Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus
A novel coronavirus (MERS-CoV) is causing severe disease in the Middle East. In this report on a hospital outbreak of MERS-CoV infection, 23 confirmed cases and evidence of person-to-person transmission were identified. The median incubation period was 5.2 days. Respiratory viruses are an emerging t...
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| Published in | The New England journal of medicine Vol. 369; no. 5; pp. 407 - 416 |
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| Main Authors | , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Waltham, MA
Massachusetts Medical Society
01.08.2013
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| Subjects | |
| Online Access | Get full text |
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| Abstract | A novel coronavirus (MERS-CoV) is causing severe disease in the Middle East. In this report on a hospital outbreak of MERS-CoV infection, 23 confirmed cases and evidence of person-to-person transmission were identified. The median incubation period was 5.2 days.
Respiratory viruses are an emerging threat to global health security and have led to worldwide epidemics with substantial morbidity, mortality, and economic consequences. Since the severe acute respiratory syndrome (SARS) pandemic in 2003–2004,
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two additional human coronaviruses — HKU-1 and NL-63 — have been identified, both of which cause mild respiratory infection and are distributed worldwide.
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In September 2012, the World Health Organization (WHO) reported two cases of severe community-acquired pneumonia caused by a novel human β-coronavirus, subsequently named the Middle East respiratory syndrome coronavirus (MERS-CoV).
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Since then, MERS-CoV has been identified as the cause of pneumonia . . . |
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| AbstractList | A novel coronavirus (MERS-CoV) is causing severe disease in the Middle East. In this report on a hospital outbreak of MERS-CoV infection, 23 confirmed cases and evidence of person-to-person transmission were identified. The median incubation period was 5.2 days.
Respiratory viruses are an emerging threat to global health security and have led to worldwide epidemics with substantial morbidity, mortality, and economic consequences. Since the severe acute respiratory syndrome (SARS) pandemic in 2003–2004,
1
–
3
two additional human coronaviruses — HKU-1 and NL-63 — have been identified, both of which cause mild respiratory infection and are distributed worldwide.
4
,
5
In September 2012, the World Health Organization (WHO) reported two cases of severe community-acquired pneumonia caused by a novel human β-coronavirus, subsequently named the Middle East respiratory syndrome coronavirus (MERS-CoV).
6
–
8
Since then, MERS-CoV has been identified as the cause of pneumonia . . . In September 2012, the World Health Organization reported the first cases of pneumonia caused by the novel Middle East respiratory syndrome coronavirus (MERS-CoV). We describe a cluster of health care-acquired MERS-CoV infections.BACKGROUNDIn September 2012, the World Health Organization reported the first cases of pneumonia caused by the novel Middle East respiratory syndrome coronavirus (MERS-CoV). We describe a cluster of health care-acquired MERS-CoV infections.Medical records were reviewed for clinical and demographic information and determination of potential contacts and exposures. Case patients and contacts were interviewed. The incubation period and serial interval (the time between the successive onset of symptoms in a chain of transmission) were estimated. Viral RNA was sequenced.METHODSMedical records were reviewed for clinical and demographic information and determination of potential contacts and exposures. Case patients and contacts were interviewed. The incubation period and serial