Hospital-Associated Outbreak of Middle East Respiratory Syndrome Coronavirus: A Serologic, Epidemiologic, and Clinical Description
Background. In April 2012, the Jordan Ministry of Health investigated an outbreak of lower respiratory illnesses at a hospital in Jordan; 2 fatal cases were retrospectively confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) to be the first detected cases of Middle East...
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| Published in | Clinical infectious diseases Vol. 59; no. 9; pp. 1225 - 1233 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
OXFORD UNIVERSITY PRESS
01.11.2014
Oxford University Press |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Background. In April 2012, the Jordan Ministry of Health investigated an outbreak of lower respiratory illnesses at a hospital in Jordan; 2 fatal cases were retrospectively confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) to be the first detected cases of Middle East respiratory syndrome (MERS-CoV). Methods. Epidemiologic and clinical characteristics of selected potential cases were assessed through serum blood specimens, medical record reviews, and interviews with surviving outbreak members, household contacts, and healthcare personnel. Cases of MERS-CoV infection were identified using 3 US Centers for Disease Control and Prevention serologic tests for detection of anti–MERS-CoV antibodies. Results. Specimens and interviews were obtained from 124 subjects. Seven previously unconfirmed individuals tested positive for anti–MERS-CoV antibodies by at least 2 of 3 serologic tests, in addition to 2 fatal cases identified by rRT-PCR. The case-fatality rate among the 9 total cases was 22%. Six subjects were healthcare workers at the outbreak hospital, yielding an attack rate of 10% among potentially exposed outbreak hospital personnel. There was no evidence of MERS-CoV transmission at 2 transfer hospitals having acceptable infection control practices. Conclusions. Novel serologic tests allowed for the detection of otherwise unrecognized cases of MERS-CoV infection among contacts in a Jordanian hospital-associated respiratory illness outbreak in April 2012, resulting in a total of 9 test-positive cases. Serologic results suggest that further spread of this outbreak to transfer hospitals did not occur. Most subjects had no major, underlying medical conditions; none were on hemodialysis. Our observed case-fatality rate was lower than has been reported from outbreaks elsewhere. |
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| AbstractList | In April 2012, the Jordan Ministry of Health investigated an outbreak of lower respiratory illnesses at a hospital in Jordan; 2 fatal cases were retrospectively confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) to be the first detected cases of Middle East respiratory syndrome (MERS-CoV). Epidemiologic and clinical characteristics of selected potential cases were assessed through serum blood specimens, medical record reviews, and interviews with surviving outbreak members, household contacts, and healthcare personnel. Cases of MERS-CoV infection were identified using 3 US Centers for Disease Control and Prevention serologic tests for detection of anti-MERS-CoV antibodies. Specimens and interviews were obtained from 124 subjects. Seven previously unconfirmed individuals tested positive for anti-MERS-CoV antibodies by at least 2 of 3 serologic tests, in addition to 2 fatal cases identified by rRT-PCR. The case-fatality rate among the 9 total cases was 22%. Six subjects were healthcare workers at the outbreak hospital, yielding an attack rate of 10% among potentially exposed outbreak hospital personnel. There was no evidence of MERS-CoV transmission at 2 transfer hospitals having acceptable infection control practices. Novel serologic tests allowed for the detection of otherwise unrecognized cases of MERS-CoV infection among contacts in a Jordanian hospital-associated respiratory illness outbreak in April 2012, resulting in a total of 9 test-positive cases. Serologic results suggest that further spread of this outbreak to transfer hospitals did not occur. Most subjects had no major, underlying medical conditions; none were on hemodialysis. Our observed case-fatality rate was lower than has been reported from outbreaks elsewhere. In April 2012, the Jordan Ministry of Health investigated an outbreak of lower respiratory illnesses at a hospital in Jordan; 2 fatal cases were retrospectively confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) to be the first detected cases of Middle East respiratory syndrome (MERS-CoV). Epidemiologic and clinical characteristics of selected potential cases were assessed through serum blood specimens, medical record reviews, and interviews with surviving outbreak members, household contacts, and healthcare personnel. Cases of MERS-CoV