Introduction
Hafr al-Batin city is located in the eastern north of Saudi Arabia near Kuwait borders. Population: around 387,000, Area 144 km2, Climate: cold in winter, hot and dry in summer. The index case was 67 years old, male, Saudi. He was diabetic, hypertensive with chronic lymphocytic leukemia and ischemic cardiomyopathy. Pt. firstly has got fever and cough on the 20th of Jan where he visited Bright medical complex seeking medical advice, pt. advised to stay for more investigation but he refused and leave. Later he got more worse. The case was admitted to Dr. Noor Mohammed Khan Private Hospital between Jan 25th 2018 and Jan 29th 2018 as a case of bilateral pneumonia, pt. didn't not improved, later got worse. On Jan 29th 2018 pt. transferred to King Khalid General Hospital on ventilator, all healthcare workers who were involved in the care of the index patient at King Khalid Hospital had protected exposure to the case. Pt. directly tested for MERS-CoV and resulted POSITIVE on 1stFeb 2018. Public Health Department in Hafer city directly went to Dr. Noor Khan Private Hospital for urgent investigation, 24 HCWs have had high-risk unprotected exposure, tested and 3 of them resulted positive for MERS-CoVat 3rd of Feb. Those three HCWs were home-isolated and none of them had become symptomatic so far. Later the pt. died on 6th Feb.
Methodology
Study design:-Case series study. Study population:- All HCWs in the three hospitals . 1-Bright medical complex ,a small health private clinics center in Hafer AL-Batin city. 2-Dr.Noor Khan hospital , 50 beds capacity private hospital. 3-King Khalid Hospital, 300 beds capacity. Case definition:- -Any person who had close contact with the index case during January 2018 up to the time of confirmation of that case on 1st of Feb 2018 in the three hospitals he visited and his home.
Results
Confirmed cases overall 4 cases.- -Index case has no history of camels contact or camels milk ingestion for the last 14 days before symptoms started (20th January). -No history of visiting Makkah in the last two weeks. -History of travel for one day at 18/1/2018 to Kuwait to attend wedding party. No MERS CoV cases had been reported in Kuwait around that time- -Home contacts was 23 contacts ,two of them has cough only ,home isolation rules done ,others are a symptomatic ,all of them tested for MERS CoV none of them positive. observation period 14 days finished without any problem. .-At Bright medical complex 3 HCWs had un protected exposure to the case ,all tested and observed none of them positive .-At Dr.Noor khan hospital 24 HCWs have had high-risk unprotected exposure, tested and 3 of them resulted positive for MERS-CoV. At 3rd of Feb. -Those three HCWs were home-isolated and none of them had become symptomatic so far. Secondary cases: All the HCWs contacts of those secondary cases were traced and tested; and later all the results were negative for MERS-CoV. 36 patients were identified as contacts for those secondary cases and none of them was positive.
Conclusion
Proper isolation for all confirmed cases.- -active tracing for all contacts from patients , healthcare workers and community contacts. Identification of high and low risk contacts.- -Daily monitoring for all contacts during incubation period (14 days). . laboratory testing for high risk contacts - -Searching for additional suspected cases between patients and healthcare workers based on case definition of the disease. -Strict adherence to proper environmental cleaning/ disinfection and terminal cleaning /disinfection for hospital environment with special care to the departments included in outbreak. -Extensive training of all healthcare workers on case definition for early detection , implementation of isolation precautions , proper selection ,donning doffing of PPE, hand hygiene and environmental cleaning and disinfection. Ensure that all healthcare workers tested for N95 fitting (fit tested). - Ensure availability of supplies (hand sanitizer, PPE Particularly N95, surface disinfectants, portable HEPA filters, fumigation machines, ...). - Enforce Visual Triage for respiratory diseases in emergency department and outpatient departments especially in the private health centers, alert trained nurse cover 24/7 for early detection of patient with respiratory symptoms and proper documentation in triage form