interval (the time between the successive onset of symptoms in a chain of transmission) were estimated. Viral RNA was sequenced.Between April 1 and May 23, 2013, a total of 23 cases of MERS-CoV infection were reported in the eastern province of Saudi Arabia. Symptoms included fever in 20 patients (87%), cough in 20 (87%), shortness of breath in 11 (48%), and gastrointestinal symptoms in 8 (35%); 20 patients (87%) presented with abnormal chest radiographs. As of June 12, a total of 15 patients (65%) had died, 6 (26%) had recovered, and 2 (9%) remained hospitalized. The median incubation period was 5.2 days (95% confidence interval [CI], 1.9 to 14.7), and the serial interval was 7.6 days (95% CI, 2.5 to 23.1). A total of 21 of the 23 cases were acquired by person-to-person transmission in hemodialysis units, intensive care units, or in-patient units in three different health care facilities. Sequencing data from four isolates revealed a single monophyletic clade. Among 217 household contacts and more than 200 health care worker contacts whom we identified, MERS-CoV infection developed in 5 family members (3 with laboratory-confirmed cases) and in 2 health care workers (both with laboratory-confirmed cases).RESULTSBetween April 1 and May 23, 2013, a total of 23 cases of MERS-CoV infection were reported in the eastern province of Saudi Arabia. Symptoms included fever in 20 patients (87%), cough in 20 (87%), shortness of breath in 11 (48%), and gastrointestinal symptoms in 8 (35%); 20 patients (87%) presented with abnormal chest radiographs. As of June 12, a total of 15 patients (65%) had died, 6 (26%) had recovered, and 2 (9%) remained hospitalized. The median incubation period was 5.2 days (95% confidence interval [CI], 1.9 to 14.7), and the serial interval was 7.6 days (95% CI, 2.5 to 23.1). A total of 21 of the 23 cases were acquired by person-to-person transmission in hemodialysis units, intensive care units, or in-patient units in three different health care facilities. Sequencing data from four isolates revealed a single monophyletic clade. Among 217 household contacts and more than 200 health care worker contacts whom we identified, MERS-CoV infection developed in 5 family members (3 with laboratory-confirmed cases) and in 2 health care workers (both with laboratory-confirmed cases).Person-to-person transmission of MERS-CoV can occur in health care settings and may be associated with considerable morbidity. Surveillance and infection-control measures are critical to a global public health response.CONCLUSIONSPerson-to-person transmission of MERS-CoV can occur in health care settings and may be associated with considerable morbidity. Surveillance and infection-control measures are critical to a global public health response. In September 2012, the World Health Organization reported the first cases of pneumonia caused by the novel Middle East respiratory syndrome coronavirus (MERS-CoV). We describe a cluster of health care-acquired MERS-CoV infections. Medical records were reviewed for clinical and demographic information and determination of potential contacts and exposures. Case patients and contacts were interviewed. The incubation period and serial interval (the time between the successive onset of symptoms in a chain of transmission) were estimated. Viral RNA was sequenced. Between April 1 and May 23, 2013, a total of 23 cases of MERS-CoV infection were reported in the eastern province of Saudi Arabia. Symptoms included fever in 20 patients (87%), cough in 20 (87%), shortness of breath in 11 (48%), and gastrointestinal symptoms in 8 (35%); 20 patients (87%) presented with abnormal chest radiographs. As of June 12, a total of 15 patients (65%) had died, 6 (26%) had recovered, and 2 (9%) remained hospitalized. The median incubation period was 5.2 days (95% confidence interval [CI], 1.9 to 14.7), and the serial interval was 7.6 days (95% CI, 2.5 to 23.1). A total of 21 of the 23 cases were acquired by person-to-person transmission in hemodialysis units, intensive care