Scope and extent of healthcare-associated Middle East respiratory syndrome coronavirus transmission during two contemporaneous outbreaks in Riyadh, Saudi Arabia, 2017
Identifieur interne : 000D19 ( Pmc/Curation ); précédent : 000D18; suivant : 000D20Scope and extent of healthcare-associated Middle East respiratory syndrome coronavirus transmission during two contemporaneous outbreaks in Riyadh, Saudi Arabia, 2017
Auteurs : Khalid H. Alanazi [Arabie saoudite] ; Marie E. Killerby [États-Unis, Arabie saoudite] ; Holly M. Biggs [États-Unis] ; Glen R. Abedi [États-Unis] ; Hani Jokhdar [Arabie saoudite] ; Ali A. Alsharef [Arabie saoudite] ; Mutaz Mohammed [Arabie saoudite] ; Osman Abdalla [Arabie saoudite] ; Aref Almari [Arabie saoudite] ; Samar Bereagesh [Arabie saoudite] ; Sameh Tawfik [Arabie saoudite] ; Husain Alresheedi [Arabie saoudite] ; Raafat F. Alhakeem [Arabie saoudite] ; Ahmed Hakawi [Arabie saoudite] ; Haitham Alfalah [Arabie saoudite] ; Hala Amer [Arabie saoudite, Égypte] ; Natalie J. Thornburg [États-Unis] ; Azaibi Tamin [États-Unis] ; Suvang Trivedi [États-Unis] ; Suxiang Tong [États-Unis] ; Xiaoyan Lu [États-Unis] ; Krista Queen [États-Unis] ; Yan Li [États-Unis] ; Senthilkumar K. Sakthivel [États-Unis] ; Ying Tao [États-Unis] ; Jing Zhang [États-Unis] ; Clinton R. Paden [États-Unis] ; Hail M. Al-Abdely [Arabie saoudite] ; Abdullah M. Assiri [Arabie saoudite] ; Susan I. Gerber [États-Unis] ; John T. Watson [États-Unis]Source :
- Infection Control and Hospital Epidemiology [ 0899-823X ] ; 2018.
Abstract
To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.
Outbreak investigation.
Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.
Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.
In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.
We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.
Url:
DOI: 10.1017/ice.2018.290
PubMed: 30595141
PubMed Central: 7108661
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Alhakeem</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Hakawi, Ahmed" sort="Hakawi, Ahmed" uniqKey="Hakawi A" first="Ahmed" last="Hakawi">Ahmed Hakawi</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Alfalah, Haitham" sort="Alfalah, Haitham" uniqKey="Alfalah H" first="Haitham" last="Alfalah">Haitham Alfalah</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>King Saud Medical City</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Amer, Hala" sort="Amer, Hala" uniqKey="Amer H" first="Hala" last="Amer">Hala Amer</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>King Saud Medical City</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Department of Community Medicine</addr-line>,<addr-line>National Research Center</addr-line>,<addr-line>Cairo</addr-line>,<country>Egypt</country></nlm:aff><country xml:lang="fr">Égypte</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Thornburg, Natalie J" sort="Thornburg, Natalie J" uniqKey="Thornburg N" first="Natalie J." last="Thornburg">Natalie J. Thornburg</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Tamin, Azaibi" sort="Tamin, Azaibi" uniqKey="Tamin A" first="Azaibi" last="Tamin">Azaibi Tamin</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Trivedi, Suvang" sort="Trivedi, Suvang" uniqKey="Trivedi S" first="Suvang" last="Trivedi">Suvang Trivedi</name><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>IHRC</addr-line>,<addr-line>contractor to National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Tong, Suxiang" sort="Tong, Suxiang" uniqKey="Tong S" first="Suxiang" last="Tong">Suxiang Tong</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Lu, Xiaoyan" sort="Lu, Xiaoyan" uniqKey="Lu X" first="Xiaoyan" last="Lu">Xiaoyan Lu</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Queen, Krista" sort="Queen, Krista" uniqKey="Queen K" first="Krista" last="Queen">Krista Queen</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Li, Yan" sort="Li, Yan" uniqKey="Li Y" first="Yan" last="Li">Yan Li</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Sakthivel, Senthilkumar K" sort="Sakthivel, Senthilkumar K" uniqKey="Sakthivel S" first="Senthilkumar K." last="Sakthivel">Senthilkumar K. Sakthivel</name><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Batelle, contractor to National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA</addr-line>,<country>USA</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Tao, Ying" sort="Tao, Ying" uniqKey="Tao Y" first="Ying" last="Tao">Ying Tao</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Zhang, Jing" sort="Zhang, Jing" uniqKey="Zhang