infection were identified using 3 US Centers for Disease Control and Prevention serologic tests for detection of anti-MERS-CoV antibodies. Specimens and interviews were obtained from 124 subjects. Seven previously unconfirmed individuals tested positive for anti-MERS-CoV antibodies by at least 2 of 3 serologic tests, in addition to 2 fatal cases identified by rRT-PCR. The case-fatality rate among the 9 total cases was 22%. Six subjects were healthcare workers at the outbreak hospital, yielding an attack rate of 10% among potentially exposed outbreak hospital personnel. There was no evidence of MERS-CoV transmission at 2 transfer hospitals having acceptable infection control practices. Novel serologic tests allowed for the detection of otherwise unrecognized cases of MERS-CoV infection among contacts in a Jordanian hospital-associated respiratory illness outbreak in April 2012, resulting in a total of 9 test-positive cases. Serologic results suggest that further spread of this outbreak to transfer hospitals did not occur. Most subjects had no major, underlying medical conditions; none were on hemodialysis. Our observed case-fatality rate was lower than has been reported from outbreaks elsewhere. In April 2012, the Jordan Ministry of Health investigated an outbreak of lower respiratory illnesses at a hospital in Jordan; 2 fatal cases were retrospectively confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) to be the first detected cases of Middle East respiratory syndrome (MERS-CoV).BACKGROUNDIn April 2012, the Jordan Ministry of Health investigated an outbreak of lower respiratory illnesses at a hospital in Jordan; 2 fatal cases were retrospectively confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) to be the first detected cases of Middle East respiratory syndrome (MERS-CoV).Epidemiologic and clinical characteristics of selected potential cases were assessed through serum blood specimens, medical record reviews, and interviews with surviving outbreak members, household contacts, and healthcare personnel. Cases of MERS-CoV infection were identified using 3 US Centers for Disease Control and Prevention serologic tests for detection of anti-MERS-CoV antibodies.METHODSEpidemiologic and clinical characteristics of selected potential cases were assessed through serum blood specimens, medical record reviews, and interviews with surviving outbreak members, household contacts, and healthcare personnel. Cases of MERS-CoV infection were identified using 3 US Centers for Disease Control and Prevention serologic tests for detection of anti-MERS-CoV antibodies.Specimens and interviews were obtained from 124 subjects. Seven previously unconfirmed individuals tested positive for anti-MERS-CoV antibodies by at least 2 of 3 serologic tests, in addition to 2 fatal cases identified by rRT-PCR. The case-fatality rate among the 9 total cases was 22%. Six subjects were healthcare workers at the outbreak hospital, yielding an attack rate of 10% among potentially exposed outbreak hospital personnel. There was no evidence of MERS-CoV transmission at 2 transfer hospitals having acceptable infection control practices.RESULTSSpecimens and interviews were obtained from 124 subjects. Seven previously unconfirmed individuals tested positive for anti-MERS-CoV antibodies by at least 2 of 3 serologic tests, in addition to 2 fatal cases identified by rRT-PCR. The case-fatality rate among the 9 total cases was 22%. Six subjects were healthcare workers at the outbreak hospital, yielding an attack rate of 10% among potentially exposed outbreak hospital personnel. There was no evidence of MERS-CoV transmission at 2 transfer hospitals having acceptable infection control practices.Novel serologic tests allowed for the detection of otherwise unrecognized cases of MERS-CoV infection among contacts in a Jordanian hospital-associated respiratory illness outbreak in April 2012, resulting in a total of 9 test-positive cases. Serologic results suggest that further spread of this outbreak to transfer hospitals did not occur. Most subjects had no major, underlying medical conditions; none were on hemodialysis. Our observed case-fatality rate was lower than has been reported from outbreaks elsewhere.CONCLUSIONSNovel serologic tests allowed for the detection of otherwise unrecognized cases of MERS-CoV infection among contacts in a Jordanian hospital-associated respiratory illness outbreak in April 2012, resulting in a total of 9 test-positive cases. Serologic results suggest that further spread of this outbreak to transfer hospitals did not occur. Most subjects had no major, underlying medical conditions; none were on hemodialysis. Our observed case-fatality rate was lower than has been reported from outbreaks elsewhere. Background. In April 2012, the Jordan Ministry of Health investigated an outbreak of lower respiratory illnesses at a hospital