units, or in-patient units in three different health care facilities. Sequencing data from four isolates revealed a single monophyletic clade. Among 217 household contacts and more than 200 health care worker contacts whom we identified, MERS-CoV infection developed in 5 family members (3 with laboratory-confirmed cases) and in 2 health care workers (both with laboratory-confirmed cases). Person-to-person transmission of MERS-CoV can occur in health care settings and may be associated with considerable morbidity. Surveillance and infection-control measures are critical to a global public health response. BackgroundIn September 2012, the World Health Organization reported the first cases of pneumonia caused by the novel Middle East respiratory syndrome coronavirus (MERS-CoV). We describe a cluster of health care–acquired MERS-CoV infections.MethodsMedical records were reviewed for clinical and demographic information and determination of potential contacts and exposures. Case patients and contacts were interviewed. The incubation period and serial interval (the time between the successive onset of symptoms in a chain of transmission) were estimated. Viral RNA was sequenced.ResultsBetween April 1 and May 23, 2013, a total of 23 cases of MERS-CoV infection were reported in the eastern province of Saudi Arabia. Symptoms included fever in 20 patients (87%), cough in 20 (87%), shortness of breath in 11 (48%), and gastrointestinal symptoms in 8 (35%); 20 patients (87%) presented with abnormal chest radiographs. As of June 12, a total of 15 patients (65%) had died, 6 (26%) had recovered, and 2 (9%) remained hospitalized. The median incubation period was 5.2 days (95% confidence interval [CI], 1.9 to 14.7), and the serial interval was 7.6 days (95% CI, 2.5 to 23.1). A total of 21 of the 23 cases were acquired by person-to-person transmission in hemodialysis units, intensive care units, or in-patient units in three different health care facilities. Sequencing data from four isolates revealed a single monophyletic clade. Among 217 household contacts and more than 200 health care worker contacts whom we identified, MERS-CoV infection developed in 5 family members (3 with laboratory-confirmed cases) and in 2 health care workers (both with laboratory-confirmed cases).ConclusionsPerson-to-person transmission of MERS-CoV can occur in health care settings and may be associated with considerable morbidity. Surveillance and infection-control measures are critical to a global public health response. |
| Author | Almulhim, Abdulmohsen Madani, Hossam Al-Tawfiq, Jaffar A Watson, Simon J Assiri, Abdullah Cummings, Derek A.T Alhakeem, Rafat Zumla, Alimuddin I Kellam, Paul Makhdoom, Hatem Memish, Ziad A Cotten, Matthew McGeer, Allison Alabdullatif, Zaki N Assad, Maher Al Rabeeah, Abdullah A Price, Connie S Perl, Trish M |
| Author_xml | – sequence: 1 givenname: Abdullah surname: Assiri fullname: Assiri, Abdullah organization: From the Global Center for Mass Gatherings Medicine, Ministry of Health (A. Assiri, A.A.A.R., Z.N.A., M.A., A. Almulhim, H. Makhdoom, H. Madani, R.A., A.I.Z., Z.A.M.), and Al-Faisal University (Z.A.M.), Riyadh, and Saudi Aramco Medical Service Organization, Dahran (J.A.A.-T.) — all in Saudi Arabia; Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (A.M.); the Departments of Medicine and Pathology (T.M.P.) and the Department of Epidemiology (T.M.P., D.A.T.C.), Johns Hopkins University, Baltimore; Denver Health and University of Colorado Denver, Denver (C.S.P.); Wellcome Trust Sanger Institute, Hinxton, United Kingdom (M.C., S.J.W., P.K.); and University College London (P.K., A.I.Z.) and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.I.Z.), London – sequence: 2 givenname: Allison surname: McGeer fullname: McGeer, Allison organization: From the Global Center for Mass Gatherings Medicine, Ministry of Health (A. Assiri, A.A.A.R., Z.N.A., M.A., A. Almulhim, H. Makhdoom, H. Madani, R.A., A.I.Z., Z.A.M.), and Al-Faisal University (Z.A.M.), Riyadh, and Saudi Aramco Medical Service Organization, Dahran (J.A.A.