J" first="Jing" last="Zhang">Jing Zhang</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Paden, Clinton R" sort="Paden, Clinton R" uniqKey="Paden C" first="Clinton R." last="Paden">Clinton R. Paden</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Al Abdely, Hail M" sort="Al Abdely, Hail M" uniqKey="Al Abdely H" first="Hail M." last="Al-Abdely">Hail M. Al-Abdely</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Assiri, Abdullah M" sort="Assiri, Abdullah M" uniqKey="Assiri A" first="Abdullah M." last="Assiri">Abdullah M. Assiri</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Gerber, Susan I" sort="Gerber, Susan I" uniqKey="Gerber S" first="Susan I." last="Gerber">Susan I. Gerber</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Watson, John T" sort="Watson, John T" uniqKey="Watson J" first="John T." last="Watson">John T. Watson</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">30595141</idno><idno type="pmc">7108661</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7108661</idno><idno type="RBID">PMC:7108661</idno><idno type="doi">10.1017/ice.2018.290</idno><date when="2018">2018</date><idno type="wicri:Area/Pmc/Corpus">000D19</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000D19</idno><idno type="wicri:Area/Pmc/Curation">000D19</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000D19</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Scope and extent of healthcare-associated Middle East respiratory syndrome coronavirus transmission during two contemporaneous outbreaks in Riyadh, Saudi Arabia, 2017</title><author><name sortKey="Alanazi, Khalid H" sort="Alanazi, Khalid H" uniqKey="Alanazi K" first="Khalid H." last="Alanazi">Khalid H. Alanazi</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Killerby, Marie E" sort="Killerby, Marie E" uniqKey="Killerby M" first="Marie E." last="Killerby">Marie E. Killerby</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>King Saud Medical City</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Biggs, Holly M" sort="Biggs, Holly M" uniqKey="Biggs H" first="Holly M." last="Biggs">Holly M. Biggs</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Abedi, Glen R" sort="Abedi, Glen R" uniqKey="Abedi G" first="Glen R." last="Abedi">Glen R. Abedi</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Jokhdar, Hani" sort="Jokhdar, Hani" uniqKey="Jokhdar H" first="Hani" last="Jokhdar">Hani Jokhdar</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Alsharef, Ali A" sort="Alsharef, Ali A" uniqKey="Alsharef A" first="Ali A." last="Alsharef">Ali A. Alsharef</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Mohammed, Mutaz" sort="Mohammed, Mutaz" uniqKey="Mohammed M" first="Mutaz" last="Mohammed">Mutaz Mohammed</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Abdalla, Osman" sort="Abdalla, Osman" uniqKey="Abdalla O" first="Osman" last="Abdalla">Osman Abdalla</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Almari, Aref" sort="Almari, Aref" uniqKey="Almari A" first="Aref" last="Almari">Aref Almari</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Bereagesh, Samar" sort="Bereagesh, Samar" uniqKey="Bereagesh S" first="Samar" last="Bereagesh">Samar Bereagesh</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Tawfik, Sameh" sort="Tawfik, Sameh" uniqKey="Tawfik S" first="Sameh" last="Tawfik">Sameh Tawfik</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Alresheedi, Husain" sort="Alresheedi, Husain" uniqKey="Alresheedi H" first="Husain" last="Alresheedi">Husain Alresheedi</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Alhakeem, Raafat F" sort="Alhakeem, Raafat F" uniqKey="Alhakeem R" first="Raafat F." last="Alhakeem">Raafat F. Alhakeem</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Hakawi, Ahmed" sort="Hakawi, Ahmed" uniqKey="Hakawi A" first="Ahmed" last="Hakawi">Ahmed Hakawi</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Alfalah, Haitham" sort="Alfalah, Haitham" uniqKey="Alfalah H" first="Haitham" last="Alfalah">Haitham Alfalah</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>King Saud Medical City</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Amer, Hala" sort="Amer, Hala" uniqKey="Amer H" first="Hala" last="Amer">Hala Amer</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>King Saud Medical City</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Department of Community Medicine</addr-line>,<addr-line>National Research Center</addr-line>,<addr-line>Cairo</addr-line>,<country>Egypt</country></nlm:aff><country