study for the period 2013–2015</title><author><name sortKey="Atabani, Sowsan F" sort="Atabani, Sowsan F" uniqKey="Atabani S" first="Sowsan F." last="Atabani">Sowsan F. Atabani</name><affiliation><nlm:aff id="aff0005">Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK</nlm:aff></affiliation></author><author><name sortKey="Wilson, Steven" sort="Wilson, Steven" uniqKey="Wilson S" first="Steven" last="Wilson">Steven Wilson</name><affiliation><nlm:aff id="aff0005">Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK</nlm:aff></affiliation></author><author><name sortKey="Overton Lewis, Clare" sort="Overton Lewis, Clare" uniqKey="Overton Lewis C" first="Clare" last="Overton-Lewis">Clare Overton-Lewis</name><affiliation><nlm:aff id="aff0005">Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK</nlm:aff></affiliation></author><author><name sortKey="Workman, Judith" sort="Workman, Judith" uniqKey="Workman J" first="Judith" last="Workman">Judith Workman</name><affiliation><nlm:aff id="aff0005">Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK</nlm:aff></affiliation></author><author><name sortKey="Kidd, I Michael" sort="Kidd, I Michael" uniqKey="Kidd I" first="I. Michael" last="Kidd">I. Michael Kidd</name><affiliation><nlm:aff id="aff0010">Department of Virology, University College London Hospitals NHS Foundation Trust, London, UK</nlm:aff></affiliation></author><author><name sortKey="Petersen, Eskild" sort="Petersen, Eskild" uniqKey="Petersen E" first="Eskild" last="Petersen">Eskild Petersen</name><affiliation><nlm:aff id="aff0015">Aarhus University, Aarhus, Denmark</nlm:aff></affiliation><affiliation><nlm:aff id="aff0020">The Royal Hospital, Muscat, Oman</nlm:aff></affiliation></author><author><name sortKey="Zumla, Alimuddin" sort="Zumla, Alimuddin" uniqKey="Zumla A" first="Alimuddin" last="Zumla">Alimuddin Zumla</name><affiliation><nlm:aff id="aff0025">Division of Infection and Immunity, University College London, London, and UK National Institute for Health Research Biomedical Research Centre, UCL Hospitals National Health Service Foundation Trust, London, UK</nlm:aff></affiliation></author><author><name sortKey="Smit, Erasmus" sort="Smit, Erasmus" uniqKey="Smit E" first="Erasmus" last="Smit">Erasmus Smit</name><affiliation><nlm:aff id="aff0005">Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK</nlm:aff></affiliation></author><author><name sortKey="Osman, Husam" sort="Osman, Husam" uniqKey="Osman H" first="Husam" last="Osman">Husam Osman</name><affiliation><nlm:aff id="aff0005">Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27117200</idno><idno type="pmc">7110479</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7110479</idno><idno type="RBID">PMC:7110479</idno><idno type="doi">10.1016/j.ijid.2016.04.016</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000D51</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000D51</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Active screening and surveillance in the United Kingdom for Middle East respiratory syndrome coronavirus in returning travellers and pilgrims from the Middle East: a prospective descriptive study for the period 2013–2015</title><author><name sortKey="Atabani, Sowsan F" sort="Atabani, Sowsan F" uniqKey="Atabani S" first="Sowsan F." last="Atabani">Sowsan F. Atabani</name><affiliation><nlm:aff id="aff0005">Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK</nlm:aff></affiliation></author><author><name sortKey="Wilson, Steven" sort="Wilson, Steven" uniqKey="Wilson S" first="Steven" last="Wilson">Steven Wilson</name><affiliation><nlm:aff id="aff0005">Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK</nlm:aff></affiliation></author><author><name sortKey="Overton Lewis, Clare" sort="Overton Lewis, Clare" uniqKey="Overton Lewis C" first="Clare" last="Overton-Lewis">Clare Overton-Lewis</name><affiliation><nlm:aff id="aff0005">Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK</nlm:aff></affiliation></author><author><name sortKey="Workman, Judith" sort="Workman, Judith" uniqKey="Workman J" first="Judith" last="Workman">Judith Workman</name><affiliation><nlm:aff id="aff0005">Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK</nlm:aff></affiliation></author><author><name sortKey="Kidd, I Michael" sort="Kidd, I Michael" uniqKey="Kidd I" first="I. Michael" last="Kidd">I. Michael Kidd</name><affiliation><nlm:aff id="aff0010">Department of Virology, University College London Hospitals NHS Foundation Trust, London, UK</nlm:aff></affiliation></author><author><name sortKey="Petersen, Eskild" sort="Petersen, Eskild" uniqKey="Petersen E" first="Eskild" last="Petersen">Eskild Petersen</name><affiliation><nlm:aff id="aff0015">Aarhus University, Aarhus, Denmark</nlm:aff></affiliation><affiliation><nlm:aff id="aff0020">The Royal Hospital, Muscat, Oman</nlm:aff></affiliation></author><author><name sortKey="Zumla, Alimuddin" sort="Zumla, Alimuddin" uniqKey="Zumla A" first="Alimuddin" last="Zumla">Alimuddin Zumla</name><affiliation><nlm:aff id="aff0025">Division of Infection and Immunity, University College London, London, and UK National Institute for Health Research Biomedical Research Centre, UCL Hospitals National Health Service Foundation Trust, London, UK</nlm:aff></affiliation></author><author><name sortKey="Smit, Erasmus" sort="Smit, Erasmus" uniqKey="Smit E" first="Erasmus" last="Smit">Erasmus Smit</name><affiliation><nlm:aff id="aff0005">Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK</nlm:aff></affiliation></author><author><name sortKey="Osman, Husam" sort="Osman, Husam" uniqKey="Osman H" first="Husam" last="Osman">Husam Osman</name><affiliation><nlm:aff id="aff0005">Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK</nlm:aff></affiliation></author></analytic><series><title level="j">International Journal of Infectious Diseases</title><idno type="ISSN">1201-9712</idno><idno type="eISSN">1878-3511</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Highlights</title><p><list list-type="simple" id="lis0005"><list-item id="lsti0005"><label>•</label><p id="par0005">The Middle East respiratory syndrome coronavirus (MERS-CoV) remains a threat to global health security, and continuous surveillance for the virus in returning pilgrims or travellers from the Middle East is required.</p></list-item><list-item id="lsti0010"><label>•</label><p id="par0010">The UK is home to over two million Muslims. Around 25 000 UK pilgrims visit Mecca and Medina each year for the Hajj and Umrah pilgrimages.</p></list-item><list-item id="lsti0015"><label>•</label><p id="par0015">During the years 2013–2015, 214 UK patients who had travelled to the Middle East fulfilled the criteria of the MERS-CoV case definition algorithm and were tested for MERS-CoV infection.</p></list-item><list-item id="lsti0020"><label>•</label><p id="par0020">No MERS-CoV cases were detected over the period of Hajj seasons 2013, 2014, and 2015.</p></list-item><list-item id="lsti0025"><label>•</label><p id="par0025">A viral aetiology was detected in 50% of cases. Rhinovirus and influenza A, detected in equal proportions, were the most common viruses detected.