miércoles, 17 de junio de 2015

Lack of Transmission among Close Contacts of Patient with Case of Middle East Respiratory Syndrome Imported into the United States, 2014 - Volume 21, Number 7—July 2015 - Emerging Infectious Disease journal - CDC

full-text ►

Lack of Transmission among Close Contacts of Patient with Case of Middle East Respiratory Syndrome Imported into the United States, 2014 - Volume 21, Number 7—July 2015 - Emerging Infectious Disease journal - CDC





Volume 21, Number 7—July 2015

Research

Lack of Transmission among Close Contacts of Patient with Case of Middle East Respiratory Syndrome Imported into the United States, 2014

Lucy Breakwell1, Kimberly Pringle1, Nora Chea1, Donna Allen, Steve Allen, Shawn Richards, Pam Pantones, Michelle Sandoval, Lixia Liu, Michael Vernon, Craig Conover, Rashmi Chugh, Alfred DeMaria, Rachel Burns, Sandra Smole, Susan I. Gerber, Nicole J Cohen, David Kuhar, Lia M. Haynes, Eileen Schneider, Alan Kumar, Minal Kapoor, Marlene Madrigal, David L. Swerdlow, and Daniel R. FeikinComments to Author 
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (L. Breakwell, K. Pringle, N. Chea, M. Sandoval, S.I. Gerber, N.J. Cohen, D. Kuhar, L.M. Haynes, E. Schneider, D.L. Swerdlow, D.R. Feikin);Indiana State Health Department, Indianapolis, Indiana, USA (D. Allen, S. Allen, S. Richards, P. Pantones, M. Sandoval, L. Liu)Cook County Department of Public Health, Oak Forest, Illinois, USA (M. Vernon)Illinois Department of Public Health, Chicago, Illinois, USA (C. Conover)DuPage County Health Department, Wheaton, Illinois, USA (R. Chugh)Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA (A. DeMaria, R. Burns, S. Smole)Community Hospital, Munster, Indiana, USA (A. Kumar, M. Kapoor, M. Madrigal)

Abstract

In May 2014, a traveler from the Kingdom of Saudi Arabia was the first person identified with Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the United States. To evaluate transmission risk, we determined the type, duration, and frequency of patient contact among health care personnel (HCP), household, and community contacts by using standard questionnaires and, for HCP, global positioning system (GPS) tracer tag logs. Respiratory and serum samples from all contacts were tested for MERS-CoV. Of 61 identified contacts, 56 were interviewed. HCP exposures occurred most frequently in the emergency department (69%) and among nurses (47%); some HCP had contact with respiratory secretions. Household and community contacts had brief contact (e.g., hugging). All laboratory test results were negative for MERS-CoV. This contact investigation found no secondary cases, despite case-patient contact by 61 persons, and provides useful information about MERS-CoV transmission risk. Compared with GPS tracer tag recordings, self-reported contact may not be as accurate.
Middle East respiratory syndrome coronavirus (MERS-CoV) is a lineage C betacoronavirus that was first reported in September 2012 in a patient from the Kingdom of Saudi Arabia (1). By September 8, 2014, a total of 837 laboratory-confirmed cases and 292 associated deaths had been reported by the World Health Organization. All reported case-patients have resided in or had recent travel to the Arabian Peninsula and neighboring countries (2).
Clusters of MERS-CoV infection have occurred within extended families, households, and healthcare settings (36). Contact investigations around imported cases in the United Kingdom, France, and Tunisia identified cases among household and healthcare contacts, suggesting person-to-person transmission (79). However, these investigations found limited onward transmission: a maximum of 3 second-generation cases were found among investigations with total contacts ranging from 7–163 persons (79). Other contact investigations of imported cases outside of the Middle East have found no secondary transmission (1013).
On April 29, 2014, the Indiana State Department of Health (ISDH) informed the Centers for Disease Control and Prevention (CDC) of a patient under investigation for MERS-CoV infection. A clinical specimen from the patient was confirmed positive by CDC on May 2, 2014 (5); this infection was identified as the first imported MERS case in the United States. The case-patient, a physician and resident of Saudi Arabia, traveled by airplane to Chicago, Illinois, USA, via London, United Kingdom, then by bus to Indiana, USA. He stayed with his family in Indiana for 4 days, during which time he twice met with a business associate in Illinois before seeking medical care at an Indiana hospital; multiple healthcare personnel (HCP) at the hospital were exposed to the patient (14). Given the uncertainty around how MERS-CoV is transmitted, we conducted a comprehensive contact investigation of this case to characterize exposures in household, community, and hospital settings and to quantify the risk of transmission. We also compared contact reported by HCP during standardized interviews with those in global positioning system (GPS) tracer tag recordings.