xml:lang="fr">Égypte</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Thornburg, Natalie J" sort="Thornburg, Natalie J" uniqKey="Thornburg N" first="Natalie J." last="Thornburg">Natalie J. Thornburg</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Tamin, Azaibi" sort="Tamin, Azaibi" uniqKey="Tamin A" first="Azaibi" last="Tamin">Azaibi Tamin</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Trivedi, Suvang" sort="Trivedi, Suvang" uniqKey="Trivedi S" first="Suvang" last="Trivedi">Suvang Trivedi</name><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>IHRC</addr-line>,<addr-line>contractor to National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Tong, Suxiang" sort="Tong, Suxiang" uniqKey="Tong S" first="Suxiang" last="Tong">Suxiang Tong</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Lu, Xiaoyan" sort="Lu, Xiaoyan" uniqKey="Lu X" first="Xiaoyan" last="Lu">Xiaoyan Lu</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Queen, Krista" sort="Queen, Krista" uniqKey="Queen K" first="Krista" last="Queen">Krista Queen</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Li, Yan" sort="Li, Yan" uniqKey="Li Y" first="Yan" last="Li">Yan Li</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Sakthivel, Senthilkumar K" sort="Sakthivel, Senthilkumar K" uniqKey="Sakthivel S" first="Senthilkumar K." last="Sakthivel">Senthilkumar K. Sakthivel</name><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Batelle, contractor to National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA</addr-line>,<country>USA</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Tao, Ying" sort="Tao, Ying" uniqKey="Tao Y" first="Ying" last="Tao">Ying Tao</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Zhang, Jing" sort="Zhang, Jing" uniqKey="Zhang J" first="Jing" last="Zhang">Jing Zhang</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Paden, Clinton R" sort="Paden, Clinton R" uniqKey="Paden C" first="Clinton R." last="Paden">Clinton R. Paden</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Al Abdely, Hail M" sort="Al Abdely, Hail M" uniqKey="Al Abdely H" first="Hail M." last="Al-Abdely">Hail M. Al-Abdely</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Assiri, Abdullah M" sort="Assiri, Abdullah M" uniqKey="Assiri A" first="Abdullah M." last="Assiri">Abdullah M. Assiri</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Gerber, Susan I" sort="Gerber, Susan I" uniqKey="Gerber S" first="Susan I." last="Gerber">Susan I. Gerber</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Watson, John T" sort="Watson, John T" uniqKey="Watson J" first="John T." last="Watson">John T. Watson</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">Infection Control and Hospital Epidemiology</title><idno type="ISSN">0899-823X</idno><idno type="eISSN">1559-6834</idno><imprint><date when="2018">2018</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="abs1" sec-type="general"><title>Objective</title><p>To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.</p></sec><sec id="abs2" sec-type="general"><title>Design</title><p>Outbreak investigation.</p></sec><sec id="abs3" sec-type="general"><title>Setting</title><p>Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.</p></sec><sec id="abs4" sec-type="methods"><title>Methods</title><p>Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.</p></sec><sec id="abs5" sec-type="results"><title>Results</title><p>In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.</p></sec><sec id="abs6" sec-type="conclusions"><title>Conclusions</title><p>We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Zaki, Am" uniqKey="Zaki A">AM Zaki</name></author><author><name sortKey="Van Boheemen, S" uniqKey="Van Boheemen S">S van Boheemen</name></author><author><name sortKey="Bestebroer, Tm" uniqKey="Bestebroer T">TM Bestebroer</name></author><author><name sortKey="Osterhaus, Adme" uniqKey="Osterhaus A">ADME Osterhaus</name></author><author><name sortKey="Fouchier, Ram" uniqKey="Fouchier R">RAM Fouchier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Arabi, Ym" uniqKey="Arabi Y">YM Arabi</name></author><author><name sortKey="Balkhy, Hh" uniqKey="Balkhy H">HH Balkhy</name></author><author><name sortKey="Hayden, Fg" uniqKey="Hayden F">FG 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Al Nsour</name></author><author><name sortKey="Sheikh, Ali S" uniqKey="Sheikh A">Ali S Sheikh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Park, Wb" uniqKey="Park W">WB Park</name></author><author><name sortKey="Perera, Ra" uniqKey="Perera R">RA Perera</name></author><author><name