</p></list-item><list-item id="lsti0030"><label>•</label><p id="par0030">Heightened awareness and rapid screening are essential parts of sustained surveillance to prevent outbreaks of MERS-CoV.</p></list-item></list></p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Zaki, A M" uniqKey="Zaki A">A.M. Zaki</name></author><author><name sortKey="Van Boheemen, S" uniqKey="Van Boheemen S">S. van Boheemen</name></author><author><name sortKey="Bestebroer, T M" uniqKey="Bestebroer T">T.M. Bestebroer</name></author><author><name sortKey="Osterhaus, A D" uniqKey="Osterhaus A">A.D. Osterhaus</name></author><author><name sortKey="Fouchier, R A" uniqKey="Fouchier R">R.A. Fouchier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hijawi, B" uniqKey="Hijawi B">B. Hijawi</name></author><author><name sortKey="Abdallat, M" uniqKey="Abdallat M">M. Abdallat</name></author><author><name sortKey="Sayaydeh, A" uniqKey="Sayaydeh A">A. Sayaydeh</name></author><author><name sortKey="Algasrawi, S" uniqKey="Algasrawi S">S. Algasrawi</name></author><author><name sortKey="Haddadin, A" uniqKey="Haddadin A">A. Haddadin</name></author><author><name sortKey="Jarrour, N" uniqKey="Jarrour N">N. Jarrour</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Bermingham, A" uniqKey="Bermingham A">A. Bermingham</name></author><author><name sortKey="Chand, M A" uniqKey="Chand M">M.A. Chand</name></author><author><name sortKey="Brown, C S" uniqKey="Brown C">C.S. Brown</name></author><author><name sortKey="Aarons, E" uniqKey="Aarons E">E. Aarons</name></author><author><name sortKey="Tong, C" uniqKey="Tong C">C. Tong</name></author><author><name sortKey="Langrish, C" uniqKey="Langrish C">C. Langrish</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Drosten, C" uniqKey="Drosten C">C. Drosten</name></author><author><name sortKey="Seilmaier, M" uniqKey="Seilmaier M">M. Seilmaier</name></author><author><name sortKey="Corman, V M" uniqKey="Corman V">V.M. Corman</name></author><author><name sortKey="Hartmann, W" uniqKey="Hartmann W">W. Hartmann</name></author><author><name sortKey="Scheible, G" uniqKey="Scheible G">G. Scheible</name></author><author><name sortKey="Sack, S" uniqKey="Sack S">S. Sack</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sridhar, S" uniqKey="Sridhar S">S. Sridhar</name></author><author><name sortKey="Brouqui, P" uniqKey="Brouqui P">P. Brouqui</name></author><author><name sortKey="Parola, P" uniqKey="Parola P">P. Parola</name></author><author><name sortKey="Gautret, P" uniqKey="Gautret P">P. Gautret</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Park, H Y" uniqKey="Park H">H.Y. Park</name></author><author><name sortKey="Lee, E J" uniqKey="Lee E">E.J. Lee</name></author><author><name sortKey="Ryu, Y W" uniqKey="Ryu Y">Y.W. Ryu</name></author><author><name sortKey="Kim, Y" uniqKey="Kim Y">Y. Kim</name></author><author><name sortKey="Kim, H" uniqKey="Kim H">H. Kim</name></author><author><name sortKey="Lee, H" uniqKey="Lee H">H. Lee</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Memish, Z A" uniqKey="Memish Z">Z.A. Memish</name></author><author><name sortKey="Zumla, A" uniqKey="Zumla A">A. Zumla</name></author><author><name sortKey="Alhakeem, R F" uniqKey="Alhakeem R">R.F. Alhakeem</name></author><author><name sortKey="Assiri, A" uniqKey="Assiri A">A. Assiri</name></author><author><name sortKey="Turkestani, A" uniqKey="Turkestani A">A. Turkestani</name></author><author><name sortKey="Al Harby, K D" uniqKey="Al Harby K">K.D. Al Harby</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Corman, V M" uniqKey="Corman V">V.M. Corman</name></author><author><name sortKey="Eckerle, I" uniqKey="Eckerle I">I. Eckerle</name></author><author><name sortKey="Bleicker, T" uniqKey="Bleicker T">T. Bleicker</name></author><author><name sortKey="Zaki, A" uniqKey="Zaki A">A. Zaki</name></author><author><name sortKey="Landt, O" uniqKey="Landt O">O. Landt</name></author><author><name sortKey="Eschbach Bludau, M" uniqKey="Eschbach Bludau M">M. Eschbach-Bludau</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Mackay, I M" uniqKey="Mackay I">I.M. Mackay</name></author><author><name sortKey="Arden, K E" uniqKey="Arden K">K.E. Arden</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Memish, Z A" uniqKey="Memish Z">Z.A. Memish</name></author><author><name sortKey="Al Tawfiq, J A" uniqKey="Al Tawfiq J">J.A. Al-Tawfiq</name></author><author><name sortKey="Makhdoom, H Q" uniqKey="Makhdoom H">H.Q. Makhdoom</name></author><author><name sortKey="Assiri, A" uniqKey="Assiri A">A. Assiri</name></author><author><name sortKey="Alhakeem, R F" uniqKey="Alhakeem R">R.F. Alhakeem</name></author><author><name sortKey="Albarrak, A" uniqKey="Albarrak A">A. Albarrak</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Park, S W" uniqKey="Park S">S.W. Park</name></author><author><name sortKey="Perera, R A" uniqKey="Perera R">R.A. Perera</name></author><author><name sortKey="Choe, P G" uniqKey="Choe P">P.G. Choe</name></author><author><name sortKey="Lau, E H" uniqKey="Lau E">E.H. Lau</name></author><author><name sortKey="Choi, S J" uniqKey="Choi S">S.J. Choi</name></author><author><name sortKey="Chun, J Y" uniqKey="Chun J">J.Y. Chun</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shahkarami, M" uniqKey="Shahkarami M">M. Shahkarami</name></author><author><name sortKey="Yen, C" uniqKey="Yen C">C. Yen</name></author><author><name sortKey="Glaser, C" uniqKey="Glaser C">C. Glaser</name></author><author><name sortKey="Xia, D" uniqKey="Xia D">D. Xia</name></author><author><name sortKey="Watt, J" uniqKey="Watt J">J. Watt</name></author><author><name sortKey="Wadford, D A" uniqKey="Wadford D">D.A. Wadford</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shahkarami, M" uniqKey="Shahkarami M">M. Shahkarami</name></author><author><name sortKey="Yen, C" uniqKey="Yen C">C. Yen</name></author><author><name sortKey="Glaser, C" uniqKey="Glaser C">C. Glaser</name></author><author><name sortKey="Xia, D" uniqKey="Xia D">D. Xia</name></author><author><name sortKey="Watt, J" uniqKey="Watt J">J. Watt</name></author><author><name sortKey="Wadford, D A" uniqKey="Wadford D">D.A. Wadford</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Corman, V M" uniqKey="Corman V">V.M. Corman</name></author><author><name sortKey="Albarrak, A M" uniqKey="Albarrak A">A.M. Albarrak</name></author><author><name sortKey="Omrani, A S" uniqKey="Omrani A">A.S. Omrani</name></author><author><name sortKey="Albarrak, M M" uniqKey="Albarrak M">M.M. Albarrak</name></author><author><name sortKey="Farah, M E" uniqKey="Farah M">M.E. Farah</name></author><author><name sortKey="Almasri, M" uniqKey="Almasri M">M. Almasri</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gautret, P" uniqKey="Gautret P">P. Gautret</name></author><author><name sortKey="Benkouiten, S" uniqKey="Benkouiten S">S. Benkouiten</name></author><author><name sortKey="Al Tawfiq, J A" uniqKey="Al Tawfiq J">J.A. Al-Tawfiq</name></author><author><name sortKey="Memish, Z A" uniqKey="Memish Z">Z.A. Memish</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hui, D S" uniqKey="Hui D">D.S. Hui</name></author><author><name sortKey="Perlman, S" uniqKey="Perlman S">S. Perlman</name></author><author><name sortKey="Zumla, A" uniqKey="Zumla A">A. Zumla</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Infect Dis</journal-id><journal-id journal-id-type="iso-abbrev">Int. J. Infect. Dis</journal-id><journal-title-group><journal-title>International Journal of Infectious Diseases</journal-title></journal-title-group><issn pub-type="ppub">1201-9712</issn><issn pub-type="epub">1878-3511</issn><publisher><publisher-name>The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27117200</article-id><article-id pub-id-type="pmc">7110479</article-id><article-id pub-id-type="publisher-id">S1201-9712(16)31030-X</article-id><article-id pub-id-type="doi">10.1016/j.ijid.2016.04.016</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Active screening and surveillance in the United Kingdom for Middle East respiratory syndrome coronavirus in returning travellers and pilgrims from the Middle East: a prospective descriptive study for the period 2013–2015</article-title></title-group><contrib-group><contrib contrib-type="author" id="aut0005"><name><surname>Atabani</surname><given-names>Sowsan F.