title: Middle East respiratory syndrome coronavirus in healthcare settings.
abstract: OBJECTIVE
  Attracting global attention, Middle East respiratory syndrome coronavirus (MERS-CoV) continues to cause sporadic cases and a potential risk of healthcare-associated infections. In this review, we highlight what is known about the risk of transmission within healthcare facilities and discuss interventions to halt its transmission within healthcare.
  
  
  RESULTS
  MERS-CoV causes a wide range of infections from asymptomatic infections, mild or moderately symptomatic cases, to fatal disease. Two years after the initial reported case, MERS-CoV has caused limited disease outside the Arabian Peninsula with several cases in Europe, Asia, and the United States. Epidemiologically, these infections are linked to exposures from the region and their diagnosis outside is related to travel. Several reported clusters of disease report multiple transmissions of MERS-CoV within healthcare settings that have been attributed to poor compliance with the basic infection control measures. Factors contributing to the spread and control of MERS-CoV within healthcare settings have not been elucidated so far. Data suggest the overcrowding, late recognition of MERS-CoV cases, and inadequate infection control practices contribute significantly to the transmission.
  
  
  CONCLUSIONS
  Understanding factors contributing to the spread and the dynamic of MERS-CoV transmission within healthcare settings would further enhance the control of the disease in and outside the healthcare setting.
authors.affiliation: aJohns Hopkins Aramco Healthcare, Dhahran, Kingdom of Saudi Arabia bIndiana University School of Medicine, Indianapolis, Indiana cDivision of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Jaffar A
authors.initials: JA
authors.lastname: Al-Tawfiq
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
mesh_terms: D001083:Arabia; D018352:Coronavirus Infections / Q000517:prevention & control* / Q000635:transmission*; D003428:Cross Infection / Q000517:prevention & control* / Q000635:transmission*; D014943:Global Health; D006268:Health Facilities; D006801:Humans; D017053:Infection Control / Q000379:methods*; D014195:Travel