Volume 22, Number 4—April 2016
Research
Transmission of Middle East Respiratory Syndrome Coronavirus Infections in Healthcare Settings, Abu Dhabi
, Duc T. Nguyen, Bashir Aden, Zyad Al Bandar, Wafa Al Dhaheri, Kheir Abu Elkheir, Ahmed Khudair, Mariam Al Mulla, Feda El Saleh, Hala Imambaccus, Nawal Al Kaabi, Farrukh Amin Sheikh, Jurgen Sasse, Andrew Turner, Laila Abdel Wareth, Stefan Weber, Asma Al Ameri, Wesal Abu Amer, Negar N. Alami, Sudhir Bunga, Lia M. Haynes, Aron J. Hall, Alexander J. Kallen, David T. Kuhar, Huong T. Pham, Kimberly Pringle, Suxiang Tong, Brett L. Whitaker, Susan I. Gerber, and Farida Ismail Al Hosani
Table 1
Descriptive epidemiology of 30 cases of MERS-CoV infection transmitted in healthcare settings, Abu Dhabi, January 1, 2013–May 9, 2014*
| Demographic and clinical characteristic | Source case-patients, n = 3‡ | Healthcare-associated case-patients† |
Signif§ | |||
|---|---|---|---|---|---|---|
| All HCA case-patients, n = 27 | HCWs, n = 19 | Patients, n = 6 | Visitors, n = 2 | |||
| Median age, y (range) | 59 (30–83) | 43 (27–82) | 39 (27–63) | 65 (40–73) | 44 (34–54) | |
| Male sex | 3 (100) | 17 (63) | 11 (58) | 5 (83) | 1 (50) | |
| Expatriate¶ |
1 (33) |
26 (96) |
18 (95) |
6 (100) |
2 (100) |
0.02 |
| Exposures within 14 d before symptom onset# | ||||||
| Travel | 0 | 2 (7) | 1 (5) | 0 | 1 (50) | |
| Camel |
2 (67) |
0 |
0 |
0 |
0 |
0.01 |
| Symptoms | ||||||
| Any symptoms reported | 3 (100) | 16 (59) | 10 (53) | 5 (83) | 1 (50) | |
| Documented fever or symptom of respiratory illness** | 3 (100) | 13 (48) | 8 (42) | 5 (83) | 0 | |
| Documented fever (≥38.5°C) | 3 (100) | 9 (33) | 6 (32) | 3 (50) | 0 | |
| Shortness of breath | 3 (100) | 5 (19) | 0 | 5 (83) | 0 | 0.01 |
| Fatigue/malaise | 2 (67) | 8 (30) | 4 (21) | 3 (50) | 1 (50) | |
| Cough | 2 (67) | 7 (26) | 4 (21) | 3 (50) | 0 | |
| Cough with sputum production | 2 (67) | 2 (7) | 0 | 2 (33) | 0 | 0.04 |
| Rhinorrhea | 2 (67) | 2 (7) | 2 (11) | 0 | 0 | 0.04 |
| Muscle aches | 2 (67 | 7 (26 | 5 (26) | 1 (17) | 1 (50) | |
| Chest pain | 1 (33) | 2 (7) | 1 (5) | 1 (17) | 0 | |
| Joint pain | 2 (67) | 2 (7) | 2 (11) | 0 | 0 | 0.04 |
| Headache | 2 (67) | 4 (15) | 3 (16) | 1 (17) | 0 | |
| Sore throat | 1 (33) | 5 (19) | 5 (26) | 0 | 0 | |
| Wheezing | 1 (33) | 3 (11) | 1 (5) | 2 (33) | 0 | |
| Vomiting/nausea |
1 (33 |
1 (4) |
0 |
1 (17) |
0 |
|
| Medical history | ||||||
| Any underlying conditions | 2 (67) | 15 (56) | 7 (37) | 6 (100) | 2 (100) | |
| Diabetes mellitus | 1 (33) | 6 (22) | 1 (5) | 4 (67) | 1 (50) | |
| Dementia | 1 (33) | 0 | 0 | 0 | 0 | |
| Malignancy | 1 (33) | 0 | 0 | 0 | 0 | |
| Receiving immunosuppressant | 1 (33) | 0 | 0 | 0 | 0 | |
| Chronic pulmonary disease | 0 | 2 (7) | 0 | 2 (33) | 0 | |
| Renal disease | 0 | 5 (19) | 0 | 4 (67) | 1 (50) | |
| Congestive heart failure | 0 | 1 (4) | 0 | 1 (17) | 0 | |
| Obese†† | 0 | 2 (7) | 1 (5) | 1 (17) | 0 | |
| Hypertension | 0 | 12 (44) | 5 (26) | 5 (83) | 2 (100) | |
| Hyperlipidemia | 0 | 7 (26) | 4 (21) | 2 (33) | 1 (50) | |
| Asthma | 0 | 2 (7) | 2 (11) | 0 | 0 | |
| Ischemic heart disease |
0 |
3 (11) |
1 (5) |
2 (33) |
0 |
|
| Severity of symptoms | ||||||
| Care in ICU | 3 (100) | 5 (19) | 0 | 5 (83) | 0 | 0.01 |
| Supplemental O2 required | 3 (100) | 6 (22) | 0 | 6 (100) | 0 | 0.02 |
| Intubated | 3 (100) | 3 (11) | 0 | 3 (50) | 0 | <0.01 |
| Died |
2 (67) |
2 (7) |
0 |
2 (33) |
0 |
0.04 |
| Reason tested for MERS-CoV | ||||||
| Screening as part of contact investigation | 0 | 24 (89) | 19 (100) | 3 (50) | 2 (100) | <0.01 |
| Symptoms consistent with MERS-CoV | 3 (100) | 3 (11) | 0 | 3 (50) | 0 | <0.01 |
*Values are no. (%) patients except as indicated. HCA, healthcare-associated; HCWs, healthcare workers; MERS-CoV, Middle East respiratory syndrome coronavirus; Signif, statistically significant.
†HCA case-patients include HCWs, patients, and hospital visitors but does not include source case-patients.
‡Source case-patients are those with the earliest date of onset of symptoms in an HCA cluster of case-patients.
§Comparison between type of case (source case vs. HCA case) determined by Fisher exact test. Only significant values are shown.
¶Nationalities: Philippines, India, Somalia, Bangladesh, Egypt, Jordan, Oman, Pakistan, Sudan, and Syria.
#For case-patients with no reported symptoms, date of positive sample collection was used in place of symptom onset.
**Symptoms of respiratory illness are cough, shortness of breath, or wheezing.
††Obesity status was determined by clinical staff.