</given-names></name><email>Sowsan.Atabani@phe.gov.uk</email><xref rid="aff0005" ref-type="aff">a</xref><xref rid="cor0005" ref-type="corresp">⁎</xref></contrib><contrib contrib-type="author" id="aut0010"><name><surname>Wilson</surname><given-names>Steven</given-names></name><xref rid="aff0005" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="aut0015"><name><surname>Overton-Lewis</surname><given-names>Clare</given-names></name><xref rid="aff0005" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="aut0020"><name><surname>Workman</surname><given-names>Judith</given-names></name><xref rid="aff0005" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="aut0025"><name><surname>Kidd</surname><given-names>I. Michael</given-names></name><xref rid="aff0010" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="aut0030"><name><surname>Petersen</surname><given-names>Eskild</given-names></name><xref rid="aff0015" ref-type="aff">c</xref><xref rid="aff0020" ref-type="aff">d</xref></contrib><contrib contrib-type="author" id="aut0035"><name><surname>Zumla</surname><given-names>Alimuddin</given-names></name><xref rid="aff0025" ref-type="aff">e</xref></contrib><contrib contrib-type="author" id="aut0040"><name><surname>Smit</surname><given-names>Erasmus</given-names></name><xref rid="aff0005" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="aut0045"><name><surname>Osman</surname><given-names>Husam</given-names></name><xref rid="aff0005" ref-type="aff">a</xref></contrib></contrib-group><aff id="aff0005"><label>a</label>Public Health England Birmingham Laboratory, National Infection Service, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK</aff><aff id="aff0010"><label>b</label>Department of Virology, University College London Hospitals NHS Foundation Trust, London, UK</aff><aff id="aff0015"><label>c</label>Aarhus University, Aarhus, Denmark</aff><aff id="aff0020"><label>d</label>The Royal Hospital, Muscat, Oman</aff><aff id="aff0025"><label>e</label>Division of Infection and Immunity, University College London, London, and UK National Institute for Health Research Biomedical Research Centre, UCL Hospitals National Health Service Foundation Trust, London, UK</aff><author-notes><corresp id="cor0005"><label>⁎</label>Corresponding author. <email>Sowsan.Atabani@phe.gov.uk</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>23</day><month>4</month><year>2016</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="ppub"><month>6</month><year>2016</year></pub-date><pub-date pub-type="epub"><day>23</day><month>4</month><year>2016</year></pub-date><volume>47</volume><fpage>10</fpage><lpage>14</lpage><history><date date-type="received"><day>18</day><month>4</month><year>2016</year></date><date date-type="accepted"><day>18</day><month>4</month><year>2016</year></date></history><permissions><copyright-statement>© 2016 The Author(s)</copyright-statement><copyright-year>2016</copyright-year><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract abstract-type="author-highlights" id="abs0005"><title>Highlights</title><p><list list-type="simple" id="lis0005"><list-item id="lsti0005"><label>•</label><p id="par0005">The Middle East respiratory syndrome coronavirus (MERS-CoV) remains a threat to global health security, and continuous surveillance for the virus in returning pilgrims or travellers from the Middle East is required.</p></list-item><list-item id="lsti0010"><label>•</label><p id="par0010">The UK is home to over two million Muslims. Around 25 000 UK pilgrims visit Mecca and Medina each year for the Hajj and Umrah pilgrimages.</p></list-item><list-item id="lsti0015"><label>•</label><p id="par0015">During the years 2013–2015, 214 UK patients who had travelled to the Middle East fulfilled the criteria of the MERS-CoV case definition algorithm and were tested for MERS-CoV infection.</p></list-item><list-item id="lsti0020"><label>•</label><p id="par0020">No MERS-CoV cases were detected over the period of Hajj seasons 2013, 2014, and 2015.</p></list-item><list-item id="lsti0025"><label>•</label><p id="par0025">A viral aetiology was detected in 50% of cases. Rhinovirus and influenza A, detected in equal proportions, were the most common viruses detected.</p></list-item><list-item id="lsti0030"><label>•</label><p id="par0030">Heightened awareness and rapid screening are essential parts of sustained surveillance to prevent outbreaks of MERS-CoV.</p></list-item></list></p></abstract><abstract id="abs0010"><title>Summary</title><sec><title>Background</title><p>Over 25 000 pilgrims from the UK visit Saudi Arabia every year for the Umrah and Hajj pilgrimages. The recent outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in South Korea and the continuing reports of MERS-CoV cases from Saudi Arabia highlight the need for active surveillance for MERS-CoV in returning pilgrims or travellers from the Middle East. Public Health England Birmingham Laboratory (PHEBL) is one of a few selected UK public health laboratories responsible for MERS-CoV screening in travellers returning to the UK from the Middle East who present to hospital with severe respiratory symptoms. The results of the PHEBL MERS-CoV screening and surveillance over the past 3 years is presented.</p></sec><sec><title>Methods</title><p>UK travellers/pilgrims who returned from the Middle East and presented to a hospital with respiratory symptoms were studied over the period February 1, 2013 to December 31, 2015. Patients with respiratory symptoms, who satisfied the Public Health England MERS-CoV case algorithm, were tested for MERS-CoV and other respiratory tract viruses on admission to hospital.</p></sec><sec><title>Results</title><p>Two hundred and two patients suspected of having MERS-CoV were tested. None of them had a laboratory-confirmed MERS-CoV infection. A viral aetiology was detected in half (50.3%) of the cases, with rhinoviruses, influenza A (H1N1 and H3N2), and influenza B being most frequent. Peak testing occurred following the annual Hajj season and in other periods of raised national awareness.