Volume 22, Number 11—November 2016
Research
Risk Factors for Middle East Respiratory Syndrome Coronavirus Infection among Healthcare Personnel
Basem M. Alraddadi, Hanadi S. Al-Salmi, Kara Jacobs-Slifka, Rachel B. Slayton, Concepcion F. Estivariz, Andrew I. Geller, Hanan H. Al-Turkistani, Sanaa S. Al-Rehily, Haleema A. Alserehi, Ghassan Y. Wali, Abeer N. Alshukairi, Esam I. Azhar, Lia M. Haynes, David L. Swerdlow, John A. Jernigan1, and Tariq A. Madani1
Table 2
RR of MERS-CoV seropositivity among persons with direct MERS-CoV patient contact, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia, March–July 2014*
| Condition/exposure | Condition/exposure present (AR, %) | Condition/exposure absent (AR, %) | RR (95% CI) | p value |
|---|---|---|---|---|
| Co-morbidity | 8/68 (11.8) | 11/156 (7.1) | 1.67 (0.70–3.96) | 0.30 |
| Asthma | 2/16 (12.5) | 17/208 (8.2) | 1.53 (0.39–6.04) | 0.63 |
| Allergic rhinitis | 5/31 (16.1) | 14/192 (7.3) | 2.21 (0.86–5.71) | 0.15 |
| Chronic lung disease | 0/2 (0) | 19/222 (8.6) | – | 1 |
| Chronic heart disease | 0/10 (0) | 19/214 (8.9) | – | 1 |
| Diabetes mellitus | 3/20 (15.0) | 16/202 (7.9) | 1.89 (0.60–5.95) | 0.39 |
| Chronic kidney disease | 0 | 19/224 (8.5) | – | – |
| End-stage renal disease requiring hemodialysis | 0 | 19/224 (8.5) | – | |
| Immunosuppressive condition | 0/2 (0) | 19/222 (8.6) | – | 1 |
| Autoimmune disease | 0 | 19/224 (8.5) | – | |
| Pregnant |
0/3 (0) |
13/137 (9.5) |
– |
1 |
| Exposure to a MERS-CoV patient | 18/208 (8.7) | 1/16 (6.3) | 1.38 (0.20–9.72) | 1 |
| Taking vital signs | 10/122 (8.2) | 9/102 (8.8) | 0.92 (0.39–2.20) | 1 |
| Providing medication | 10/115 (8.7) | 9/109 (8.3) | 1.05 (0.44–2.49) | 0.91 |
| Placing urinary catheter | 3/49 (6.1) | 16/175 (9.1) | 0.67 (0.20–2.21) | 0.77 |
| Bathing | 7/76 (9.2) | 12/148 (8.1) | 1.14 (0.47–2.77) | 0.78 |
| Feeding | 6/70 (8.6) | 13/154 (8.4) | 1.02 (0.40–2.56) | 0.97 |
| Lifting, positioning | 14/131 (10.7) | 5/93 (5.4) | 1.99 (0.74–5.33) | 0.16 |
| Emptying bedpan | 8/71 (11.3) | 11/153 (7.2) | 1.57 (0.66–3.73) | 0.31 |
| Changing linen | 11/109 (10.1) | 8/115 (7.0) | 1.45 (0.61–3.47) | 0.40 |
| Providing injection | 10/94 (10.6) | 9/130 (6.9) | 1.54 (0.65–3.63) | 0.32 |
| Placing intravascular device | 10/73 (13.7) | 9/151 (6.0) | 2.30 (0.98–5.41) | 0.05 |
| Performing hemodialysis | 2/37 (5.4) | 17/187 (9.0) | 0.59 (0.14–2.46) | 0.75 |
| Taking medical history | 6/98 (6.1) | 13/126 (10.3) | 0.59 (0.23–1.50) | 0.26 |
| Performing physical exam | 9/140 (6.4) | 10/84 (11.9) | 0.54 (0.23–1.27) | 0.15 |
| Participating in surgery | 0/6 (0) | 19/218 (8.7) | – | 1 |
| Drawing blood | 11/119 (9.2) | 8/105 (7.6) | 1.21 (0.51–2.90) | 0.66 |
| Collecting respiratory laboratory specimens | 9/111 (8.1) | 10/113 (8.9) | 0.92 (0.39–2.17) | 0.84 |
| Performing radiograph | 8/60 (13.3) | 11/164 (6.7) | 1.99 (0.84–4.70) | 0.12 |
| Processing clinical specimen | 3/22 (13.6) | 16/202 (7.9) | 1.72 (0.54–5.45) | 0.41 |
| Visiting in the hospital |
5/70 (7.1) |
14/154 (9.1) |
0.79 (0.29–2.10) |
0.63 |
| Present in room when any of the following procedures were performed on a MERS-CoV patient | 16/177 (9.0) | 3/47 (6.4) | 1.42 (0.43–4.66) | 0.77 |
