2014 MERS-CoV Outbreak in Jeddah — A Link to Health Care Facilities
A substantial increase in Middle East respiratory syndrome coronavirus (MERS-CoV) infections in Saudi Arabia in 2014 raised concern about further spread of the disease. An investigation showed that health care–associated transmission was an important element in this outbreak. The Middle East respira...
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| Published in | The New England journal of medicine Vol. 372; no. 9; pp. 846 - 854 |
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| Main Authors | , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Massachusetts Medical Society
26.02.2015
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| Subjects | |
| Online Access | Get full text |
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| Abstract | A substantial increase in Middle East respiratory syndrome coronavirus (MERS-CoV) infections in Saudi Arabia in 2014 raised concern about further spread of the disease. An investigation showed that health care–associated transmission was an important element in this outbreak.
The Middle East respiratory syndrome coronavirus (MERS-CoV), an emerging novel betacoronavirus belonging to lineage C, is known to cause severe acute respiratory illness in humans. From the time the disease was first identified in 2012, mortality among patients with laboratory-confirmed infection has been reported to be approximately 30 to 40%.
1
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As of this writing, cases have been linked to seven countries in or near the Arabian Peninsula, and the majority of reported cases have been from Saudi Arabia.
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4
A zoonotic origin of MERS-CoV has been presumed on the basis of evidence to date. The reservoir, mechanism of transmission, . . . |
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| AbstractList | A marked increase in the number of cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection occurred in Jeddah, Saudi Arabia, in early 2014. We evaluated patients with MERS-CoV infection in Jeddah to explore reasons for this increase and to assess the epidemiologic and clinical features of this disease.BACKGROUNDA marked increase in the number of cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection occurred in Jeddah, Saudi Arabia, in early 2014. We evaluated patients with MERS-CoV infection in Jeddah to explore reasons for this increase and to assess the epidemiologic and clinical features of this disease.We identified all cases of laboratory-confirmed MERS-CoV infection in Jeddah that were reported to the Saudi Arabian Ministry of Health from January 1 through May 16, 2014. We conducted telephone interviews with symptomatic patients who were not health care personnel, and we reviewed hospital records. We identified patients who were reported as being asymptomatic and interviewed them regarding a history of symptoms in the month before testing. Descriptive analyses were performed.METHODSWe identified all cases of laboratory-confirmed MERS-CoV infection in Jeddah that were reported to the Saudi Arabian Ministry of Health from January 1 through May 16, 2014. We conducted telephone interviews with symptomatic patients who were not health care personnel, and we reviewed hospital records. We identified patients who were reported as being asymptomatic and interviewed them regarding a history of symptoms in the month before testing. Descriptive analyses were performed.Of 255 patients with laboratory-confirmed MERS-CoV infection, 93 died (case fatality rate, 36.5%). The median age of all patients was 45 years (interquartile range, 30 to 59), and 174 patients (68.2%) were male. A total of 64 patients (25.1%) were reported to be asymptomatic. Of the 191 symptomatic patients, 40 (20.9%) were health care personnel. Among the 151 symptomatic patients who were not health care personnel, 112 (74.2%) had data that could be assessed, and 109 (97.3%) of these patients had had contact with a health care facility, a person