Basem Alraddadi

2014 MERS-CoV Outbreak in Jeddah — A Link to Health Care Facilities

BACKGROUND A marked increase in the number of cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection occurred in Jeddah, Saudi Arabia, in early 2014. We evaluated patients with MERS-CoV infection in Jeddah to explore reasons for this increase and to assess the epidemiologic and clinical features of this disease. METHODS We identified all cases of laboratory-confirmed MERS-CoV infection in Jeddah that were reported to the Saudi Arabian Ministry of Health from January 1 through May 16, 2014. We conducted telephone interviews with symptomatic patients who were not health care personnel, and we reviewed hospital records. We identified patients who were reported as being asymptomatic and interviewed them regarding a history of symptoms in the month before testing. Descriptive analyses were performed. RESULTS Of 255 patients with laboratory-confirmed MERS-CoV infection, 93 died (case fatality rate, 36.5%). The median age of all patients was 45 years (interquartile range, 30 to 59), and 174 patients (68.2%) were male. A total of 64 patients (25.1%) were reported to be asymptomatic. Of the 191 symptomatic patients, 40 (20.9%) were health care personnel. Among the 151 symptomatic patients who were not health care personnel, 112 (74.2%) had data that could be assessed, and 109 (97.3%) of these patients had had contact with a health care facility, a person with a confirmed case of MERS-CoV infection, or someone with severe respiratory illness in the 14 days before the onset of illness. The remaining 3 patients (2.7%) reported no such contacts. Of the 64 patients who had been reported as asymptomatic, 33 (52%) were interviewed, and 26 of these 33 (79%) reported at least one symptom that was consistent with a viral respiratory illness. CONCLUSIONS The majority of patients in the Jeddah MERS-CoV outbreak had contact with a health care facility, other patients, or both. This highlights the role of health care-associated transmission. (Supported by the Ministry of Health, Saudi Arabia, and by the U.S. Centers for Disease Control and Prevention.).

Risk Factors for Primary Middle East Respiratory Syndrome Coronavirus Illness in Humans, Saudi Arabia, 2014.

Direct exposure to camels, diabetes mellitus, heart disease, and smoking were independently associated with this illness.

Association of Higher MERS-CoV Virus Load with Severe Disease and Death, Saudi Arabia, 2014.

More data are needed to determine whether modulation of virus load by therapeutic agents affects clinical outcomes.

Acute Management and Long-Term Survival Among Subjects With Severe Middle East Respiratory Syndrome Coronavirus Pneumonia and ARDS

BACKGROUND: Data on the management, clinical course, and outcome of critical patients with Middle East Respiratory Syndrome coronavirus are scarce. We report here our experience and long-term outcome of such patients. METHODS: Subjects intubated for management of ARDS from Middle East Respiratory Syndrome coronavirus pneumonia and ARDS during the April-May 2014 outbreak were included. Their characteristics, ICU course, management, and outcome were evaluated. RESULTS: Fourteen subjects, including 3 health-care workers, met study criteria. Besides 2 health-care workers, all subjects had comorbidities. Predominant symptoms were fever, cough, and dyspnea. The worst median PaO2/FIO2 ratio of 118 post-intubation was seen on the third day, and median APACHE II score was 27. All subjects received lung-protective ventilation and 1 mg/kg/d methylprednisolone infusion for ARDS. Eleven subjects received ribavirin and peginterferon α-2a. Subjects had a critical ICU course and required neuromuscular blockade (n = 11; 79%), required rescue therapy for respiratory failure (n = 8; 57%), developed shock (n = 10; 71%), and required renal replacement therapy (n = 8; 57%). Declining C-reactive protein levels correlated with clinical improvement despite continued positive real-time polymerase chain reaction results. Nine subjects died in ICU. Five subjects, including 3 health-care workers, were discharged from hospital and were alive after 1 y. CONCLUSIONS: Middle East Respiratory Syndrome coronavirus pneumonia with ARDS has high mortality in subjects with comorbidities. The mainstay of treatment is meticulous ARDS management. Those who survived the acute infection and its complications remained well after 1 y in our study. The role of ribavirin and interferon warrants urgent further evaluation.

Antibody Response and Disease Severity in Healthcare Worker MERS Survivors

We studied antibody response in 9 healthcare workers in Jeddah, Saudi Arabia, who survived Middle East respiratory syndrome, by using serial ELISA and indirect immunofluorescence assay testing. Among patients who had experienced severe pneumonia, antibody was detected for >18 months after infection. Antibody longevity was more variable in patients who had experienced milder disease.

Outbreak of Middle East Respiratory Syndrome at Tertiary Care Hospital, Jeddah, Saudi Arabia, 2014.

Infection probably was transmitted in the emergency department, inpatient areas, and dialysis unit.

Risk Factors for Middle East Respiratory Syndrome Coronavirus Infection among Healthcare Personnel

Infections occurred exclusively among personnel who had close contact with MERS-CoV patients.

Middle East Respiratory Syndrome Coronavirus Transmission in Extended Family, Saudi Arabia, 2014.

Casual contact was not associated with transmission, and serologic methods were more sensitive than real-time reverse transcription-PCR.

766Clinical Features and Outcome of Patients with Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) Infection

Background. The number of laboratory confirmed cases of Middle East Respiratory Syndrome-Corona Virus is increasing and has been associated with high mortality rate. Our aim is to describe clinical features and outcome of patients infected with MERS CoV in a tertiary hospital outbreak in Jeddah, Saudi Arabia. Methods. We reviewed the medical records of 30 patients with confirmed MERS CoV infections during hospital outbreak between April 7 until April 30, 2014. We followed WHO definitions for confirmed MERS CoV infection. Results. A total of 30 patients were diagnosed with confirmed MERS CoV infection. 16 patients were health care workers. The mean age was 43 years (SD 16.5). Seventeen patients were male (54.8%). Majority of patients N = 20 (66.7%) were symptomatic on presentation. Fever was the most presenting symptoms N = 20 (66.7%) followed by cough N = 18 (60%). Although only 10 patients (35.7%) reported shortness of breath on presentation, 27 patients (93.1%) had abnormal chest xary. In terms of laboratory findings, 13 patients (54.2%) had lymphopenia on presentation. Significant number of patients developed progressive respiratory disease; 9 patients (30%) required mechanical ventilation and 12 patients (38.7%) required ICU admission. Conclusion. Fever and abnormal chest x ray were the most common clinical features in patients with MERS CoV infection. Significant number of MERS CoV patient’s required mechanical ventilation and ICU admission. Disclosures. All authors: No reported disclosures.