sortKey="Choe, Pg" uniqKey="Choe P">PG Choe</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">Infect Control Hosp Epidemiol</journal-id><journal-id journal-id-type="iso-abbrev">Infect Control Hosp Epidemiol</journal-id><journal-id journal-id-type="publisher-id">ICE</journal-id><journal-title-group><journal-title>Infection Control and Hospital Epidemiology</journal-title></journal-title-group><issn pub-type="ppub">0899-823X</issn><issn pub-type="epub">1559-6834</issn><publisher><publisher-name>Cambridge University Press</publisher-name><publisher-loc>New York, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">30595141</article-id><article-id pub-id-type="pmc">7108661</article-id><article-id pub-id-type="doi">10.1017/ice.2018.290</article-id><article-id pub-id-type="publisher-id">S0899823X18002908</article-id><article-id pub-id-type="publisher-id">00290</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Scope and extent of healthcare-associated Middle East respiratory syndrome coronavirus transmission during two contemporaneous outbreaks in Riyadh, Saudi Arabia, 2017</article-title><alt-title alt-title-type="left-running">Khalid H. Alanazi <italic>et al</italic></alt-title><alt-title alt-title-type="right-running">Infection Control & Hospital Epidemiology</alt-title><fn-group content-type="footnotes"><fn><p><bold>Cite this article:</bold> Alanazi KH, <italic>et al.</italic> (2019). Scope and extent of healthcare-associated Middle East respiratory syndrome coronavirus transmission during two contemporaneous outbreaks in Riyadh, Saudi Arabia, 2017. <italic>Infection Control & Hospital Epidemiology</italic> 2019, 40, 79–88. doi: <uri xlink:type="simple" xlink:href="https://dx.doi.org/10.1017/ice.2018.290">10.1017/ice.2018.290</uri></p></fn></fn-group></title-group><contrib-group><contrib contrib-type="author"><name><surname>Alanazi</surname><given-names>Khalid H.</given-names></name><degrees>MD, MPH</degrees><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="author-notes" rid="fn1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0003-1992-7079</contrib-id><name><surname>Killerby</surname><given-names>Marie E.</given-names></name><degrees>VetMB, MPH</degrees><xref ref-type="aff" rid="aff2">2</xref><xref ref-type="aff" rid="aff3">3</xref><xref ref-type="corresp" rid="cor1"></xref><xref ref-type="author-notes" rid="fn1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Biggs</surname><given-names>Holly M.</given-names></name><degrees>MD, MPH</degrees><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Abedi</surname><given-names>Glen R.</given-names></name><degrees>MPH</degrees><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Jokhdar</surname><given-names>Hani</given-names></name><degrees>MBBS, MSc, PhD</degrees><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Alsharef</surname><given-names>Ali A.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Mohammed</surname><given-names>Mutaz</given-names></name><degrees>MBBS, MPH</degrees><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Abdalla</surname><given-names>Osman</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Almari</surname><given-names>Aref</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Bereagesh</surname><given-names>Samar</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Tawfik</surname><given-names>Sameh</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Alresheedi</surname><given-names>Husain</given-names></name><degrees>MSN, DIPC</degrees><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Alhakeem</surname><given-names>Raafat F.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Hakawi</surname><given-names>Ahmed</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Alfalah</surname><given-names>Haitham</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Amer</surname><given-names>Hala</given-names></name><degrees>MD, MPH, PhD, CIC</degrees><xref ref-type="aff" rid="aff3">3</xref><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Thornburg</surname><given-names>Natalie J.</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Tamin</surname><given-names>Azaibi</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Trivedi</surname><given-names>Suvang</given-names></name><degrees>MS</degrees><xref ref-type="aff" rid="aff5">5</xref></contrib><contrib contrib-type="author"><name><surname>Tong</surname><given-names>Suxiang</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Lu</surname><given-names>Xiaoyan</given-names></name><degrees>MS</degrees><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Queen</surname><given-names>Krista</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Li</surname><given-names>Yan</given-names></name><degrees>MS</degrees><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Sakthivel</surname><given-names>Senthilkumar K.