with a confirmed case of MERS-CoV infection, or someone with severe respiratory illness in the 14 days before the onset of illness. The remaining 3 patients (2.7%) reported no such contacts. Of the 64 patients who had been reported as asymptomatic, 33 (52%) were interviewed, and 26 of these 33 (79%) reported at least one symptom that was consistent with a viral respiratory illness.RESULTSOf 255 patients with laboratory-confirmed MERS-CoV infection, 93 died (case fatality rate, 36.5%). The median age of all patients was 45 years (interquartile range, 30 to 59), and 174 patients (68.2%) were male. A total of 64 patients (25.1%) were reported to be asymptomatic. Of the 191 symptomatic patients, 40 (20.9%) were health care personnel. Among the 151 symptomatic patients who were not health care personnel, 112 (74.2%) had data that could be assessed, and 109 (97.3%) of these patients had had contact with a health care facility, a person with a confirmed case of MERS-CoV infection, or someone with severe respiratory illness in the 14 days before the onset of illness. The remaining 3 patients (2.7%) reported no such contacts. Of the 64 patients who had been reported as asymptomatic, 33 (52%) were interviewed, and 26 of these 33 (79%) reported at least one symptom that was consistent with a viral respiratory illness.The majority of patients in the Jeddah MERS-CoV outbreak had contact with a health care facility, other patients, or both. This highlights the role of health care-associated transmission. (Supported by the Ministry of Health, Saudi Arabia, and by the U.S. Centers for Disease Control and Prevention.).CONCLUSIONSThe majority of patients in the Jeddah MERS-CoV outbreak had contact with a health care facility, other patients, or both. This highlights the role of health care-associated transmission. (Supported by the Ministry of Health, Saudi Arabia, and by the U.S. Centers for Disease Control and Prevention.). A marked increase in the number of cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection occurred in Jeddah, Saudi Arabia, in early 2014. We evaluated patients with MERS-CoV infection in Jeddah to explore reasons for this increase and to assess the epidemiologic and clinical features of this disease. We identified all cases of laboratory-confirmed MERS-CoV infection in Jeddah that were reported to the Saudi Arabian Ministry of Health from January 1 through May 16, 2014. We conducted telephone interviews with symptomatic patients who were not health care personnel, and we reviewed hospital records. We identified patients who were reported as being asymptomatic and interviewed them regarding a history of symptoms in the month before testing. Descriptive analyses were performed. Of 255 patients with laboratory-confirmed MERS-CoV infection, 93 died (case fatality rate, 36.5%). The median age of all patients was 45 years (interquartile range, 30 to 59), and 174 patients (68.2%) were male. A total of 64 patients (25.1%) were reported to be asymptomatic. Of the 191 symptomatic patients, 40 (20.9%) were health care personnel. Among the 151 symptomatic patients who were not health care personnel, 112 (74.2%) had data that could be assessed, and 109 (97.3%) of these patients had had contact with a health care facility, a person with a confirmed case of MERS-CoV infection, or someone with severe respiratory illness in the 14 days before the onset of illness. The remaining 3 patients (2.7%) reported no such contacts. Of the 64 patients who had been reported as asymptomatic, 33 (52%) were interviewed, and 26 of these 33 (79%) reported at least one symptom that was consistent with a viral respiratory illness. The majority of patients in the Jeddah MERS-CoV outbreak had contact with a health care facility, other patients, or both. This highlights the role of health care-associated transmission. (Supported by the Ministry of Health, Saudi Arabia, and by the U.S. Centers for Disease Control and Prevention.). BackgroundA marked increase in the number of cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection occurred