</p></sec><sec><title>Conclusions</title><p>Respiratory tract infections in travellers/pilgrims returning to the UK from the Middle East are mainly due to rhinoviruses, influenza A, and influenza B. Whilst MERS-CoV was not detected in the 202 patients studied, heightened awareness of the possibility of MERS-CoV and continuous proactive surveillance are essential to rapidly identify cases of MERS-CoV and other seasonal respiratory tract viruses such as avian influenza, in patients presenting to hospital. Early identification and isolation may prevent outbreaks in nosocomial settings.</p></sec></abstract><kwd-group id="kwd0005"><title>Keywords</title><kwd>Surveillance</kwd><kwd>Middle East respiratory syndrome coronavirus (MERS-CoV)</kwd><kwd>Respiratory viruses</kwd><kwd>Mass gatherings</kwd><kwd>Pilgrimage</kwd></kwd-group></article-meta><notes><p id="misc0005"><bold>Corresponding Editor:</bold> Eskild Petersen, Aarhus, Denmark.</p></notes></front><body><sec id="sec0005"><label>1</label><title>Introduction</title><p id="par0035">The Middle East respiratory syndrome coronavirus (MERS-CoV) was first isolated in a patient with fatal pneumonia and renal failure in the Kingdom of Saudi Arabia (KSA) in June 2012.<xref rid="bib0125" ref-type="bibr"><sup>1</sup></xref> A further nine patients in Jordan were detected retrospectively.<xref rid="bib0130" ref-type="bibr"><sup>2</sup></xref> The disease was named Middle East respiratory syndrome (MERS) and it presents as a clinical spectrum ranging from asymptomatic to a severe fulminant multisystem disease affecting all organs.<xref rid="bib0135" ref-type="bibr"><sup>3</sup></xref> MERS-CoV has remained on the radar of global public health authorities since its first discovery in 2012 because of recurrent nosocomial and community outbreaks and its association with severe disease and high mortality rates, especially in patients with co-morbidities. MERS-CoV is endemic throughout the Arabian Peninsula,<xref rid="bib0140" ref-type="bibr"><sup>4</sup></xref> although Saudi Arabia appears to bear the majority of reported cases. MERS-CoV cases have been reported in travellers to the Middle East returning to Europe, North Africa, North America, and Asia.<xref rid="bib0135" ref-type="bibr">3</xref>, <xref rid="bib0145" ref-type="bibr">5</xref>, <xref rid="bib0150" ref-type="bibr">6</xref>, <xref rid="bib0155" ref-type="bibr">7</xref> Whilst primary transmission of MERS-CoV appears to be from camels, evidence of person-to-person and nosocomial transmission of MERS-CoV is well documented.<xref rid="bib0160" ref-type="bibr">8</xref>, <xref rid="bib0165" ref-type="bibr">9</xref></p><p id="par0040">The largest outbreak of MERS-CoV outside the Middle East occurred in South Korea in 2015 and was attributed to poor hospital infection control measures.<xref rid="bib0165" ref-type="bibr"><sup>9</sup></xref> This outbreak only serves to highlight the continued threat of this novel virus to global health security and calls for all health systems to have proactive MERS-CoV surveillance and screening systems in place for ill returning travellers from the Middle East.</p><p id="par0045">Three of the four laboratory-confirmed cases of MERS-CoV reported in the UK in 2013 were initially identified by the Public Health England Birmingham Laboratory (PHEBL).<xref rid="bib0160" ref-type="bibr"><sup>8</sup></xref> The first of these cases was in a traveller returning from KSA following a religious pilgrimage. The UK is home to over two million Muslims, who make up 4.8% of the overall population of England and Wales,<xref rid="bib0170" ref-type="bibr"><sup>10</sup></xref> and these Muslims will visit Mecca and Medina in the KSA for religious purposes at least once in a lifetime. There are three main religious ceremonies or events that occur in KSA,<xref rid="bib0175" ref-type="bibr"><sup>11</sup></xref> for which over 25 000 pilgrims from the UK travel to KSA each year: (1) the Hajj, which is the main obligatory pilgrimage and attracts up to three million pilgrims per year, (2) Umrah, which is a mini pilgrimage and is undertaken at any time during the year, and (3) Ramadan, the month of fasting. During these events, mass gatherings of pilgrims group together and simultaneously carry out the various religious rituals over a period of days or weeks. These mass gatherings are known to be associated with the transmission of a range of infectious diseases, with respiratory tract infections being exceedingly common.<xref rid="bib0175" ref-type="bibr"><sup>11</sup></xref></p><p id="par0050">Birmingham is the second largest city in the UK, and 21% of its population are Muslims.<xref rid="bib0170" ref-type="bibr"><sup>10</sup></xref> The city also acts as a hub for travel to and from the Middle East from the surrounding areas. The regional public health laboratory situated in Birmingham provides a 7-day service. It is one of the few laboratories in the UK that has been responsible for enhanced surveillance covering the South West, the Midlands and the North of England, for returning travellers with severe respiratory symptoms that fit the clinical and epidemiological criteria of the Public Health England (PHE) MERS-CoV algorithm.<xref rid="bib0180" ref-type="bibr"><sup>12</sup></xref> A detailed analysis of the results from this continued surveillance for MERS-CoV and other viral respiratory tract infections was conducted, which included the period over the three Hajj seasons of 2013, 2014, and 2015.</p></sec><sec id="sec0010"><label>2</label><title>Materials and methods</title><sec id="sec0015"><label>2.1</label><title>Patients</title><p id="par0055">From February 1, 2013 to December 31, 2015, returning travellers presenting to hospitals in the Midlands, South West, and North England with respiratory symptoms were actively investigated. Risk assessments were performed routinely by liaison between the PHE Birmingham consultant virologist and the referring hospital microbiologist, including advice on infection control precautions for healthcare workers, sample preparation, and transport arrangements. Patients were admitted or moved to hospital side rooms and staff instructed to use FFP3 masks and personal protective equipment (PPE) until MERS-CoV had been excluded by laboratory testing. Local health protection teams were routinely involved, both at the time of presentation and when the results of testing became available.</p></sec><sec id="sec0020"><label>2.2</label><title>Samples</title><p id="par0060">Both upper respiratory tract (URT) samples, such as nose and throat swabs and nasopharyngeal aspirates, and lower respiratory tract (LRT) samples, such as sputum and bronchoalveolar lavage samples, were tested. The sample type provided was dependent on the severity of infection and urgency of testing. PHE ensured that all samples were transported using category B shipping regulations, in accordance with World Health Organization guidance on the regulation for the transport of infectious agents 2013–14,<xref rid="bib0185" ref-type="bibr"><sup>13</sup></xref> using a specialized courier with a ‘same day’ delivery service. Microbiology investigations were performed routinely in the local laboratories using PHE guidance on the handling and processing of samples suspected of MERS-CoV.<xref rid="bib0190" ref-type="bibr"><sup>14</sup></xref> Clotted blood was also requested and serum stored for possible future serological testing.