Comparative Analysis of Eleven Healthcare-Associated Outbreaks of Middle East Respiratory Syndrome Coronavirus (Mers-Cov) from 2015 to 2017

Sci Rep. 2019 May 14;9(1):7385. doi: 10.1038/s41598-019-43586-9.

Abstract

Since its emergence in 2012, 2,260 cases and 803 deaths due to Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported to the World Health Organization. Most cases were due to transmission in healthcare settings, sometimes causing large outbreaks. We analyzed epidemiologic and clinical data of laboratory-confirmed MERS-CoV cases from eleven healthcare-associated outbreaks in the Kingdom of Saudi Arabia and the Republic of Korea between 2015-2017. We quantified key epidemiological differences between outbreaks. Twenty-five percent (n = 105/422) of MERS cases who acquired infection in a hospital setting were healthcare personnel. In multivariate analyses, age ≥65 (OR 4.8, 95%CI: 2.6-8.7) and the presence of underlying comorbidities (OR: 2.7, 95% CI: 1.3-5.7) were associated with increased mortality whereas working as healthcare personnel was protective (OR 0.07, 95% CI: 0.01-0.34). At the start of these outbreaks, the reproduction number ranged from 1.0 to 5.7; it dropped below 1 within 2 to 6 weeks. This study provides a comprehensive characterization of MERS HCA-outbreaks. Our results highlight heterogeneities in the epidemiological profile of healthcare-associated outbreaks. The limitations of our study stress the urgent need for standardized data collection for high-threat respiratory pathogens, such as MERS-CoV.

Publication types

  • Comparative Study
  • Historical Article
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Comorbidity
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / transmission
  • Coronavirus Infections / virology
  • Cross Infection / epidemiology*
  • Cross Infection / transmission
  • Cross Infection / virology
  • Disease Outbreaks / history
  • Disease Outbreaks / prevention & control
  • Disease Outbreaks / statistics & numerical data*
  • Female
  • Health Personnel / statistics & numerical data
  • History, 21st Century
  • Hospitals / statistics & numerical data*
  • Humans
  • Infectious Disease Transmission, Patient-to-Professional / prevention & control
  • Infectious Disease Transmission, Patient-to-Professional / statistics & numerical data
  • Infectious Disease Transmission, Professional-to-Patient / prevention & control
  • Infectious Disease Transmission, Professional-to-Patient / statistics & numerical data
  • Male
  • Middle Aged
  • Middle East Respiratory Syndrome Coronavirus / isolation & purification*
  • Republic of Korea / epidemiology
  • Risk Factors
  • Saudi Arabia / epidemiology