in Jeddah, Saudi Arabia, in early 2014. We evaluated patients with MERS-CoV infection in Jeddah to explore reasons for this increase and to assess the epidemiologic and clinical features of this disease.MethodsWe identified all cases of laboratory-confirmed MERS-CoV infection in Jeddah that were reported to the Saudi Arabian Ministry of Health from January 1 through May 16, 2014. We conducted telephone interviews with symptomatic patients who were not health care personnel, and we reviewed hospital records. We identified patients who were reported as being asymptomatic and interviewed them regarding a history of symptoms in the month before testing. Descriptive analyses were performed.ResultsOf 255 patients with laboratory-confirmed MERS-CoV infection, 93 died (case fatality rate, 36.5%). The median age of all patients was 45 years (interquartile range, 30 to 59), and 174 patients (68.2%) were male. A total of 64 patients (25.1%) were reported to be asymptomatic. Of the 191 symptomatic patients, 40 (20.9%) were health care personnel. Among the 151 symptomatic patients who were not health care personnel, 112 (74.2%) had data that could be assessed, and 109 (97.3%) of these patients had had contact with a health care facility, a person with a confirmed case of MERS-CoV infection, or someone with severe respiratory illness in the 14 days before the onset of illness. The remaining 3 patients (2.7%) reported no such contacts. Of the 64 patients who had been reported as asymptomatic, 33 (52%) were interviewed, and 26 of these 33 (79%) reported at least one symptom that was consistent with a viral respiratory illness.ConclusionsThe majority of patients in the Jeddah MERS-CoV outbreak had contact with a health care facility, other patients, or both. This highlights the role of health care–associated transmission. (Supported by the Ministry of Health, Saudi Arabia, and by the U.S. Centers for Disease Control and Prevention.) A substantial increase in Middle East respiratory syndrome coronavirus (MERS-CoV) infections in Saudi Arabia in 2014 raised concern about further spread of the disease. An investigation showed that health care–associated transmission was an important element in this outbreak. The Middle East respiratory syndrome coronavirus (MERS-CoV), an emerging novel betacoronavirus belonging to lineage C, is known to cause severe acute respiratory illness in humans. From the time the disease was first identified in 2012, mortality among patients with laboratory-confirmed infection has been reported to be approximately 30 to 40%. 1 , 2 As of this writing, cases have been linked to seven countries in or near the Arabian Peninsula, and the majority of reported cases have been from Saudi Arabia. 3 , 4 A zoonotic origin of MERS-CoV has been presumed on the basis of evidence to date. The reservoir, mechanism of transmission, . . . |
| Author | Al-Asmari, Ahmad M Almohammadi, Emad L Swerdlow, David L Gerber, Susan I Tomczyk, Sara M Alkhaldi, Khulud Z Aloraini, Muhannad S Madani, Tariq A Watson, John T Oboho, Ikwo K Alraddadi, Basem M Banjar, Ayman A Al-Mugti, Hani |
| Author_xml | – sequence: 1 givenname: Ikwo K surname: Oboho fullname: Oboho, Ikwo K organization: From the Centers for Disease Control and Prevention (CDC) (I.K.O., S.M.T., S.I.G., D.L.S., J.T.W.) and the Epidemic Intelligence Service, CDC (I.K.O., S.M.T.), Atlanta; and the Ministry of Health (A.M.A.-A., A.A.B., K.Z.A., E.L.A., B.M.A., T.A.M.), the Community and Preventive Medicine Center, National Guard Health Affairs, Western Region, Ministry of National Guard (H.A.-M.), King Faisal Specialist Hospital and Research Center (B.M.A.), and the Department of Medicine, Faculty of Medicine, King Abdulaziz University (T.A.M.), Jeddah, and the Department of Family and Community Medicine, Faculty of Medicine, Al-Qassim University, Al-Qassim (M.S.A.) — all in Saudi Arabia – sequence: 2 givenname: Sara M surname: Tomczyk fullname: Tomczyk, Sara M organization: From the Centers for Disease Control and Prevention (CDC) (I.K.O., S.M.T., S.I.G., D.L.S., J.T.W.) and the Epidemic Intelligence Service, CDC (I.K.O., S.M.T.), Atlanta; and the Ministry of Health (A.M.A.