Nosocomial outbreak of the Middle East Respiratory Syndrome coronavirus: a phylogenetic, epidemiological, clinical and infection control analysis

Barry, M. et al. (2020) Nosocomial outbreak of the Middle East Respiratory Syndrome coronavirus: a phylogenetic, epidemiological, clinical and infection control analysis. Travel Medicine and Infectious Disease, 37, 101807. (doi: 10.1016/j.tmaid.2020.101807) (PMID:32599173) (PMCID:PMC7319941)

Abstract

Background: Middle East Respiratory Syndrome coronavirus (MERS-CoV) continues to cause intermittent community and nosocomial outbreaks. Obtaining data on specific source(s) and transmission dynamics of MERS-CoV during nosocomial outbreaks has been challenging. We performed a clinical, epidemiological and phylogenetic investigation of an outbreak of MERS-CoV at a University Hospital in Riyadh, Kingdom of Saudi Arabia. Methods: Clinical, epidemiological and infection control data were obtained from patients and Healthcare workers (HCWs). Full genome sequencing was conducted on nucleic acid extracted directly from MERS-CoV PCR-confirmed clinical samples and phylogenetic analysis performed. Phylogenetic analysis combined with published MERS-CoV genomes was performed. HCWs compliance with infection control practices was also assessed. Results: Of 235 persons investigated, there were 23 laboratory confirmed MERS cases, 10 were inpatients and 13 HCWs. Eight of 10 MERS inpatients died (80% mortality). There were no deaths among HCWs. The primary index case assumed from epidemiological investigation was not substantiated phylogenetically. 17/18 of MERS cases were linked both phylogenetically and epidemiologically. One asymptomatic HCW yielded a MERS-CoV genome not directly linked to any other case in the investigation. Five HCWs with mild symptoms yielded >75% full MERS-CoV genome sequences. HCW compliance with use of gowns was 62.1%, gloves 69.7%, and masks 57.6%. Conclusions: Several factors and sources, including a HCW MERS-CoV ‘carrier phenomenon’, occur during nosocomial MERS-CoV outbreaks. Phylogenetic analyses of MERS-CoV linked to clinical and epidemiological information is essential for outbreak investigation. The specific role of apparently healthy HCWs in causing nosocomial outbreaks requires further definition.

• Item Type: Articles
• Keywords: Middle east respiratory syndrome, nosocomial, outbreak, phylogenetics, epidemiology, healthcare workers, MERS-CoV carrier phenomenon.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cotten, Professor Matthew
• Authors: Barry, M., Phan, M. V., Akkielah, L., Al-Majed, F., Alhetheel, A., Somily, A., Alsubaie, S. S., McNabb, S. J., Cotten, M., Zumla, A., and Memish, Z. A.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity; College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Virus Research
• Journal Name: Travel Medicine and Infectious Disease
• Publisher: Elsevier
• ISSN: 1477-8939
• ISSN (Online): 1873-0442
• Published Online: 27 June 2020
• Copyright Holders: Copyright © 2020 Elsevier Ltd.
• First Published: First published in Travel Medicine and Infectious Disease 37: 101807
• Publisher Policy: Reproduced in accordance with the publisher copyright policy