in Jordan; 2 fatal cases were retrospectively confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) to be the first detected cases of Middle East respiratory syndrome (MERS-CoV). Methods. Epidemiologic and clinical characteristics of selected potential cases were assessed through serum blood specimens, medical record reviews, and interviews with surviving outbreak members, household contacts, and healthcare personnel. Cases of MERS-CoV infection were identified using 3 US Centers for Disease Control and Prevention serologic tests for detection of anti–MERS-CoV antibodies. Results. Specimens and interviews were obtained from 124 subjects. Seven previously unconfirmed individuals tested positive for anti–MERS-CoV antibodies by at least 2 of 3 serologic tests, in addition to 2 fatal cases identified by rRT-PCR. The case-fatality rate among the 9 total cases was 22%. Six subjects were healthcare workers at the outbreak hospital, yielding an attack rate of 10% among potentially exposed outbreak hospital personnel. There was no evidence of MERS-CoV transmission at 2 transfer hospitals having acceptable infection control practices. Conclusions. Novel serologic tests allowed for the detection of otherwise unrecognized cases of MERS-CoV infection among contacts in a Jordanian hospital-associated respiratory illness outbreak in April 2012, resulting in a total of 9 test-positive cases. Serologic results suggest that further spread of this outbreak to transfer hospitals did not occur. Most subjects had no major, underlying medical conditions; none were on hemodialysis. Our observed case-fatality rate was lower than has been reported from outbreaks elsewhere. Novel serological tests allowed for the detection of otherwise unrecognized cases of Middle East respiratory syndrome coronavirus infection among contacts in a hospital-associated respiratory illness outbreak in Jordan in April 2012, resulting in a total of 9 test-positive cases. Background. In April 2012, the Jordan Ministry of Health investigated an outbreak of lower respiratory illnesses at a hospital in Jordan; 2 fatal cases were retrospectively confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) to be the first detected cases of Middle East respiratory syndrome (MERS-CoV). Methods. Epidemiologic and clinical characteristics of selected potential cases were assessed through serum blood specimens, medical record reviews, and interviews with surviving outbreak members, household contacts, and healthcare personnel. Cases of MERS-CoV infection were identified using 3 US Centers for Disease Control and Prevention serologic tests for detection of anti–MERS-CoV antibodies. Results. Specimens and interviews were obtained from 124 subjects. Seven previously unconfirmed individuals tested positive for anti–MERS-CoV antibodies by at least 2 of 3 serologic tests, in addition to 2 fatal cases identified by rRT-PCR. The case-fatality rate among the 9 total cases was 22%. Six subjects were healthcare workers at the outbreak hospital, yielding an attack rate of 10% among potentially exposed outbreak hospital personnel. There was no evidence of MERS-CoV transmission at 2 transfer hospitals having acceptable infection control practices. Conclusions. Novel serologic tests allowed for the detection of otherwise unrecognized cases of MERS-CoV infection among contacts in a Jordanian hospital-associated respiratory illness outbreak in April 2012, resulting in a total of 9 test-positive cases. Serologic results suggest that further spread of this outbreak to transfer hospitals did not occur. Most subjects had no major, underlying medical conditions; none were on hemodialysis. Our observed case-fatality rate was lower than has been reported from outbreaks elsewhere. |
| Author | Tamin, Azaibi Farag, Noha H. Abedi, Glen R. Al Nsour, Mohannad Erdman, Dean D. Alqasrawi, Sultan Harcourt, Jennifer L. Al-Abdallat, Mohammad Mousa Pallansch, Mark A. Rha, Brian Swerdlow, David L. Jarour, Najwa Haynes, Lia M. Al-Sanouri, Tarek Haddadin, Aktham Gerber, Susan I. Tohme, Rania A. Kuhar, David T. Iblan, Ibrahim Payne, Daniel C. |
| AuthorAffiliation | 5 Eastern Mediterranean Public Health Network 7 Division of High-Consequence Pathogens and Pathology , National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia 9 Division of Healthcare Quality Promotion , National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia 4 Global Immunization Division , Center for Global Health, Centers for Disease Control and Prevention , Atlanta, Georgia 6 Field Epidemiology Training Program , Jordan Ministry of Health , Amman 3 Epidemic Intelligence Service 8 Directorate of Laboratories , Jordan Ministry of Health , Amman 2 Division of Viral Diseases, National Center for Immunization and Respiratory Diseases 1 Communicable Diseases Directorate , Jordan Ministry of Health , Amman |
