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Outbreak investigation of Middle East Respiratory Syndrome (MERS-CoV) Cases, in a private hospital, Eastern province February-2015


On 16 February 2015, field epidemiology training program (FETP) was requested to investigate a cluster of confirmed Middle East Respiratory Syndrome Corona Virus (MERS CoV) cases in a private hospital in Alkhobar city of the Eastern province. The mission aimed to explore the circumstances that lead to this outbreak and to verify the assumption of health workers related transmission. Also to establish hypotheses about the possible risk factors responsible for this outbreak and to help in controlling it.


Investigation of cases based on reviewing patients' charts in the hospitals and interviewing the treating doctors. Available data of the cases in the public health department and Corona center were also reviewed and compared with that of the hospitals. Meetings with health directors and concerned officials were held and all hospitals where MERS CoV cases registered were visited.


Out of the total 21 cases were identified in eastern province, 15 laboratory confirmed MERS CoV cases (71.4%) in Saad hospital during February 2015; 6 healthcare workers and 9 patients. General case fatality rate in this outbreak is 7/21 (33.3%) while hospital-specific case fatality rate was 7/15 (46.7%) and all dead cases had severe chronic underlying diseases.


There was evidence of person-to-person transmission in the hospital following contact with the primary case in the hospital. Infected healthcare workers were most probably responsible for transmitting infection to the patients and to their colleagues. All primary cases in this outbreak had no relationship with each other, no history of contact with positive MERS CoV cases or animals and no visit to health facility. However, preliminary epidemiological investigation suggested that there may be indirect contact through their children who study in the same school.