-A., A.A.B., K.Z.A., E.L.A., B.M.A., T.A.M.), the Community and Preventive Medicine Center, National Guard Health Affairs, Western Region, Ministry of National Guard (H.A.-M.), King Faisal Specialist Hospital and Research Center (B.M.A.), and the Department of Medicine, Faculty of Medicine, King Abdulaziz University (T.A.M.), Jeddah, and the Department of Family and Community Medicine, Faculty of Medicine, Al-Qassim University, Al-Qassim (M.S.A.) — all in Saudi Arabia – sequence: 3 givenname: Ahmad M surname: Al-Asmari fullname: Al-Asmari, Ahmad M organization: From the Centers for Disease Control and Prevention (CDC) (I.K.O., S.M.T., S.I.G., D.L.S., J.T.W.) and the Epidemic Intelligence Service, CDC (I.K.O., S.M.T.), Atlanta; and the Ministry of Health (A.M.A.-A., A.A.B., K.Z.A., E.L.A., B.M.A., T.A.M.), the Community and Preventive Medicine Center, National Guard Health Affairs, Western Region, Ministry of National Guard (H.A.-M.), King Faisal Specialist Hospital and Research Center (B.M.A.), and the Department of Medicine, Faculty of Medicine, King Abdulaziz University (T.A.M.), Jeddah, and the Department of Family and Community Medicine, Faculty of Medicine, Al-Qassim University, Al-Qassim (M.S.A.) — all in Saudi Arabia – sequence: 4 givenname: Ayman A surname: Banjar fullname: Banjar, Ayman A organization: From the Centers for Disease Control and Prevention (CDC) (I.K.O., S.M.T., S.I.G., D.L.S., J.T.W.) and the Epidemic Intelligence Service, CDC (I.K.O., S.M.T.), Atlanta; and the Ministry of Health (A.M.A.-A., A.A.B., K.Z.A., E.L.A., B.M.A., T.A.M.), the Community and Preventive Medicine Center, National Guard Health Affairs, Western Region, Ministry of National Guard (H.A.-M.), King Faisal Specialist Hospital and Research Center (B.M.A.), and the Department of Medicine, Faculty of Medicine, King Abdulaziz University (T.A.M.), Jeddah, and the Department of Family and Community Medicine, Faculty of Medicine, Al-Qassim University, Al-Qassim (M.S.A.) — all in Saudi Arabia – sequence: 5 givenname: Hani surname: Al-Mugti fullname: Al-Mugti, Hani organization: From the Centers for Disease Control and Prevention (CDC) (I.K.O., S.M.T., S.I.G., D.L.S., J.T.W.) and the Epidemic Intelligence Service, CDC (I.K.O., S.M.T.), Atlanta; and the Ministry of Health (A.M.A.-A., A.A.B., K.Z.A., E.L.A., B.M.A., T.A.M.), the Community and Preventive Medicine Center, National Guard Health Affairs, Western Region, Ministry of National Guard (H.A.-M.), King Faisal Specialist Hospital and Research Center (B.M.A.), and the Department of Medicine, Faculty of Medicine, King Abdulaziz University (T.A.M.), Jeddah, and the Department of Family and Community Medicine, Faculty of Medicine, Al-Qassim University, Al-Qassim (M.S.A.) — all in Saudi Arabia – sequence: 6 givenname: Muhannad S surname: Aloraini fullname: Aloraini, Muhannad S organization: From the Centers for Disease Control and Prevention (CDC) (I.K.O., S.M.T., S.I.G., D.L.S., J.T.W.) and the Epidemic Intelligence Service, CDC (I.K.O., S.M.T.), Atlanta; and the Ministry of Health (A.M.A.-A., A.A.B., K.Z.A., E.L.A., B.M.A., T.A.M.), the Community and Preventive Medicine Center, National Guard Health Affairs, Western Region, Ministry of National Guard (H.A.-M.), King Faisal Specialist Hospital and Research Center (B.M.A.), and the Department of Medicine, Faculty of Medicine, King Abdulaziz University (T.A.M.), Jeddah, and the Department of Family and Community Medicine, Faculty of Medicine, Al-Qassim University, Al-Qassim (M.S.A.) — all in Saudi Arabia – sequence: 7 givenname: Khulud Z surname: Alkhaldi fullname: Alkhaldi, Khulud Z organization: From the Centers for Disease Control and Prevention (CDC) (I.K.O., S.M.T., S.I.G., D.L.S., J.T.W.) and the Epidemic Intelligence Service, CDC (I.K.O., S.M.T.), Atlanta; and the Ministry of Health (A.M.A.-A., A.A.B., K.Z.A., E.L.A., B.M.A., T.A.M.), the Community and Preventive Medicine Center, National Guard Health Affairs, Western Region, Ministry of National Guard (H.A.