| AuthorAffiliation_xml | – name: 3 Epidemic Intelligence Service – name: 8 Directorate of Laboratories , Jordan Ministry of Health , Amman – name: 6 Field Epidemiology Training Program , Jordan Ministry of Health , Amman – name: 1 Communicable Diseases Directorate , Jordan Ministry of Health , Amman – name: 4 Global Immunization Division , Center for Global Health, Centers for Disease Control and Prevention , Atlanta, Georgia – name: 5 Eastern Mediterranean Public Health Network – name: 2 Division of Viral Diseases, National Center for Immunization and Respiratory Diseases – name: 7 Division of High-Consequence Pathogens and Pathology , National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia – name: 9 Division of Healthcare Quality Promotion , National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia |
| Author_xml | – sequence: 1 givenname: Mohammad Mousa surname: Al-Abdallat fullname: Al-Abdallat, Mohammad Mousa – sequence: 2 givenname: Daniel C. surname: Payne fullname: Payne, Daniel C. – sequence: 3 givenname: Sultan surname: Alqasrawi fullname: Alqasrawi, Sultan – sequence: 4 givenname: Brian surname: Rha fullname: Rha, Brian – sequence: 5 givenname: Rania A. surname: Tohme fullname: Tohme, Rania A. – sequence: 6 givenname: Glen R. surname: Abedi fullname: Abedi, Glen R. – sequence: 7 givenname: Mohannad surname: Al Nsour fullname: Al Nsour, Mohannad – sequence: 8 givenname: Ibrahim surname: Iblan fullname: Iblan, Ibrahim – sequence: 9 givenname: Najwa surname: Jarour fullname: Jarour, Najwa – sequence: 10 givenname: Noha H. surname: Farag fullname: Farag, Noha H. – sequence: 11 givenname: Aktham surname: Haddadin fullname: Haddadin, Aktham – sequence: 12 givenname: Tarek surname: Al-Sanouri fullname: Al-Sanouri, Tarek – sequence: 13 givenname: Azaibi surname: Tamin fullname: Tamin, Azaibi – sequence: 14 givenname: Jennifer L. surname: Harcourt fullname: Harcourt, Jennifer L. – sequence: 15 givenname: David T. surname: Kuhar fullname: Kuhar, David T. – sequence: 16 givenname: David L. surname: Swerdlow fullname: Swerdlow, David L. – sequence: 17 givenname: Dean D. surname: Erdman fullname: Erdman, Dean D. – sequence: 18 givenname: Mark A. surname: Pallansch fullname: Pallansch, Mark A. – sequence: 19 givenname: Lia M. surname: Haynes fullname: Haynes, Lia M. – sequence: 20 givenname: Susan I. surname: Gerber fullname: Gerber, Susan I. |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/24829216$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1128/CVI.00351-06 10.3201/eid2004.131375 10.1086/423286 10.1056/NEJMoa1306742 10.1093/infdis/jiu068 10.1093/cid/ciu226 10.1111/j.1440-1843.2006.00783.x 10.1007/s15010-013-0509-9 10.2807/ese.17.40.20290-en 10.3201/eid1912.130701 10.1056/NEJMoa1211721 10.1056/NEJMc070348 10.1073/pnas.0307140101 10.7326/M13-2486 10.1016/S1473-3099(13)70154-3 10.1016/S1473-3099(13)70204-4 10.26719/2013.19.supp1.S12 10.1128/mBio.01146-14 10.1086/500469 10.1016/S0140-6736(13)60982-4 |
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| Copyright | Copyright © 2014 Oxford University Press on behalf of the Infectious Diseases Society of America Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US. Copyright Oxford University Press, UK Nov 1, 2014 Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US. 2014 |
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| Snippet | Background. In April 2012, the Jordan Ministry of Health investigated an outbreak of lower respiratory illnesses at a hospital in Jordan; 2 fatal cases were... In April 2012, the Jordan Ministry of Health investigated an outbreak of lower respiratory illnesses at a hospital in Jordan; 2 fatal cases were... Novel serological tests allowed for the detection of otherwise unrecognized cases of Middle East respiratory syndrome coronavirus infection among contacts in a... |
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| SubjectTerms | Adult and Commentaries Antibodies Antibodies, Viral - blood ARTICLES AND COMMENTARIES Coronavirus Coronavirus Infections - diagnosis Coronavirus Infections - epidemiology Coronavirus Infections - immunology Coronavirus Infections - prevention & control Cough Cross Infection - diagnosis Cross Infection - epidemiology Cross Infection - immunology Cross Infection - prevention & control Disease outbreaks Disease Outbreaks - statistics & numerical data Dyspnea Editor's Choice Enzyme linked immunosorbent assay Epidemics Epidemiology Female Health care industry Health Personnel Hospitals Humans Infections Jordan - epidemiology Male Middle Aged Middle East Respiratory Syndrome Coronavirus - immunology Nosocomial infections Polymerase chain reaction Respiratory diseases Seroepidemiologic Studies Viruses |
| Title | Hospital-Associated Outbreak of Middle East Respiratory Syndrome Coronavirus: A Serologic, Epidemiologic, and Clinical Description |
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