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MERS virus proves easily transmissible in care settings


The Middle East respiratory syndrome coronavirus poses a serious risk to hospitals because it is easily transmitted in healthcare settings, according to an investigative team.

Researchers with Johns Hopkins, the University of Colorado and the University of Toronto investigated MERS CoV in four local Saudi hospitals in May, and concluded it is even more deadly than the related coronavirus responsible for the severe acute respiratory syndrome outbreak in Toronto hospitals in 2003. The same team investigated that event as well.

Initially, 23 people in Saudi Arabia were infected with MERS at the time of the investigation, with 15 deaths. Saudi health officials most recently put the death toll at 32, with another 49 infected. There have been scattered cases reported in other Middle Eastern countries and Europe, and none in the United States.

The researchers, whose report was published June 19 on the website of the New England Journal of Medicine, said MERS is not only easily transmitted from patient to patient, but also from the transfer of sick patients to other hospitals.

Trish Perl, MD, MSc, senior hospital epidemiologist for Johns Hopkins Medicine and a professor at the Johns Hopkins University School of Medicine, said swift action by local health officials to quickly monitor the situation and spread of the disease, supported by rapid detection, isolation and treatment of those infected, has helped largely stem the outbreak.

Hospital staff also tightened infection control procedures, introducing more vigorous cleaning procedures with stronger disinfectants and treating infected patients in private rooms, while wearing masks, gowns and gloves and masking any other non-infected patients who were nearby.

Saudi health officials invited Perl and fellow infectious disease specialists Connie Price, MD, from the University of Colorado in Denver, and Allison McGeer, MD, from the University of Toronto, to assist the country with its investigation.

Among the team’s major findings was that MERS, although infecting fewer people than did the SARS outbreak, had a death rate many times higher: 65% versus 8%. Researchers have cautioned the MERS death rate may come down if more cases are identified, including among those with mild symptoms.

The time from viral exposure to the first signs of symptoms of coughing, shortness of breath, fever, or vomiting was 5.2 days. The virus took an average of 7.6 days to spread from one person to the next.

Among the 23 infected initially, five were family members and two were healthcare workers — including a nurse who had worked with other nurses who cared for infected patients, and an ICU physician who had cared for and been directly exposed to MERS patients.

Nine infected patients had received dialysis treatment at the same hospital, some at the same time. Another dialysis patient had been transferred between units at different hospitals, where others became infected. Eight other infected patients were transferred for care between facilities, which the research team believes led to additional exposures.

Perl said intense monitoring helps with early detection of those infected, which can then lead to immediate isolation and treatment. No cure exists for MERS, but infected people can be supported on mechanical ventilation, if needed, or offered fluids to lower fever.

Perl said early detection makes a difference: Three of four died among those who were diagnosed while already ill and in the hospital, while only three of 19 died among those who were diagnosed early after admission to a hospital.

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