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2014 MERS-CoV outbreak in Jeddah--a link to health care facilities
Ikwo K Oboho1, Sara M Tomczyk, Ahmad M Al-Asmari
1From 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.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.).
Insights
The 2014 Jeddah outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) showed a high fatality rate. Most MERS-CoV patients had health care exposure, indicating significant health care-associated transmission.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- A significant increase in Middle East respiratory syndrome coronavirus (MERS-CoV) cases was observed in Jeddah, Saudi Arabia, during early 2014.
- This study aimed to investigate the reasons behind the MERS-CoV surge and characterize its epidemiologic and clinical aspects.
Purpose of the Study:
- To explore the reasons for the increased incidence of MERS-CoV infections in Jeddah.
- To assess the epidemiologic and clinical features of MERS-CoV in the affected population.
Main Methods:
- Identified laboratory-confirmed MERS-CoV cases reported in Jeddah from January 1 to May 16, 2014.
- Conducted telephone interviews with symptomatic and asymptomatic patients, and reviewed hospital records.
- Performed descriptive analyses to summarize the data.
Main Results:
- Of 255 confirmed MERS-CoV cases, 93 died (36.5% case fatality rate).
- The majority of symptomatic patients (97.3%) without health care roles had contact with health care facilities or individuals with MERS-CoV or severe respiratory illness.
- A significant proportion of initially reported asymptomatic patients (79%) experienced symptoms consistent with viral respiratory illness.
Conclusions:
- The findings indicate that health care-associated transmission played a substantial role in the Jeddah MERS-CoV outbreak.
- Contact with healthcare facilities and other patients is a key factor in MERS-CoV transmission.
- The study underscores the importance of infection control measures within healthcare settings to prevent MERS-CoV spread.
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