On February 22 2016, an outbreak of Middle East Respiratory Syndrome-Corona Virus (MERS-CoV) began in Qassim Saudi Arabia at King Fahd Hospital, Buraidh Central Hospital, Alrass Hospital and Alhabib Hospital.Objective: Conduct a contact investigation to identify risk factors for MERS-CoV transmission and potential control measures.
Methodology
We defined a case as a person visiting or working at one of the above mentioned facilities from 22 Feb to 29 March, 2016 who developed fever and respiratory symptoms and was MERS-CoV positive by PCR. Cases were either primary or secondary depending on exposure to a known case prior to symptom onset. Contact was defined as spending prolonged period of time indoors in the presence of a case. We conducted medical chart abstractions and patient interviews to determine timeline, exposures and potential contacts. We inspected the adequacy of infection control practices.
Results
A total of 37 cases were PCR positive for MERS-CoV. Age range 22- 91 years (mean 53, SD 22); 24 (65%) cases were males; 16 (43%) were primary cases and 21 (57%) were secondary. Among the secondary cases were 7 healthcare workers (HCW). One secondary case was a dialysis patient, who presented with epigastric pain, nausea, vomiting, fever and uncontrolled hypertension. Despite the ongoing outbreak, MERS-CoV infection was not suspected until 7 days after admission. This period without respiratory precautions lead to a large number of laboratory positive contacts. In addition, we noted HCWs in the emergency department intubated MERS patients and other aerosol generating procedures without use of personal protective equipment and in open work areas.
Conclusion
Complicating medical conditions can lead to delay in diagnosis of MERS even in patients present with typical symptoms. MERS-CoV should always be considered in febrile patients presenting with respiratory symptoms in Saudi Arabia. Improvements in infection control practices were also recommended.