Middle East respiratory syndrome coronavirus transmission among health care workers: Implication for infection control

• Type of Material: Article
• Authors: Sarah H. Alfaraj, Ministry of Health Saudi Arabia; Jaffar A. Al-Tawfiq, Indiana University; Talal A. Altuwaijri, Ministry of Health Saudi Arabia; Marzouqa Alanazi, Ministry of Health Saudi Arabia; Nojoom Alzahrani, Ministry of Health Saudi Arabia; Ziad Memish, Emory University
• Language: English
• Date: 2018-02-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ajic.2017.08.010
• Title of Journal or Parent Work: American Journal of Infection Control
• Volume: 46
• Issue: 2
• Start Page: 165
• End Page: 168
• Grant/Funding Information: None declared
• Keywords: Philippines; Contact Tracing; Infection Control; Adult; Middle East respiratory syndrome coronavirus; Coronavirus Infections; Female; Saudi Arabia; MERS-CoV; Infection control; Outbreak; Humans; Middle East Respiratory Syndrome Coronavirus; Health Personnel; Male
• Research Categories: Health Sciences, Occupational Health and Safety; Health Sciences, Public Health; Health Sciences, Health Care Management; Health Sciences, Epidemiology

Abstract

Background: Many outbreaks of Middle East respiratory syndrome coronavirus (MERS-CoV) have occurred in health care settings and involved health care workers (HCWs). We describe the occurrence of an outbreak among HCWs and attempt to characterize at-risk exposures to improve future infection control interventions. Methods: This study included an index case and all HCW contacts. All contacts were screened for MERS-CoV using polymerase chain reaction. Results: During the study period in 2015, the index case was a 30-year-old Filipino nurse who had a history of unprotected exposure to a MERS-CoV–positive case on May 15, 2015, and had multiple negative tests for MERS-CoV. Weeks later, she was diagnosed with pulmonary tuberculosis and MERS-CoV infection. A total of 73 staff were quarantined for 14 days, and nasopharyngeal swabs were taken on days 2, 5, and 12 postexposure. Of those contacts, 3 (4%) were confirmed positive for MERS-CoV. An additional 18 staff were quarantined and had MERS-CoV swabs. A fourth case was confirmed positive on day 12. Subsequent contact investigations revealed a fourth-generation transmission. Only 7 (4.5%) of the total 153 contacts were positive for MERS-CoV. Conclusions: The role of HCWs in MERS-CoV transmission is complex. Although most MERS-CoV–infected HCWs are asymptomatic or have mild disease, fatal infections can occur and HCWs can play a major role in propagating health care facility outbreaks. This investigation highlights the need to continuously review infection control guidance relating to the role of HCWs in MERS-CoV transmission in health care outbreaks, especially as it relates to the complex questions on definition of risky exposures, who to test, and the frequency of MERS-CoV testing; criteria for who to quarantine and for how long; and clearance and return to active duty criteria.