</p></sec><sec id="sec0025"><label>2.3</label><title>Respiratory virus screening</title><p id="par0065">Investigation for MERS-CoV RNA was included in the routine panel of respiratory viruses tested for by qualitative real-time reverse transcription PCR (rRT-PCR), as described elsewhere.<xref rid="bib0195" ref-type="bibr"><sup>15</sup></xref> The routine panel included testing for influenza A (both H1 and H3), influenza B, respiratory syncytial virus (RSV), rhinoviruses, parainfluenza virus types 1–4, human metapneumovirus, and adenoviruses.</p></sec><sec id="sec0030"><label>2.4</label><title>Statistical methods</title><p id="par0070">The comparison between the likelihood of virus detection and the destination of travel (KSA vs. Dubai) was performed using <italic>Z</italic>-ratio proportion analysis. The comparison of the duration of symptoms with the detection of a viral agent was performed using the Mann–Whitney <italic>U</italic>-test.</p></sec></sec><sec id="sec0035"><label>3</label><title>Results</title><sec id="sec0040"><label>3.1</label><title>Patients</title><p id="par0075">Two hundred and fourteen patients fulfilled the criteria of the PHE case definition algorithm and were tested for MERS-CoV infection. Twelve patients were tested elsewhere due to a 5-month cessation of testing at Birmingham as a result of a PHE policy change; these patients were excluded from the analysis. The remaining 202 patient samples were tested at Birmingham. Patient demographic characteristics are shown in <xref rid="tbl0005" ref-type="table">Table 1</xref>. The median age of the patients was 54 years (range 4 months to 85 years).<table-wrap position="float" id="tbl0005"><label>Table 1</label><caption><p>Demographic characteristics of 202 patients tested, February 2013 to December 2015</p></caption><alt-text id="at1">Table 1</alt-text><table frame="hsides" rules="groups"><thead><tr><th></th><th align="left">0–16 years</th><th align="left">17–65 years</th><th align="left">>65 years</th><th align="left">Total (%)</th></tr></thead><tbody><tr><td align="left">Male</td><td align="char">5</td><td align="char">84</td><td align="char">28</td><td align="char">117 (57.9)</td></tr><tr><td align="left">Female</td><td align="char">5</td><td align="char">55</td><td align="char">25</td><td align="char">85 (42.1)</td></tr><tr><td align="left">Total (%)</td><td align="char">10 (5.0)</td><td align="char">139 (68.8)</td><td align="char">53 (26.2)</td><td align="char">202 (100)</td></tr></tbody></table></table-wrap></p></sec><sec id="sec0045"><label>3.2</label><title>Sample types</title><p id="par0080">All (100%) of the 202 samples were tested for MERS-CoV and other respiratory viruses and the results were reported within 24 h of sample receipt, which corresponded to the defined PHE turnaround time. Amongst the positive samples, 57% were from the LRT. Since one of the criteria for MERS-CoV testing is evidence of LRT involvement, 39 patients had a sample taken from the LRT in addition to the URT. In this subset, 21 (53.8%) had a virus detected in both samples, 13 (33.4%) had virus detected in the LRT sample only, and five (12.8%) had a virus detected only in the URT sample.</p></sec><sec id="sec0050"><label>3.3</label><title>Respiratory virus detection</title><p id="par0085">Of all the samples obtained from the 202 patients tested, none was MERS-CoV-positive. However, a viral aetiology for clinical illness was found in 50.3% of cases, as shown in <xref rid="fig0005" ref-type="fig">Figure 1</xref>A.<fig id="fig0005"><label>Figure 1</label><caption><p>(A) Total number of patients with a viral pathogen. (B) Respiratory viral pathogens detected in returning travellers.</p></caption><graphic xlink:href="gr1_lrg"></graphic></fig></p><p id="par0090"><xref rid="fig0005" ref-type="fig">Figure 1</xref>B represents the proportions of all the respiratory viruses detected. An almost equal number of patients were found to be positive for influenza A (<italic>n</italic> = 28; either H1N1 or H3N2) and rhinovirus (<italic>n</italic> = 29). Thirteen (6.4%) of the patients were influenza B-positive and there were 10 cases (5.0%) of parainfluenza virus (types 1–4), 10 (5.0%) of adenovirus, five (2.5%) of RSV, and three (1.5%) of human metapneumovirus. Viral nucleic acid from more than one virus was simultaneously detected in 14 cases (6.7%), with one patient having three viruses detected.</p><p id="par0095">A bacterial diagnosis was reported in seven patients: four were positive for <italic>Legionella pneumophila</italic> and one was positive for <italic>Streptococcus pneumoniae</italic> by urinary antigen testing, one was positive for <italic>Escherichia coli</italic> and one for <italic>Brucella</italic> species on positive blood culture.</p></sec><sec id="sec0055"><label>3.4</label><title>Travel history</title><p id="par0100">Amongst those with a detailed travel history, the main countries visited were KSA (46.2%) and Dubai (35.5%). A small number of travellers were also tested following return from UAE, Oman, and Iraq. A significant difference in proportion of virus detection in patients returning from KSA vs. Dubai was observed (<italic>p</italic> < 0.024).</p></sec><sec id="sec0060"><label>3.5</label><title>Duration of symptoms</title><p id="par0105">The median duration of symptoms prior to sample testing was 5 days (range 1–22 days). No significant difference in symptom duration was observed between patients with or without a positive viral agent detected (<italic>p</italic> = 0.384).</p></sec><sec id="sec0065"><label>3.6</label><title>Peak testing times</title><p id="par0110">During 2013, the greatest number of samples were tested following the first positive MERS-CoV patients identified in Birmingham, rather than during the Ramadan (July–August) or Hajj (November) seasons (<xref rid="fig0010" ref-type="fig">Figure 2</xref>A).<fig id="fig0010"><label>Figure 2</label><caption><p>(A) Testing in 2013 by month. (B) Testing in 2014 by month; the asterisk (*) indicates the period of time between April and August 2014 in which testing for MERS-CoV ceased at Public Health England Birmingham Laboratory and testing was transferred to the Public Health England laboratory in London, but resumed post-Ramadan. (C) Testing in 2015 by month.</p></caption><graphic xlink:href="gr2_lrg"></graphic></fig></p><p id="par0115">During 2014, the largest number of samples tested was seen post-Hajj in October (<xref rid="fig0010" ref-type="fig">Figure 2</xref>B). Similarly, in 2015, the largest number of samples tested was during the post-Hajj season in October (<xref rid="fig0010" ref-type="fig">Figure 2</xref>C), with an increase in testing also observed following the outbreak reported in South Korea in May 2015.</p></sec></sec><sec id="sec0070"><label>4</label><title>Discussion</title><p id="par0120">During the 3-year period of MERS-CoV surveillance, there were no cases of MERS-CoV detected by laboratory testing in 202 returning pilgrims or other travellers to the UK who presented to hospitals with respiratory symptoms. This concurs with the wider global finding of no record of person-to-person transmission of MERS-CoV during the mass gatherings at the Hajj during the period 2013–15.