Ahead of Print -Contact Investigation for Imported Case of Middle East Respiratory Syndrome, Germany - Volume 20, Number 4—April 2014 - Emerging Infectious Disease journal - CDC
Volume 20, Number 4—April 2014
Contact Investigation for Imported Case of Middle East Respiratory Syndrome, Germany
Annicka Reuss , Annette Litterst, Christian Drosten, Michael Seilmaier, Merle Böhmer1, Petra Graf, Hermann Gold, Clemens-Martin Wendtner, Arina Zanuzdana, Lars Schaade, Walter Haas, and Udo Buchholz
Author affiliations: Robert Koch Institute, Berlin, Germany (A. Reuss, M, Böhmer, A. Zanuzdana, L. Schaade, W. Haas, U. Buchholz); Department of Health and Environment, Munich, Germany (A. Litterst, P. Graf, H. Gold); University of Bonn Medical Centre Institute of Virology, Bonn, Germany (C. Drosten); Hospital Schwabing, Munich, Germany (M. Seilmaier, C.-M. Wendtner);Bavarian Health and Food Safety Authority, Oberschleißheim, Germany (M. Böhmer)
Middle East respiratory syndrome coronavirus (MERS-CoV) infection was initially reported to the World Health Organization (WHO) in September 2012 (1,2). By November 11, 2013, a total of 153 laboratory-confirmed cases of human infection with MERS-CoV had been identified; 64 (42%) of those with confirmed cases had died (3). Most (63%) case-patients had severe respiratory disease; 76% also had >1 underlying chronic condition (4). The median age of case-patients was 50 years (range 14 months to 94 years). All cases were directly or indirectly related to countries in the Middle East or on the Arabian Peninsula.
MERS-CoV shows a close genetic relationship with coronaviruses found in bats (1,5–10), but no zoonotic link has been confirmed. Person-to-person transmission has been reported in the work environment, among family contacts, or to health care workers (HCWs) (11–13). Although situations involving consecutive human transmission events have been documented (13), none of the known clusters have led to sustained person-to-person transmission in the general population. In Europe, single imported infections have been reported in the United Kingdom, Germany, France, and Italy, and secondary cases have been reported in the United Kingdom, France, and Italy (12,14,15). Because a large proportion of cases are fatal and the virus could acquire the ability to spread more efficiently (as was the case with severe acute respiratory syndrome coronavirus), WHO has recommended thorough contact investigations for confirmed human cases to identify, quantify, and prevent person-to-person transmission (16).
In Germany, MERS-CoV infection was initially reported in a person from Qatar (17). He was in his third week of illness and was already on mechanical ventilation when he was admitted to a hospital in Essen in October 2012. A retrospective contact investigation found no indication of person-to-person transmission to contacts in Germany (17).