title: Middle East respiratory syndrome coronavirus: implications for health care facilities.
abstract: BACKGROUND
  Middle East respiratory syndrome coronavirus (MERS-CoV) is a novel coronavirus that causes a severe respiratory disease with high case fatality rate. Starting in March 2014, a dramatic increase of cases has occurred in the Arabian Peninsula, many of which were acquired in health care settings. As of May 9, 2014, 536 laboratory-confirmed cases and 145 deaths have been reported globally.
  
  
  METHODS
  Review of publicly available data about MERS-CoV health care-associated transmission.
  
  
  RESULTS
  We identified 11 events of possible or confirmed health care-associated transmission with high morbidity and mortality, mainly among patients with comorbidities. Health care workers are also frequently affected; however, they tend to have milder symptoms and better prognosis. Gaps in infection control were noted in all events. Currently, health care-associated outbreaks are playing a pivotal role in the evolution of the MERS-CoV epidemic in countries in the Arabian Peninsula.
  
  
  CONCLUSIONS
  There is a need to increase infection control capacity in affected areas and areas at increased risk of being affected to prevent transmission in health care settings. Vaccines and antiviral agents are urgently needed. Overall, our knowledge about the epidemiologic characteristics of MERS-CoV that impact health care transmission is very limited. As the MERS-CoV epidemic continues to evolve, issues concerning best infection control measures will arise, and studies to better define their effectiveness in real life are needed.
authors.affiliation: Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece. Electronic address: helen-maltezou@ath.forthnet.gr.
authors.forename: Helena C
authors.initials: HC
authors.lastname: Maltezou
authors.affiliation: Fourth Department of Internal Medicine, University of Athens Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Tsiodras
mesh_terms: D018352:Coronavirus Infections / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D003428:Cross Infection / Q000453:epidemiology* / Q000821:virology; D004196:Disease Outbreaks; D006268:Health Facilities / Q000592:standards*; D006761:Hospitals / Q000592:standards; D006801:Humans; D017053:Infection Control / Q000379:methods*; D065207:Middle East Respiratory Syndrome Coronavirus / Q000502:physiology*; D012529:Saudi Arabia / Q000453:epidemiology; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology / Q000635:transmission; D014479:United Arab Emirates / Q000453:epidemiology
keywords: Health care associated; Health care workers; Hospital; Middle East respiratory syndrome; Middle East respiratory syndrome coronavirus; Outbreak