</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff6">6</xref></contrib><contrib contrib-type="author"><name><surname>Tao</surname><given-names>Ying</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Zhang</surname><given-names>Jing</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Paden</surname><given-names>Clinton R.</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Al-Abdely</surname><given-names>Hail M.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Assiri</surname><given-names>Abdullah M.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Gerber</surname><given-names>Susan I.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Watson</surname><given-names>John T.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff2">2</xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Ministry of Health</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></aff><aff id="aff2"><label>2</label><addr-line>Division of Viral Diseases</addr-line>,<addr-line>National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></aff><aff id="aff3"><label>3</label><addr-line>King Saud Medical City</addr-line>,<addr-line>Riyadh</addr-line>,<country>Saudi Arabia</country></aff><aff id="aff4"><label>4</label><addr-line>Department of Community Medicine</addr-line>,<addr-line>National Research Center</addr-line>,<addr-line>Cairo</addr-line>,<country>Egypt</country></aff><aff id="aff5"><label>5</label><addr-line>IHRC</addr-line>,<addr-line>contractor to National Center for Immunization and Respiratory Diseases</addr-line>,<addr-line>Centers for Disease Control and Prevention</addr-line>,<addr-line>Atlanta</addr-line>,<addr-line>Georgia</addr-line>,<country>United States</country></aff><aff id="aff6"><label>6</label><addr-line>Batelle, contractor to National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA</addr-line>,<country>USA</country></aff><author-notes><corresp id="cor1"><bold>Author for correspondence:</bold> Marie E. Killerby, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA. E-mail: <email>lxo9@cdc.gov</email></corresp><fn><p>PREVIOUS PRESENTATION: Data from this study were presented at the International Conference on Emerging Infectious Diseases (ICEID) on August 29, 2018, in Atlanta, Georgia.</p></fn><fn id="fn1"><label>a
</label><p>Authors of equal contribution.</p></fn></author-notes><pub-date pub-type="collection"><month>1</month><year>2019</year></pub-date><pub-date pub-type="epub"><day>31</day><month>12</month><year>2018</year></pub-date><volume>40</volume><issue>1</issue><fpage>79</fpage><lpage>88</lpage><history><date date-type="received"><day>16</day><month>7</month><year>2018</year></date><date date-type="accepted"><day>16</day><month>10</month><year>2018</year></date></history><permissions><copyright-statement>© The Society for Healthcare Epidemiology of America 2018</copyright-statement><copyright-year>2018</copyright-year><copyright-holder>The Society for Healthcare Epidemiology of America</copyright-holder><license license-type="open-access"><license-p>This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means subject to acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.</license-p></license></permissions><self-uri xlink:title="pdf" xlink:href="S0899823X18002908a.pdf"></self-uri><abstract abstract-type="normal"><sec id="abs1" sec-type="general"><title>Objective</title><p>To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.</p></sec><sec id="abs2" sec-type="general"><title>Design</title><p>Outbreak investigation.</p></sec><sec id="abs3" sec-type="general"><title>Setting</title><p>Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.</p></sec><sec id="abs4" sec-type="methods"><title>Methods</title><p>Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.</p></sec><sec id="abs5" sec-type="results"><title>Results</title><p>In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.</p></sec><sec id="abs6" sec-type="conclusions"><title>Conclusions</title><p>We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.</p></sec></abstract><counts><fig-count count="4"></fig-count><table-count count="3"></table-count><page-count count="10"></page-count></counts></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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