Dr. Breakwell is an Epidemic Intelligence Service (EIS) Officer with the Meningitis and Vaccine Preventable Diseases Branch at CDC whose primary research interests focus on pertussis vaccine effectiveness and meningococcal disease outbreaks. Dr. Pringle is an EIS Officer with the Viral Gastroenteritis Branch at CDC whose primary research interests are vaccine efficacy and impact of the rotavirus vaccine internationally and surveillance of norovirus domestically. Dr. Chea is an EIS Officer of Prevention and Response Branch of the Division of Healthcare Quality Promotion, CDC, whose primary research interests include health care–associated infections and infection prevention and control.

Acknowledgment

We thank Community Hospital Munster, Indiana; Indiana State Department of Health; Illinois Department of Public Health; Massachusetts Department of Public Health; Cook County Department of Public Health, Illinois; and Dupage County Health Department, Illinois, for their participation in this investigation. We also acknowledge the work of Hayat Caidi, Congrong Miao, Jennifer Harcourt, Azaibi Tamin, Seyhan Boyoglu-Barnum, and Suvang Trivedi on serologic testing.

References

  1. Zaki AMvan Boheemen SBestebroer TMOsterhaus ADFouchier RAIsolation of a novel coronavirus from a man with pneumonia in Saudi Arabia.N Engl J Med2012;367:181420DOIPubMed
  2. Bialek SRAllen DAlvarado-Ramy FArthur RBalajee ABell DFirst confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the United States, updated information on the epidemiology of MERS-CoV infection, and guidance for the public, clinicians, and public health authorities—May 2014. MMWR Morb Mortal Wkly Rep2014;63:4316 .PubMed
  3. Omrani ASMatin MAHaddad QAl-Nakhli DMemish ZAAlbarrak AMA family cluster of Middle East respiratory syndrome coronavirus infections related to a likely unrecognized asymptomatic or mild case. Int J Infect Dis2013;17:e66872DOIPubMed
  4. Memish ZAZumla AIAl-Hakeem RFAl-Rabeeah AAStephens GMFamily cluster of Middle East respiratory syndrome coronavirus infections. N Engl J Med2013;368:248794DOIPubMed
  5. Al-Abdallat MMPayne DCAlqasrawi SRha BTohme RAAbedi GRHospital-associated outbreak of Middle East respiratory syndrome coronavirus: a serologic, epidemiologic, and clinical description. Clin Infect Dis2014;59:122533DOIPubMed
  6. Assiri AMcGeer APerl TMPrice CSAl Rabeeah AACummings DAHospital outbreak of Middle East respiratory syndrome coronavirus. N Engl J Med2013;369:40716DOIPubMed
  7. Health Protection Agency UK Novel Coronavirus Investigation teamEvidence of person-to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013. Euro Surveill2013;18:20427 .PubMed
  8. Gulland ATwo cases of novel coronavirus are confirmed in France. BMJ2013;346:f3114 . DOIPubMed
  9. Abroug FSlim AOuanes-Besbes LKacem MHDachraoui FOuanes IFamily cluster of Middle East respiratory syndrome coronavirus infections, Tunisia, 2013. Emerg Infect Dis2014;20:152730DOIPubMed
  10. Pebody RGChand MAThomas HLGreen HKBoddington NLCarvalho CThe United Kingdom public health response to an imported laboratory confirmed case of a novel coronavirus in September 2012. Euro Surveill2012;17:20292 .PubMed
  11. Buchholz UMuller MANitsche ASanewski AWevering NBauer-Balci TContact investigation of a case of human novel coronavirus infection treated in a German hospital, October–November 2012. Euro Surveill2013;18:20406 .PubMed
