MERS CoV poses serious risk in hospital setting

AN investigative team of infectious disease experts who travelled to Saudi Arabia during an outbreak of the Middle East respiratory syndrome coronavirus reports that the virus poses a serious risk to hospitals because it is easily transmitted in health care settings.

The team, from Johns Hopkins and elsewhere, investigated the spread of the virus, or MERS CoV for short, in four local Saudi hospitals in May, and concluded that it is even more deadly than the related coronavirus responsible for the severe acute respiratory syndrome (SARS) outbreak in Toronto hospitals in 2003. The same team investigated that event, as well. Initially, 23 people in Saudi Arabia were infected with MERS at the time of the investigation, and 15 had died of the SARS-like virus. Saudi health officials now put the death toll at 32, with another 49 infected.

The experts, whose report on the outbreak is to be published in The New England Journal of Medicine online June 19, say that MERS is not only easily transmitted from patient to patient, but also from the transfer of sick patients to other hospitals.

Trish Perl, M.D., M.Sc., senior hospital epidemiologist for Johns Hopkins Medicine, a professor at the Johns Hopkins University School of Medicine, and a member of the team, says that swift action by local health officials to quickly monitor the situation and spread of the disease, supported by rapid detection, isolation and treatment of those infected, has largely helped stem the outbreak. Hospital staff also tightened infection control procedures, introducing more vigorous cleaning procedures with stronger disinfectants, and treating infected patients in private rooms, while wearing masks, gowns and gloves, and masking any other non-infected patients who are nearby.

Saudi health officials invited Perl, along with fellow infectious disease specialists Connie Price, M.D., from the University of Colorado in Denver, and Allison McGeer, M.D., from the University of Toronto in Canada, to assist the country with its investigation. Greeting the team upon their arrival was a dolly cart full of cartons of medical records, which the team reviewed in their hotel room. Additional data and blood samples collected after site visits to all four hospitals were later shared with colleagues at the Johns Hopkins University Bloomberg School of Public Health, and experts in viral genetics at the Wellcome Trust Sanger Institute in the United Kingdom.

Among the team’s other major findings was that MERS, even with relatively fewer people infected than in the SARS outbreak, had a death rate many times higher than SARS, at 65%  and 8%, respectively. However, experts caution that the MERS death rate may come down if more cases are identified, including among those with mild symptoms.

The time from viral exposure to the first signs of symptoms of coughing, shortness of breath, fever, or vomiting, was 5.2 days, while it took on average 7.6 days for the virus to spread from one person to the next.

Among the 23 infected initially, five were family members, two were health care workers, including a nurse who had worked with other nurses caring for infected patients, and an ICUAdidas Falcon