<xref rid="bib0200" ref-type="bibr"><sup>16</sup></xref> Since the diagnostic yield of MERS-CoV is dependent on the quality and type of respiratory tract sample,<xref rid="bib0205" ref-type="bibr"><sup>17</sup></xref> MERS-CoV cases may have been missed. Furthermore, since MERS-CoV causes a wide clinical spectrum of presentations from mild to severe,<xref rid="bib0135" ref-type="bibr"><sup>3</sup></xref> there is a possibility that returning pilgrims with MERS-CoV infection are being missed since they may recover without presenting to healthcare or may recover before a diagnosis is made. Thus the follow-up of patients to test for seroconversion and further epidemiological studies using serological tests<xref rid="bib0210" ref-type="bibr"><sup>18</sup></xref> are necessary to establish whether any MERS CoV infections occur in pilgrims that we are unaware of.</p><p id="par0125">The main finding of this study was that approximately 50% of the patient samples had one or more respiratory viruses detected. The viruses most frequently found were influenza A and rhinovirus, in approximately equal proportions. This is in contrast to some previous reports, which have indicated influenza A to be predominant.<xref rid="bib0215" ref-type="bibr">19</xref>, <xref rid="bib0220" ref-type="bibr">20</xref> As befits the investigation of a LRT illness, the site of sampling appeared to have a bearing on the likelihood of a virus being detected: almost 60% of all positive results were obtained from LRT samples. Where patients had samples obtained from both the LRT and URT, and thus a direct comparison of results could be made, influenza A was more likely to be detected in LRT samples, whereas rhinovirus, parainfluenza, and influenza B were more likely in URT samples. This finding emphasizes the role played by influenza A in the development of pneumonia, and also the desirability of obtaining the most reliable specimen type to give an accurate diagnosis. This mirrors the optimal approach to the detection of MERS-CoV with the reported pronounced and prolonged shedding of virus from the LRT.<xref rid="bib0225" ref-type="bibr"><sup>21</sup></xref></p><p id="par0130">By extension, this frequency of detection of influenza A and B in patients suspected of having MERS-CoV infection also supports the use of empirical antiviral treatment with neuraminidase inhibitors pending the results of laboratory testing. Indeed, the use of antivirals should not be dependent on the prevailing likelihood of circulating influenza in the UK, since most travellers arrived back in the UK outside of the seasonal influenza activity period and most likely had acquired it following exposure to other Hajj pilgrims travelling from the Southern hemisphere.</p><p id="par0135">Analysis of the proportions of travellers being positive for any virus in relation to their travel history showed that a significantly greater proportion were positive if they had travelled from KSA. Since the overwhelming reason for visiting KSA is for religious pilgrimage, this suggests a higher likelihood of viral exposure associated with such a mass gathering. In particular, together with the above data implicating influenza A in the development of LRT infections, it is recommended that a documented history of influenza vaccination within the previous year is introduced as part of the pre-assessment of all Hajj pilgrims, in a similar fashion to the meningococcal vaccine pre-requisite.</p><p id="par0140">All patients had a sample collected for MERS-CoV testing within 24 h of hospital presentation, indicating that the hospital staff showed appropriate awareness of travel risk factors. Peak demand for MERS-CoV testing was associated with times of increased public health awareness of the incidence of MERS; for example, after the detection of three MERS cases in Birmingham, the immediate post-Hajj pilgrimage period, and more recently, during the outbreak in South Korea. Even with these fluctuations in demand, it is imperative to maintain heightened awareness and enhanced surveillance with rapid detection of viral pathogens.<xref rid="bib0230" ref-type="bibr"><sup>22</sup></xref> This should ensure that an outbreak due to MERS-CoV or other seasonal respiratory viruses, does not result from an undiagnosed returning traveller. MERS-CoV continues to spread within the Middle East and remains a global public health risk. The South Korean outbreak<xref rid="bib0165" ref-type="bibr"><sup>9</sup></xref> and the nosocomial outbreaks in KSA emphasize the importance of recognizing that healthcare workers can be exposed to MERS-CoV patients seeking medical care.<xref rid="bib0235" ref-type="bibr">23</xref>, <xref rid="bib0240" ref-type="bibr">24</xref></p></sec></body><back><ref-list id="bibl0005"><title>References</title><ref id="bib0125"><label>1</label><element-citation publication-type="journal" id="sbref0125"><person-group person-group-type="author"><name><surname>Zaki</surname><given-names>A.M.</given-names></name><name><surname>van Boheemen</surname><given-names>S.</given-names></name><name><surname>Bestebroer</surname><given-names>T.M.</given-names></name><name><surname>Osterhaus</surname><given-names>A.D.</given-names></name><name><surname>Fouchier</surname><given-names>R.A.</given-names></name></person-group><article-title>Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia</article-title><source>New Engl J Med</source><volume>367</volume><year>2012</year><fpage>1814</fpage><lpage>1820</lpage><pub-id pub-id-type="pmid">23075143</pub-id></element-citation></ref><ref id="bib0130"><label>2</label><element-citation publication-type="journal" id="sbref0130"><person-group person-group-type="author"><name><surname>Hijawi</surname><given-names>B.</given-names></name><name><surname>Abdallat</surname><given-names>M.</given-names></name><name><surname>Sayaydeh</surname><given-names>A.</given-names></name><name><surname>Algasrawi</surname><given-names>S.</given-names></name><name><surname>Haddadin</surname><given-names>A.</given-names></name><name><surname>Jarrour</surname><given-names>N.</given-names></name></person-group><article-title>Novel coronavirus infections in Jordan, April 2012: epidemiological findings from a retrospective investigation</article-title><source>East Mediterr Health J</source><volume>19</volume><issue>Suppl 1</issue><year>2013</year><fpage>S12</fpage><lpage>S18</lpage><pub-id pub-id-type="pmid">23888790</pub-id></element-citation></ref><ref id="bib0135"><label>3</label><mixed-citation publication-type="other" id="oref0015">Zumla A, Hui DS, Perlman S. Seminar: Middle East respiratory syndrome. Lancet 2015. Jun 3. pii: S0140-6736(15)60454-8.</mixed-citation></ref><ref id="bib0140"><label>4</label><mixed-citation publication-type="other" id="oref0020">World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV). Geneva: WHO; 2016. Available at: <ext-link ext-link-type="uri" xlink:href="http://www.who.int/emergencies/mers-cov/en/" id="intr0005">http://www.who.int/emergencies/mers-cov/en/</ext-link> (accessed April 2016).