-T.) — all in Saudi Arabia; Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (A.M.); the Departments of Medicine and Pathology (T.M.P.) and the Department of Epidemiology (T.M.P., D.A.T.C.), Johns Hopkins University, Baltimore; Denver Health and University of Colorado Denver, Denver (C.S.P.); Wellcome Trust Sanger Institute, Hinxton, United Kingdom (M.C., S.J.W., P.K.); and University College London (P.K., A.I.Z.) and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.I.Z.), London – sequence: 3 givenname: Trish M surname: Perl fullname: Perl, Trish M organization: From the Global Center for Mass Gatherings Medicine, Ministry of Health (A. Assiri, A.A.A.R., Z.N.A., M.A., A. Almulhim, H. Makhdoom, H. Madani, R.A., A.I.Z., Z.A.M.), and Al-Faisal University (Z.A.M.), Riyadh, and Saudi Aramco Medical Service Organization, Dahran (J.A.A.-T.) — all in Saudi Arabia; Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (A.M.); the Departments of Medicine and Pathology (T.M.P.) and the Department of Epidemiology (T.M.P., D.A.T.C.), Johns Hopkins University, Baltimore; Denver Health and University of Colorado Denver, Denver (C.S.P.); Wellcome Trust Sanger Institute, Hinxton, United Kingdom (M.C., S.J.W., P.K.); and University College London (P.K., A.I.Z.) and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.I.Z.), London – sequence: 4 givenname: Connie S surname: Price fullname: Price, Connie S organization: From the Global Center for Mass Gatherings Medicine, Ministry of Health (A. Assiri, A.A.A.R., Z.N.A., M.A., A. Almulhim, H. Makhdoom, H. Madani, R.A., A.I.Z., Z.A.M.), and Al-Faisal University (Z.A.M.), Riyadh, and Saudi Aramco Medical Service Organization, Dahran (J.A.A.-T.) — all in Saudi Arabia; Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (A.M.); the Departments of Medicine and Pathology (T.M.P.) and the Department of Epidemiology (T.M.P., D.A.T.C.), Johns Hopkins University, Baltimore; Denver Health and University of Colorado Denver, Denver (C.S.P.); Wellcome Trust Sanger Institute, Hinxton, United Kingdom (M.C., S.J.W., P.K.); and University College London (P.K., A.I.Z.) and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.I.Z.), London – sequence: 5 givenname: Abdullah A surname: Al Rabeeah fullname: Al Rabeeah, Abdullah A organization: From the Global Center for Mass Gatherings Medicine, Ministry of Health (A. Assiri, A.A.A.R., Z.N.A., M.A., A. Almulhim, H. Makhdoom, H. Madani, R.A., A.I.Z., Z.A.M.), and Al-Faisal University (Z.A.M.), Riyadh, and Saudi Aramco Medical Service Organization, Dahran (J.A.A.-T.) — all in Saudi Arabia; Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (A.M.); the Departments of Medicine and Pathology (T.M.P.) and the Department of Epidemiology (T.M.P., D.A.T.C.), Johns Hopkins University, Baltimore; Denver Health and University of Colorado Denver, Denver (C.S.P.); Wellcome Trust Sanger Institute, Hinxton, United Kingdom (M.C., S.J.W., P.K.); and University College London (P.K., A.I.Z.) and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.I.Z.), London – sequence: 6 givenname: Derek A.T surname: Cummings fullname: Cummings, Derek A.T organization: From the Global Center for Mass Gatherings Medicine, Ministry of Health (A. Assiri, A.A.A.R., Z.N.A., M.A., A. Almulhim, H. Makhdoom, H. Madani, R.A., A.I.Z., Z.A.M.), and Al-Faisal University (Z.A.M.), Riyadh, and Saudi Aramco Medical Service Organization, Dahran (J.A.A.-T.) — all in Saudi Arabia; Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (A.M.); the Departments of Medicine and Pathology (T.M.P.) and the Department of Epidemiology (T.M.P., D.A.T.C.), Johns Hopkins University, Baltimore; Denver Health and University of Colorado Denver, Denver (C.S.P.); Wellcome Trust Sanger Institute, Hinxton, United Kingdom (M.C., S.J.W., P.K.); and University College London (P.K., A.I.Z.) and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.I.Z.), London – sequence: 7 givenname: Zaki N surname: Alabdullatif fullname: Alabdullatif, Zaki N organization: From the Global Center for Mass Gatherings Medicine, Ministry of Health (A. Assiri, A.A.A.R., Z.N.A., M.A., A. Almulhim, H. Makhdoom, H. Madani, R.A., A.I.Z., Z.A.M.), and Al-Faisal University (Z.A.M.), Riyadh, and Saudi Aramco Medical Service Organization, Dahran (J.A.A.