| Manipulation of oxygen face mask or tubing† | 13/157 (8.3) | 6/67 (9.0) | 0.92 (0.37–2.33) | 0.87 |
| Airway suction† | 9/128 (7.0) | 10/96 (10.4) | 0.67 (0.29–1.60) | 0.37 |
| Noninvasive ventilation† | 9/105 (8.6) | 10/119 (8.4) | 1.02 (0.43–2.41) | 0.96 |
| Manual ventilation† | 5/90 (5.6) | 14/134 (10.5) | 0.53 (0.20–1.42) | 0.23 |
| Nebulizer treatments† | 9/103 (8.7) | 10/121 (8.3) | 1.05 (0.45–2.50) | 0.90 |
| Intubation† | 7/105 (6.7) | 12/119 (10.1) | 0.66 (0.27–1.63) | 0.36 |
| Cardiopulmonary resuscitation† | 6/87 (6.9) | 13/137 (9.5) | 0.73 (0.29–1.84) | 0.50 |
| High-frequency oscillatory ventilation† | 1/19 (5.3) | 18/205 (8.8) | 0.60 (0.08–4.25) | 1 |
| Chest tube insertion or removal | 0/20 (0) | 19/204 (9.3) | – | 0.23 |
| Insertion of nasogastric tubes | 5/64 (7.8) | 14/160 (8.8) | 0.89 (0.34–2.38) | 1 |
| Insertion of peripheral line | 9/110 (8.2) | 10/114 (8.8) | 0.93 (0.39–2.21) | 0.87 |
| Insertion of central venous line | 4/67 (6.0) | 15/157 (9.6) | 0.62 (0.22–1.81) | 0.44 |
| Chest physiotherapy | 3/49 (6.1) | 16/175 (9.1) | 0.67 (0.20–2.21) | 0.77 |
| Tracheostomy care | 5/55 (9.1) | 14/169 (8.3) | 1.10 (0.41–2.91) | 0.79 |
| Bronchoscopy† | 0/4 (0) | 19/220 (8.6) | – | 1 |
| Extubation† | 1/4 (25.0) | 18/220 (8.2) | 3.06 (0.53–17.67) | 0.30 |
| Any aerosol-generating procedure |
15/172 (8.7) |
4/52 (7.7) |
1.13 (0.39–3.27) |
1 |
| Direct contact with any blood, body fluid, or excretion of MERS-CoV patient | 5/78 (6.4) | 14/145 (9.7) | 0.66 (0.25–1.77) | 0.46 |
| Blood | 4/53 (7.6) | 15/171 (8.8) | 0.86 (0.30–2.48) | 1 |
| Sputum | 4/52 (7.7) | 15/172 (8.7) | 0.88 (0.31–2.54) | 1 |
| Urine | 3/27 (11.1) | 16/197 (8.1) | 1.37 (0.43–4.39) | 0.71 |
| Feces | 3/32 (9.4) | 16/192 (8.3) | 1.12 (0.35–3.64) | 0.74 |
| Other fluids |
1/8 (12.5) |
18/216 (8.3) |
1.50 (0.23–9.89) |
0.51 |
| Smoking | 10/85 (11.8) | 9/139 (6.5) | 1.82 (0.77–4.29) | 0.17 |
| Currently smokes tobacco | 4/52 (7.7) | 15/172 (8.7) | 0.88 (0.31–2.54) | 1 |
| Smoked tobacco in the past |
7/40 (17.5) |
8/141 (5.7) |
3.08 (1.12–7.99) |
0.02 |
| Other exposures | ||||
| Respiratory pathogen infection control training | 15/202 (7.4) | 4/17 (23.5) | 0.32 (0.12–0.85) | 0.05 |
| MERS-CoV infection control training | 7/138 (5.1) | 12/82 (14.6) | 0.35 (0.14–0.85) | 0.01 |
| Same room or <2 m of any other hospitalized patient with pneumonia or respiratory illness | 15/188 (8.0) | 2/29 (6.9) | 1.16 (0.28–4.80) | 1 |
| Contact with persons other than patients sick with fever or respiratory illness | 5/76 (6.6) | 14/145 (9.7) | 0.68 (0.26–1.82) | 0.61 |
| Contact with persons other than patients who were MERS-CoV positive | 2/36 (5.6) | 16/177 (9.0) | 0.61 (0.15–2.56) | 0.74 |
| Hijab wear while working (women) | 2/11 (18.2) | 11/132 (8.3) | 2.18 (0.55–8.64) | 0.26 |
| Any travel | 9/87 (10.3) | 10/132 (7.6) | 1.37 (0.58–3.22) | 0.48 |
*AR, attack rate; MERS-CoV, Middle East respiratory syndrome coronavirus; RR, relative risk.
†Aerosol-generating procedure.
1These authors contributed equally to this article.
Page created: October 18, 2016
Page updated: October 18, 2016
Page reviewed: October 18, 2016
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.