-M.), King Faisal Specialist Hospital and Research Center (B.M.A.), and the Department of Medicine, Faculty of Medicine, King Abdulaziz University (T.A.M.), Jeddah, and the Department of Family and Community Medicine, Faculty of Medicine, Al-Qassim University, Al-Qassim (M.S.A.) — all in Saudi Arabia – sequence: 8 givenname: Emad L surname: Almohammadi fullname: Almohammadi, Emad L organization: From the Centers for Disease Control and Prevention (CDC) (I.K.O., S.M.T., S.I.G., D.L.S., J.T.W.) and the Epidemic Intelligence Service, CDC (I.K.O., S.M.T.), Atlanta; and the Ministry of Health (A.M.A.-A., A.A.B., K.Z.A., E.L.A., B.M.A., T.A.M.), the Community and Preventive Medicine Center, National Guard Health Affairs, Western Region, Ministry of National Guard (H.A.-M.), King Faisal Specialist Hospital and Research Center (B.M.A.), and the Department of Medicine, Faculty of Medicine, King Abdulaziz University (T.A.M.), Jeddah, and the Department of Family and Community Medicine, Faculty of Medicine, Al-Qassim University, Al-Qassim (M.S.A.) — all in Saudi Arabia – sequence: 9 givenname: Basem M surname: Alraddadi fullname: Alraddadi, Basem M organization: From the Centers for Disease Control and Prevention (CDC) (I.K.O., S.M.T., S.I.G., D.L.S., J.T.W.) and the Epidemic Intelligence Service, CDC (I.K.O., S.M.T.), Atlanta; and the Ministry of Health (A.M.A.-A., A.A.B., K.Z.A., E.L.A., B.M.A., T.A.M.), the Community and Preventive Medicine Center, National Guard Health Affairs, Western Region, Ministry of National Guard (H.A.-M.), King Faisal Specialist Hospital and Research Center (B.M.A.), and the Department of Medicine, Faculty of Medicine, King Abdulaziz University (T.A.M.), Jeddah, and the Department of Family and Community Medicine, Faculty of Medicine, Al-Qassim University, Al-Qassim (M.S.A.) — all in Saudi Arabia – sequence: 10 givenname: Susan I surname: Gerber fullname: Gerber, Susan I organization: From the Centers for Disease Control and Prevention (CDC) (I.K.O., S.M.T., S.I.G., D.L.S., J.T.W.) and the Epidemic Intelligence Service, CDC (I.K.O., S.M.T.), Atlanta; and the Ministry of Health (A.M.A.-A., A.A.B., K.Z.A., E.L.A., B.M.A., T.A.M.), the Community and Preventive Medicine Center, National Guard Health Affairs, Western Region, Ministry of National Guard (H.A.-M.), King Faisal Specialist Hospital and Research Center (B.M.A.), and the Department of Medicine, Faculty of Medicine, King Abdulaziz University (T.A.M.), Jeddah, and the Department of Family and Community Medicine, Faculty of Medicine, Al-Qassim University, Al-Qassim (M.S.A.) — all in Saudi Arabia – sequence: 11 givenname: David L surname: Swerdlow fullname: Swerdlow, David L organization: From the Centers for Disease Control and Prevention (CDC) (I.K.O., S.M.T., S.I.G., D.L.S., J.T.W.) and the Epidemic Intelligence Service, CDC (I.K.O., S.M.T.), Atlanta; and the Ministry of Health (A.M.A.-A., A.A.B., K.Z.A., E.L.A., B.M.A., T.A.M.), the Community and Preventive Medicine Center, National Guard Health Affairs, Western Region, Ministry of National Guard (H.A.-M.), King Faisal Specialist Hospital and Research Center (B.M.A.), and the Department of Medicine, Faculty of Medicine, King Abdulaziz University (T.A.M.), Jeddah, and the Department of Family and Community Medicine, Faculty of Medicine, Al-Qassim University, Al-Qassim (M.S.A.) — all in Saudi Arabia – sequence: 12 givenname: John T surname: Watson fullname: Watson, John T organization: From the Centers for Disease Control and Prevention (CDC) (I.K.O., S.M.T., S.I.G., D.L.S., J.T.W.) and the Epidemic Intelligence Service, CDC (I.K.O., S.M.T.), Atlanta; and the Ministry of Health (A.M.A.-A., A.A.B., K.Z.A., E.L.A., B.M.A., T.A.M.), the Community and Preventive Medicine Center, National Guard Health Affairs, Western Region, Ministry of National Guard (H.A.