-T.) — all in Saudi Arabia; Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (A.M.); the Departments of Medicine and Pathology (T.M.P.) and the Department of Epidemiology (T.M.P., D.A.T.C.), Johns Hopkins University, Baltimore; Denver Health and University of Colorado Denver, Denver (C.S.P.); Wellcome Trust Sanger Institute, Hinxton, United Kingdom (M.C., S.J.W., P.K.); and University College London (P.K., A.I.Z.) and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.I.Z.), London – sequence: 8 givenname: Maher surname: Assad fullname: Assad, Maher organization: From the Global Center for Mass Gatherings Medicine, Ministry of Health (A. Assiri, A.A.A.R., Z.N.A., M.A., A. Almulhim, H. Makhdoom, H. Madani, R.A., A.I.Z., Z.A.M.), and Al-Faisal University (Z.A.M.), Riyadh, and Saudi Aramco Medical Service Organization, Dahran (J.A.A.-T.) — all in Saudi Arabia; Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (A.M.); the Departments of Medicine and Pathology (T.M.P.) and the Department of Epidemiology (T.M.P., D.A.T.C.), Johns Hopkins University, Baltimore; Denver Health and University of Colorado Denver, Denver (C.S.P.); Wellcome Trust Sanger Institute, Hinxton, United Kingdom (M.C., S.J.W., P.K.); and University College London (P.K., A.I.Z.) and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.I.Z.), London – sequence: 9 givenname: Abdulmohsen surname: Almulhim fullname: Almulhim, Abdulmohsen organization: From the Global Center for Mass Gatherings Medicine, Ministry of Health (A. Assiri, A.A.A.R., Z.N.A., M.A., A. Almulhim, H. Makhdoom, H. Madani, R.A., A.I.Z., Z.A.M.), and Al-Faisal University (Z.A.M.), Riyadh, and Saudi Aramco Medical Service Organization, Dahran (J.A.A.-T.) — all in Saudi Arabia; Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (A.M.); the Departments of Medicine and Pathology (T.M.P.) and the Department of Epidemiology (T.M.P., D.A.T.C.), Johns Hopkins University, Baltimore; Denver Health and University of Colorado Denver, Denver (C.S.P.); Wellcome Trust Sanger Institute, Hinxton, United Kingdom (M.C., S.J.W., P.K.); and University College London (P.K., A.I.Z.) and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.I.Z.), London – sequence: 10 givenname: Hatem surname: Makhdoom fullname: Makhdoom, Hatem organization: From the Global Center for Mass Gatherings Medicine, Ministry of Health (A. Assiri, A.A.A.R., Z.N.A., M.A., A. Almulhim, H. Makhdoom, H. Madani, R.A., A.I.Z., Z.A.M.), and Al-Faisal University (Z.A.M.), Riyadh, and Saudi Aramco Medical Service Organization, Dahran (J.A.A.-T.) — all in Saudi Arabia; Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (A.M.); the Departments of Medicine and Pathology (T.M.P.) and the Department of Epidemiology (T.M.P., D.A.T.C.), Johns Hopkins University, Baltimore; Denver Health and University of Colorado Denver, Denver (C.S.P.); Wellcome Trust Sanger Institute, Hinxton, United Kingdom (M.C., S.J.W., P.K.); and University College London (P.K., A.I.Z.) and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.I.Z.), London – sequence: 11 givenname: Hossam surname: Madani fullname: Madani, Hossam organization: From the Global Center for Mass Gatherings Medicine, Ministry of Health (A. Assiri, A.A.A.R., Z.N.A., M.A., A. Almulhim, H. Makhdoom, H. Madani, R.A., A.I.Z., Z.A.M.), and Al-Faisal University (Z.A.M.), Riyadh, and Saudi Aramco Medical Service Organization, Dahran (J.A.A.