  12. Reuss ALitterst ADrosten CSeilmaier MBohmer MGraf PContact investigation for imported case of Middle East respiratory syndrome, Germany. Emerg Infect Dis2014;20:6205DOIPubMed
  13. Premila Devi JNoraini WNorhayati RChee Kheong CBadrul AZainah SLaboratory-confirmed case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Malaysia: preparedness and response, April 2014. Euro Surveill2014;19:20797 .PubMed
  14. Kapoor MPringle KKumar ADearth SLiu LLovchik JClinical and laboratory findings of the first imported case of Middle East respiratory syndrome coronavirus (MERS-CoV) into the United States. Clin Infect Dis2014;59:15118DOIPubMed
  15. Lu XWhitaker BSakthivel SKKamili SRose LELowe LReal-time reverse transcription-PCR assay panel for Middle East respiratory syndrome coronavirus. J Clin Microbiol2014;52:6775DOIPubMed
  16. Kraaij-Dirkzwager MTimen ADirksen KGelinck LLeyten EGroeneveld PMiddle East respiratory syndrome coronavirus (MERS-CoV) infections in two returning travellers in the Netherlands, May 2014. Euro Surveill2014;19:20817 .PubMed
  17. Xu RHHe JFEvans MRPeng GWField HEYu DWEpidemiologic clues to SARS origin in China. Emerg Infect Dis2004;10:10307.DOIPubMed
  18. Zhao ZZhang FXu MHuang KZhong WCai WDescription and clinical treatment of an early outbreak of severe acute respiratory syndrome (SARS) in Guangzhou, PR China. J Med Microbiol2003;52:71520DOIPubMed
  19. Wang MYan MXu HLiang WKan BZheng BSARS-CoV infection in a restaurant from palm civet. Emerg Infect Dis2005;11:18605.DOIPubMed
  20. Song HDTu CCZhang GWWang SYZheng KLei LCCross-host evolution of severe acute respiratory syndrome coronavirus in palm civet and human. Proc Natl Acad Sci U S A2005;102:24305DOIPubMed
  21. Briese TMishra NJain KZalmout ISJabado OJKaresh WBMiddle East respiratory syndrome coronavirus quasispecies that include homologues of human isolates revealed through whole-genome analysis and virus cultured from dromedary camels in Saudi Arabia. MBio2014;5:e0114614.DOIPubMed
  22. Nowotny NKolodziejek JMiddle East respiratory syndrome coronavirus (MERS-CoV) in dromedary camels, Oman, 2013. Euro Surveill.2014;19:20781 .PubMed
  23. Breban RRiou JFontanet AInterhuman transmissibility of Middle East respiratory syndrome coronavirus: estimation of pandemic risk. Lancet.2013;382:6949DOIPubMed
  24. Scales DCGreen KChan AKPoutanen SMFoster DNowak KIllness in intensive care staff after brief exposure to severe acute respiratory syndrome. Emerg Infect Dis2003;9:120510DOIPubMed
  25. Wong THDearlove BLHedge JGiess APPiazza PTrebes AWhole genome sequencing and de novo assembly identifies Sydney-like variant noroviruses and recombinants during the winter 2012/2013 outbreak in England. Virol J2013;10:335DOIPubMed
  26. Yu ITLi YWong TWTam WChan ATLee JHEvidence of airborne transmission of the severe acute respiratory syndrome virus. N Engl J Med.2004;350:17319DOIPubMed
  27. Lee NHui DWu AChan PCameron PJoynt GMA major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med.2003;348:198694 . DOIPubMed

Figures

Table

Suggested citation for this article: Breakwell L, Pringle K, Chea N, Allen D, Allen S, Richards S, et al. Lack of transmission among close contacts of patient with imported case of Middle East respiratory syndrome into the United States, 2014. Emerg Infect Dis. 2015 Jul [date cited].http://dx.doi.org/10.3201/eid2107.150054
DOI: 10.3201/eid2107.150054
1These authors contributed equally to this article.

No hay comentarios:

Publicar un comentario