</mixed-citation></ref><ref id="bib0145"><label>5</label><element-citation publication-type="journal" id="sbref0145"><person-group person-group-type="author"><name><surname>Bermingham</surname><given-names>A.</given-names></name><name><surname>Chand</surname><given-names>M.A.</given-names></name><name><surname>Brown</surname><given-names>C.S.</given-names></name><name><surname>Aarons</surname><given-names>E.</given-names></name><name><surname>Tong</surname><given-names>C.</given-names></name><name><surname>Langrish</surname><given-names>C.</given-names></name></person-group><article-title>Severe respiratory illness caused by a novel coronavirus in a patient transferred to United Kingdom from the Middle East, September 2012</article-title><source>Euro Surveill</source><volume>17</volume><year>2012</year><fpage>20290</fpage><pub-id pub-id-type="pmid">23078800</pub-id></element-citation></ref><ref id="bib0150"><label>6</label><element-citation publication-type="journal" id="sbref0150"><person-group person-group-type="author"><name><surname>Drosten</surname><given-names>C.</given-names></name><name><surname>Seilmaier</surname><given-names>M.</given-names></name><name><surname>Corman</surname><given-names>V.M.</given-names></name><name><surname>Hartmann</surname><given-names>W.</given-names></name><name><surname>Scheible</surname><given-names>G.</given-names></name><name><surname>Sack</surname><given-names>S.</given-names></name></person-group><article-title>Clinical features and virological analysis of a case of Middle East respiratory syndrome coronavirus infection</article-title><source>Lancet Infect Dis</source><volume>13</volume><year>2013</year><fpage>745</fpage><lpage>751</lpage><pub-id pub-id-type="pmid">23782859</pub-id></element-citation></ref><ref id="bib0155"><label>7</label><element-citation publication-type="journal" id="sbref0155"><person-group person-group-type="author"><name><surname>Sridhar</surname><given-names>S.</given-names></name><name><surname>Brouqui</surname><given-names>P.</given-names></name><name><surname>Parola</surname><given-names>P.</given-names></name><name><surname>Gautret</surname><given-names>P.</given-names></name></person-group><article-title>Imported cases of Middle East respiratory syndrome: an update</article-title><source>Travel Med Infect Dis</source><volume>13</volume><year>2015</year><fpage>106</fpage><lpage>109</lpage><pub-id pub-id-type="pmid">25477148</pub-id></element-citation></ref><ref id="bib0160"><label>8</label><mixed-citation publication-type="other" id="oref0040">Health Protection Agency (HPA) UK Novel Coronavirus Investigation Team. Evidence of person to person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013. Euro Surveill 2013;18:20427.</mixed-citation></ref><ref id="bib0165"><label>9</label><element-citation publication-type="journal" id="sbref0165"><person-group person-group-type="author"><name><surname>Park</surname><given-names>H.Y.</given-names></name><name><surname>Lee</surname><given-names>E.J.</given-names></name><name><surname>Ryu</surname><given-names>Y.W.</given-names></name><name><surname>Kim</surname><given-names>Y.</given-names></name><name><surname>Kim</surname><given-names>H.</given-names></name><name><surname>Lee</surname><given-names>H.</given-names></name></person-group><article-title>Epidemiological investigation of MERS-CoV spread in a single hospital in South Korea, May to June 2015</article-title><source>Euro Surveill</source><volume>20</volume><year>2015</year><fpage>1</fpage><lpage>6</lpage><pub-id pub-id-type="pmid">26132766</pub-id></element-citation></ref><ref id="bib0170"><label>10</label><mixed-citation publication-type="other" id="oref0050">Office of National Statistics. Religion in England and Wales 2011. UK: ONS; 2012. Available at: <ext-link ext-link-type="uri" xlink:href="http://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/religion/articles/religioninenglandandwales2011/2012-12-11" id="intr0010">http://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/religion/articles/religioninenglandandwales2011/2012-12-11</ext-link> (accessed April 16, 2016).</mixed-citation></ref><ref id="bib0175"><label>11</label><element-citation publication-type="journal" id="sbref0175"><person-group person-group-type="author"><name><surname>Memish</surname><given-names>Z.A.</given-names></name><name><surname>Zumla</surname><given-names>A.</given-names></name><name><surname>Alhakeem</surname><given-names>R.F.</given-names></name><name><surname>Assiri</surname><given-names>A.</given-names></name><name><surname>Turkestani</surname><given-names>A.</given-names></name><name><surname>Al Harby</surname><given-names>K.D.</given-names></name></person-group><article-title>Hajj: infectious disease surveillance and control</article-title><source>Lancet</source><volume>383</volume><year>2014</year><fpage>2073</fpage><lpage>2082</lpage><pub-id pub-id-type="pmid">24857703</pub-id></element-citation></ref><ref id="bib0180"><label>12</label><mixed-citation publication-type="other" id="oref0060">Public Health England. MERS-CoV case algorithm. London, UK: PHE; 2016. Available at: <ext-link ext-link-type="uri" xlink:href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/491902/Algorithm_case_v27-13January2016.pdf" id="intr0015">https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/491902/Algorithm_case_v27-13January2016.pdf</ext-link> (accessed April 17, 2016).</mixed-citation></ref><ref id="bib0185"><label>13</label><mixed-citation publication-type="other" id="oref0065">World Health Organization. Strengthening health security by implementing the International Health Regulations 2005. Geneva, Switzerland: WHO; 2012. Available at: <ext-link ext-link-type="uri" xlink:href="http://www.who.int/ihr/publications/who_hse_ihr_2012.12/en" id="intr0020">http://www.who.int/ihr/publications/who_hse_ihr_2012.12/en</ext-link> (accessed April 16, 2016).</mixed-citation></ref><ref id="bib0190"><label>14</label><mixed-citation publication-type="other" id="oref0070">Public Health England. Interim guidance: Handling and processing of specimens associated with Middle East respiratory syndrome coronavirus (MERS-CoV) in clinical diagnostic laboratories. London, UK: PHE; 2016.</mixed-citation></ref><ref id="bib0195"><label>15</label><element-citation publication-type="journal" id="sbref0195"><person-group person-group-type="author"><name><surname>Corman</surname><given-names>V.M.</given-names></name><name><surname>Eckerle</surname><given-names>I.</given-names></name><name><surname>Bleicker</surname><given-names>T.</given-names></name><name><surname>Zaki</surname><given-names>A.</given-names></name><name><surname>Landt</surname><given-names>O.</given-names></name><name><surname>Eschbach-Bludau</surname><given-names>M.</given-names></name></person-group><article-title>Detection of a novel coronavirus by real-time reverse transcription polymerase chain reaction</article-title><source>Euro Surveill</source><volume>17</volume><year>2012</year><fpage>20285</fpage><pub-id pub-id-type="pmid">23041020</pub-id></element-citation></ref><ref id="bib0200"><label>16</label><mixed-citation publication-type="other" id="oref0080">Public Health England. MERS-CoV: infection control guidance for possible or confirmed cases version 2.0. London, UK: PHE; 2013. Available at: <ext-link ext-link-type="uri" xlink:href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/361569/MERS-CoV_infection_control.pdf" id="intr0025">https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/361569/MERS-CoV_infection_control.pdf</ext-link> (accessed April 16, 2016).