-T.) — all in Saudi Arabia; Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (A.M.); the Departments of Medicine and Pathology (T.M.P.) and the Department of Epidemiology (T.M.P., D.A.T.C.), Johns Hopkins University, Baltimore; Denver Health and University of Colorado Denver, Denver (C.S.P.); Wellcome Trust Sanger Institute, Hinxton, United Kingdom (M.C., S.J.W., P.K.); and University College London (P.K., A.I.Z.) and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.I.Z.), London – sequence: 12 givenname: Rafat surname: Alhakeem fullname: Alhakeem, Rafat organization: From the Global Center for Mass Gatherings Medicine, Ministry of Health (A. Assiri, A.A.A.R., Z.N.A., M.A., A. Almulhim, H. Makhdoom, H. Madani, R.A., A.I.Z., Z.A.M.), and Al-Faisal University (Z.A.M.), Riyadh, and Saudi Aramco Medical Service Organization, Dahran (J.A.A.-T.) — all in Saudi Arabia; Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (A.M.); the Departments of Medicine and Pathology (T.M.P.) and the Department of Epidemiology (T.M.P., D.A.T.C.), Johns Hopkins University, Baltimore; Denver Health and University of Colorado Denver, Denver (C.S.P.); Wellcome Trust Sanger Institute, Hinxton, United Kingdom (M.C., S.J.W., P.K.); and University College London (P.K., A.I.Z.) and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.I.Z.), London – sequence: 13 givenname: Jaffar A surname: Al-Tawfiq fullname: Al-Tawfiq, Jaffar A organization: From the Global Center for Mass Gatherings Medicine, Ministry of Health (A. Assiri, A.A.A.R., Z.N.A., M.A., A. Almulhim, H. Makhdoom, H. Madani, R.A., A.I.Z., Z.A.M.), and Al-Faisal University (Z.A.M.), Riyadh, and Saudi Aramco Medical Service Organization, Dahran (J.A.A.-T.) — all in Saudi Arabia; Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (A.M.); the Departments of Medicine and Pathology (T.M.P.) and the Department of Epidemiology (T.M.P., D.A.T.C.), Johns Hopkins University, Baltimore; Denver Health and University of Colorado Denver, Denver (C.S.P.); Wellcome Trust Sanger Institute, Hinxton, United Kingdom (M.C., S.J.W., P.K.); and University College London (P.K., A.I.Z.) and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.I.Z.), London – sequence: 14 givenname: Matthew surname: Cotten fullname: Cotten, Matthew organization: From the Global Center for Mass Gatherings Medicine, Ministry of Health (A. Assiri, A.A.A.R., Z.N.A., M.A., A. Almulhim, H. Makhdoom, H. Madani, R.A., A.I.Z., Z.A.M.), and Al-Faisal University (Z.A.M.), Riyadh, and Saudi Aramco Medical Service Organization, Dahran (J.A.A.-T.) — all in Saudi Arabia; Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (A.M.); the Departments of Medicine and Pathology (T.M.P.) and the Department of Epidemiology (T.M.P., D.A.T.C.), Johns Hopkins University, Baltimore; Denver Health and University of Colorado Denver, Denver (C.S.P.); Wellcome Trust Sanger Institute, Hinxton, United Kingdom (M.C., S.J.W., P.K.); and University College London (P.K., A.I.Z.) and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.I.Z.), London – sequence: 15 givenname: Simon J surname: Watson fullname: Watson, Simon J organization: From the Global Center for Mass Gatherings Medicine, Ministry of Health (A. Assiri, A.A.A.R., Z.N.A., M.A., A. Almulhim, H. Makhdoom, H. Madani, R.A., A.I.Z., Z.A.M.), and Al-Faisal University (Z.A.M.), Riyadh, and Saudi Aramco Medical Service Organization, Dahran (J.A.A.-T.) — all in Saudi Arabia; Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (A.M.); the Departments of Medicine and Pathology (T.M.P.) and the Department of Epidemiology (T.M.P., D.A.T.C.), Johns Hopkins University, Baltimore; Denver Health and University of Colorado Denver, Denver (C.S.P.); Wellcome Trust Sanger Institute, Hinxton, United Kingdom (M.C., S.J.W., P.K.); and University College London (P.K., A.I.Z.) and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.I.Z.), London – sequence: 16 givenname: Paul surname: Kellam fullname: Kellam, Paul organization: From the Global Center for Mass Gatherings Medicine, Ministry of Health (A. Assiri, A.A.A.R., Z.N.A., M.A., A. Almulhim, H. Makhdoom, H. Madani, R.A., A.I.Z., Z.A.M.), and Al-Faisal University (Z.A.M.), Riyadh, and Saudi Aramco Medical Service Organization, Dahran (J.A.A.