-M.), King Faisal Specialist Hospital and Research Center (B.M.A.), and the Department of Medicine, Faculty of Medicine, King Abdulaziz University (T.A.M.), Jeddah, and the Department of Family and Community Medicine, Faculty of Medicine, Al-Qassim University, Al-Qassim (M.S.A.) — all in Saudi Arabia – sequence: 13 givenname: Tariq A surname: Madani fullname: Madani, Tariq A organization: From the Centers for Disease Control and Prevention (CDC) (I.K.O., S.M.T., S.I.G., D.L.S., J.T.W.) and the Epidemic Intelligence Service, CDC (I.K.O., S.M.T.), Atlanta; and the Ministry of Health (A.M.A.-A., A.A.B., K.Z.A., E.L.A., B.M.A., T.A.M.), the Community and Preventive Medicine Center, National Guard Health Affairs, Western Region, Ministry of National Guard (H.A.-M.), King Faisal Specialist Hospital and Research Center (B.M.A.), and the Department of Medicine, Faculty of Medicine, King Abdulaziz University (T.A.M.), Jeddah, and the Department of Family and Community Medicine, Faculty of Medicine, Al-Qassim University, Al-Qassim (M.S.A.) — all in Saudi Arabia |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25714162$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1136/bmj.g2968 10.1016/j.jcv.2014.07.002 10.1056/NEJMoa1303729 10.1093/cid/ciu359 10.1016/S1473-3099(14)70918-1 10.1016/S1473-3099(13)70690-X 10.1056/NEJMoa1306742 10.1093/cid/ciu812 10.1056/NEJMoa1401505 |
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| References | Haagmans, BL, Al Dhahiry, SH, Reusken, CB (r007) 2014; 14 Gulland, A (r013) 2014; 348 r001 Drosten, C, Muth, D, Corman, VM (r015) 2015; 60 r018 r008 r019 Poissy, J, Goffard, A, Parmentier-Decrucq, E (r020) 2014; 61 r009 Madani, TA (r017) 2014; 14 r002 r003 Azhar, EI, El-Kafrawy, SA, Farraj, SA (r006) 2014; 370 r014 r004 r005 Memish, ZA, Zumla, AI, Al-Hakeem, RF, Al-Rabeeah, AA, Stephens, GM (r010) 2013; 368 Al-Abdallat, MM, Payne, DC, Alqasrawi, S (r012) 2014; 59 Assiri, A, McGeer, A, Perl, TM (r011) 2013; 369 Madani, TA, Althaqafi, AO, Alraddadi, BM (r016) 2014; 35 r006 r017 r007 r013 r015 r020 r010 r011 r012 Madani TA (r016) 2014; 35 |
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World Health Organization, June 13, 2014 ( http://www.who.int/csr/disease/coronavirus_infections/MERS_CoV_RA_20140613.pdf ). – volume: 60 start-page: 369 year: 2015 end-page: 377 ident: r015 article-title: An observational, laboratory-based study of outbreaks of Middle East respiratory syndrome coronavirus in Jeddah and Riyadh, Kindom of Saudi Arabia. publication-title: Clin Infect Dis – volume: 35 start-page: 897 year: 2014 end-page: 913 ident: r016 article-title: Infection prevention and control guidelines for patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection. publication-title: Saudi Med J – ident: r014 article-title: Soaring MERS cases cause pandemic jitters, but causes are unclear. Science Insider 2014 ( http://news.sciencemag.org/health/2014/04/soaring-mers-cases-cause-pandemic-jitters-causes-are-unclear ). – ident: r004 article-title: Middle East respiratory syndrome coronavirus (MERS-CoV) summary and literature update — as of 11 June 2014. 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| Snippet | A substantial increase in Middle East respiratory syndrome coronavirus (MERS-CoV) infections in Saudi Arabia in 2014 raised concern about further spread of the... A marked increase in the number of cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection occurred in Jeddah, Saudi Arabia, in early 2014.... BackgroundA marked increase in the number of cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection occurred in Jeddah, Saudi Arabia, in... |
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| SubjectTerms | Adult Aged Asymptomatic Coronaviridae Coronavirus Infections - epidemiology Coronavirus Infections - transmission Coronaviruses Cross Infection - epidemiology Disease Outbreaks Disease transmission Epidemiology Female Health facilities Humans Infection Control Infections Infectious Disease Transmission, Professional-to-Patient Male Middle Aged Middle East Respiratory Syndrome Coronavirus Outbreaks Personnel Respiratory diseases Saudi Arabia - epidemiology Zoonoses |
| Title | 2014 MERS-CoV Outbreak in Jeddah — A Link to Health Care Facilities |
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