</mixed-citation></ref><ref id="bib0205"><label>17</label><element-citation publication-type="journal" id="sbref0205"><person-group person-group-type="author"><name><surname>Mackay</surname><given-names>I.M.</given-names></name><name><surname>Arden</surname><given-names>K.E.</given-names></name></person-group><article-title>MERS coronavirus: diagnostics, epidemiology and transmission</article-title><source>Virol J</source><volume>12</volume><year>2015</year><fpage>222</fpage><lpage>243</lpage><pub-id pub-id-type="pmid">26695637</pub-id></element-citation></ref><ref id="bib0210"><label>18</label><element-citation publication-type="journal" id="sbref0210"><person-group person-group-type="author"><name><surname>Memish</surname><given-names>Z.A.</given-names></name><name><surname>Al-Tawfiq</surname><given-names>J.A.</given-names></name><name><surname>Makhdoom</surname><given-names>H.Q.</given-names></name><name><surname>Assiri</surname><given-names>A.</given-names></name><name><surname>Alhakeem</surname><given-names>R.F.</given-names></name><name><surname>Albarrak</surname><given-names>A.</given-names></name></person-group><article-title>Respiratory tract samples, viral load, and genome fraction yield in patients with Middle East respiratory syndrome</article-title><source>J Infect Dis</source><volume>210</volume><year>2014</year><fpage>1590</fpage><lpage>1594</lpage><pub-id pub-id-type="pmid">24837403</pub-id></element-citation></ref><ref id="bib0215"><label>19</label><element-citation publication-type="journal" id="sbref0215"><person-group person-group-type="author"><name><surname>Park</surname><given-names>S.W.</given-names></name><name><surname>Perera</surname><given-names>R.A.</given-names></name><name><surname>Choe</surname><given-names>P.G.</given-names></name><name><surname>Lau</surname><given-names>E.H.</given-names></name><name><surname>Choi</surname><given-names>S.J.</given-names></name><name><surname>Chun</surname><given-names>J.Y.</given-names></name></person-group><article-title>Comparison of serological assays in human Middle East respiratory syndrome (MERS) coronavirus infection</article-title><source>Euro Surveill</source><year>2015</year><fpage>20</fpage></element-citation></ref><ref id="bib0220"><label>20</label><element-citation publication-type="journal" id="sbref0220"><person-group person-group-type="author"><name><surname>Shahkarami</surname><given-names>M.</given-names></name><name><surname>Yen</surname><given-names>C.</given-names></name><name><surname>Glaser</surname><given-names>C.</given-names></name><name><surname>Xia</surname><given-names>D.</given-names></name><name><surname>Watt</surname><given-names>J.</given-names></name><name><surname>Wadford</surname><given-names>D.A.</given-names></name></person-group><article-title>Laboratory testing for Middle East Respiratory Syndrome coronavirus, California USA 2013-2014</article-title><source>Emerg Infect Dis</source><volume>21</volume><year>2015</year><fpage>1664</fpage><lpage>1666</lpage><pub-id pub-id-type="pmid">26291839</pub-id></element-citation></ref><ref id="bib0225"><label>21</label><element-citation publication-type="journal" id="sbref0225"><person-group person-group-type="author"><name><surname>Shahkarami</surname><given-names>M.</given-names></name><name><surname>Yen</surname><given-names>C.</given-names></name><name><surname>Glaser</surname><given-names>C.</given-names></name><name><surname>Xia</surname><given-names>D.</given-names></name><name><surname>Watt</surname><given-names>J.</given-names></name><name><surname>Wadford</surname><given-names>D.A.</given-names></name></person-group><article-title>Laboratory testing for Middle East respiratory syndrome coronavirus, California USA, 2013-2014</article-title><source>Emerg Infect Dis</source><volume>21</volume><year>2015</year><fpage>1664</fpage><lpage>1666</lpage><pub-id pub-id-type="pmid">26291839</pub-id></element-citation></ref><ref id="bib0230"><label>22</label><element-citation publication-type="journal" id="sbref0230"><person-group person-group-type="author"><name><surname>Corman</surname><given-names>V.M.</given-names></name><name><surname>Albarrak</surname><given-names>A.M.</given-names></name><name><surname>Omrani</surname><given-names>A.S.</given-names></name><name><surname>Albarrak</surname><given-names>M.M.</given-names></name><name><surname>Farah</surname><given-names>M.E.</given-names></name><name><surname>Almasri</surname><given-names>M.</given-names></name></person-group><article-title>Viral shedding and antibody response in 37 patients with MERS-coronavirus infection</article-title><source>Clin Infect Dis</source><year>2015</year></element-citation></ref><ref id="bib0235"><label>23</label><element-citation publication-type="journal" id="sbref0235"><person-group person-group-type="author"><name><surname>Gautret</surname><given-names>P.</given-names></name><name><surname>Benkouiten</surname><given-names>S.</given-names></name><name><surname>Al-Tawfiq</surname><given-names>J.A.</given-names></name><name><surname>Memish</surname><given-names>Z.A.</given-names></name></person-group><article-title>The spectrum of respiratory pathogens among returning Hajj pilgrims: myth and reality</article-title><source>Int J Infect Dis</source><year>2016</year></element-citation></ref><ref id="bib0240"><label>24</label><element-citation publication-type="journal" id="sbref0240"><person-group person-group-type="author"><name><surname>Hui</surname><given-names>D.S.</given-names></name><name><surname>Perlman</surname><given-names>S.</given-names></name><name><surname>Zumla</surname><given-names>A.</given-names></name></person-group><article-title>Spread of MERS to South Korea and China</article-title><source>Lancet Respir Med</source><volume>3</volume><year>2015</year><fpage>509</fpage><lpage>510</lpage><pub-id pub-id-type="pmid">26050550</pub-id></element-citation></ref></ref-list><ack id="ack0005"><title>Acknowledgements</title><p>We would like to thank all of the staff at PHEBL and the local PHE teams.</p><p><italic>Conflict of interest:</italic> The authors of this manuscript have no conflicts of interest to declare.</p></ack></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Sante/explor/MersV1/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000D51 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 000D51 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Sante
|area= MersV1
|flux= Pmc
|étape= Corpus
|type= RBID
|clé= PMC:7110479
|texte= Active screening and surveillance in the United Kingdom for Middle East respiratory syndrome coronavirus in returning travellers and pilgrims from the Middle East: a prospective descriptive study for the period 2013–2015
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i -Sk "pubmed:27117200" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a MersV1
| This area was generated with Dilib version V0.6.33. |  |