-T.) — all in Saudi Arabia; Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (A.M.); the Departments of Medicine and Pathology (T.M.P.) and the Department of Epidemiology (T.M.P., D.A.T.C.), Johns Hopkins University, Baltimore; Denver Health and University of Colorado Denver, Denver (C.S.P.); Wellcome Trust Sanger Institute, Hinxton, United Kingdom (M.C., S.J.W., P.K.); and University College London (P.K., A.I.Z.) and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.I.Z.), London – sequence: 17 givenname: Alimuddin I surname: Zumla fullname: Zumla, Alimuddin I organization: From the Global Center for Mass Gatherings Medicine, Ministry of Health (A. Assiri, A.A.A.R., Z.N.A., M.A., A. Almulhim, H. Makhdoom, H. Madani, R.A., A.I.Z., Z.A.M.), and Al-Faisal University (Z.A.M.), Riyadh, and Saudi Aramco Medical Service Organization, Dahran (J.A.A.-T.) — all in Saudi Arabia; Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (A.M.); the Departments of Medicine and Pathology (T.M.P.) and the Department of Epidemiology (T.M.P., D.A.T.C.), Johns Hopkins University, Baltimore; Denver Health and University of Colorado Denver, Denver (C.S.P.); Wellcome Trust Sanger Institute, Hinxton, United Kingdom (M.C., S.J.W., P.K.); and University College London (P.K., A.I.Z.) and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.I.Z.), London – sequence: 18 givenname: Ziad A surname: Memish fullname: Memish, Ziad A organization: From the Global Center for Mass Gatherings Medicine, Ministry of Health (A. Assiri, A.A.A.R., Z.N.A., M.A., A. Almulhim, H. Makhdoom, H. Madani, R.A., A.I.Z., Z.A.M.), and Al-Faisal University (Z.A.M.), Riyadh, and Saudi Aramco Medical Service Organization, Dahran (J.A.A.-T.) — all in Saudi Arabia; Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (A.M.); the Departments of Medicine and Pathology (T.M.P.) and the Department of Epidemiology (T.M.P., D.A.T.C.), Johns Hopkins University, Baltimore; Denver Health and University of Colorado Denver, Denver (C.S.P.); Wellcome Trust Sanger Institute, Hinxton, United Kingdom (M.C., S.J.W., P.K.); and University College London (P.K., A.I.Z.) and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.I.Z.), London |
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| Copyright | Copyright © 2013 Massachusetts Medical Society. All rights reserved. 2014 INIST-CNRS Copyright © 2013 Massachusetts Medical Society. 2013 |
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| Snippet | A novel coronavirus (MERS-CoV) is causing severe disease in the Middle East. In this report on a hospital outbreak of MERS-CoV infection, 23 confirmed cases... In September 2012, the World Health Organization reported the first cases of pneumonia caused by the novel Middle East respiratory syndrome coronavirus... BackgroundIn September 2012, the World Health Organization reported the first cases of pneumonia caused by the novel Middle East respiratory syndrome... |
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| SubjectTerms | Adult Aged Aged, 80 and over Base Sequence Biological and medical sciences Coronaviridae Coronavirus - genetics Coronavirus - isolation & purification Coronavirus Infections - epidemiology Coronavirus Infections - transmission Coronavirus Infections - virology Coronaviruses Cough Cross Infection - epidemiology Cross Infection - transmission Cross Infection - virology Disease Outbreaks Disease transmission Disease Transmission, Infectious DNA, Viral - analysis Female Fever General aspects Hemodialysis Hospitals Human infectious diseases. Experimental studies and models Humans Infections Infectious Disease Incubation Period Infectious Disease Transmission, Patient-to-Professional Infectious diseases Intensive Care Units Male Medical personnel Medical records Medical sciences Middle Aged Morbidity Mortality Outbreaks Phylogeny Pneumonia Pneumonia, Viral - epidemiology Pneumonia, Viral - transmission Pneumonia, Viral - virology Public health Radiography Renal Dialysis Ribonucleic acid RNA Saudi Arabia - epidemiology |
| Title | Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus |
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