title: Middle East respiratory syndrome coronavirus (MERS-CoV): A cluster analysis with implications for global management of suspected cases.
abstract: Since the initial description of the Middle East respiratory syndrome (MERS) in September 2012, a total of 1038 cases of MERS-CoV including 460 deaths have been reported from Saudi Arabia. From August 24, 2013 to September 3, 2013, a total of 397 patients and contacts were tested for MERS-CoV. Of those tested, there were 18 (4.5%) MERS-CoV cases reported in Al-Madinah al-Munawwarah with one large cluster. In this report, we describe the outcome, epidemiology and clinical characteristics of this cluster of which 4 cases involved healthcare workers. Fourteen cases appeared to be linked to one cluster involving healthcare workers (HCWs), family and patient contacts. Of the 18 cases, five (including 2 HCWs) were community acquired, two were household contacts, and 11 were healthcare associated (including 4 HCWs). All except 4 cases were symptomatic and the case fatality rate was 39% (7 of 18). The outbreak resulted in human to human transmission of an estimated 6 cases. Contact screening showed positive test in 1 of 56 (1.8%) household contacts, and 3 of 250 (1.2%) HCWs.
authors.affiliation: Ministry of Health, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. Electronic address: zmemish@yahoo.com.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Memish
authors.affiliation: Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA. Electronic address: jaltawfi@yahoo.com.
authors.forename: Jaffar A
authors.initials: JA
authors.lastname: Al-Tawfiq
authors.affiliation: Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Rafat F
authors.initials: RF
authors.lastname: Alhakeem
authors.affiliation: Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Assiri
authors.affiliation: Regional Health Directorate, Ministry of Health, Madinah, Saudi Arabia.
authors.forename: Khalid D
authors.initials: KD
authors.lastname: Alharby
authors.affiliation: Regional Health Directorate, Ministry of Health, Madinah, Saudi Arabia.
authors.forename: Maher S
authors.initials: MS
authors.lastname: Almahallawi
authors.affiliation: Regional Health Directorate, Ministry of Health, Madinah, Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alkhallawi
mesh_terms: D016000:Cluster Analysis; D016358:Contact Tracing; D018352:Coronavirus Infections / Q000453:epidemiology* / Q000635:transmission*; D003428:Cross Infection / Q000453:epidemiology / Q000635:transmission; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D065207:Middle East Respiratory Syndrome Coronavirus; D012529:Saudi Arabia / Q000453:epidemiology
keywords: Clusters; Coronavirus; MERS-CoV; Middle East; RT-PCR