Hospital-associated outbreak of Middle East respiratory syndrome coronavirus: a serologic, epidemiologic, and clinical description.
BACKGROUND
In April 2012, the Jordan Ministry of Health investigated an outbreak of lower respiratory illnesses at a hospital in Jordan; 2 fatal cases were retrospectively confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) to be the first detected cases of Middle East respiratory syndrome (MERS-CoV).


METHODS
Epidemiologic and clinical characteristics of selected potential cases were assessed through serum blood specimens, medical record reviews, and interviews with surviving outbreak members, household contacts, and healthcare personnel. Cases of MERS-CoV infection were identified using 3 US Centers for Disease Control and Prevention serologic tests for detection of anti-MERS-CoV antibodies.


RESULTS
Specimens and interviews were obtained from 124 subjects. Seven previously unconfirmed individuals tested positive for anti-MERS-CoV antibodies by at least 2 of 3 serologic tests, in addition to 2 fatal cases identified by rRT-PCR. The case-fatality rate among the 9 total cases was 22%. Six subjects were healthcare workers at the outbreak hospital, yielding an attack rate of 10% among potentially exposed outbreak hospital personnel. There was no evidence of MERS-CoV transmission at 2 transfer hospitals having acceptable infection control practices.


CONCLUSIONS
Novel serologic tests allowed for the detection of otherwise unrecognized cases of MERS-CoV infection among contacts in a Jordanian hospital-associated respiratory illness outbreak in April 2012, resulting in a total of 9 test-positive cases. Serologic results suggest that further spread of this outbreak to transfer hospitals did not occur. Most subjects had no major, underlying medical conditions; none were on hemodialysis. Our observed case-fatality rate was lower than has been reported from outbreaks elsewhere.
Communicable Diseases Directorate, Jordan Ministry of Health, Amman.
Mohammad Mousa
MM
Al-Abdallat
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.
Daniel C
DC
Payne
Communicable Diseases Directorate, Jordan Ministry of Health, Amman.
Sultan
S
Alqasrawi
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases Epidemic Intelligence Service.
Brian
B
Rha
Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
Rania A
RA
Tohme
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.
Glen R
GR
Abedi
Eastern Mediterranean Public Health Network.
Mohannad
M
Al Nsour
Field Epidemiology Training Program, Jordan Ministry of Health, Amman.
Ibrahim
I
Iblan
Communicable Diseases Directorate, Jordan Ministry of Health, Amman.
Najwa
N
Jarour
Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Noha H
NH
Farag
Directorate of Laboratories, Jordan Ministry of Health, Amman.
Aktham
A
Haddadin
Directorate of Laboratories, Jordan Ministry of Health, Amman.
Tarek
T
Al-Sanouri
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.
Azaibi
A
Tamin
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.
Jennifer L
JL
Harcourt
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
David T
DT
Kuhar
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.
David L
DL
Swerdlow
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.
Dean D
DD
Erdman
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.
Mark A
MA
Pallansch
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.
Lia M
LM
Haynes
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.
Susan I
SI
Gerber
D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D018352:Coronavirus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006282:Health Personnel; D006801:Humans; D007597:Jordan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D065207:Middle East Respiratory Syndrome Coronavirus / Q000276:immunology*; D016036:Seroepidemiologic Studies
D000914:Antibodies, Viral
Jordan; MERS-CoV; Middle East respiratory syndrome; novel coronavirus; seroepidemiology