Acute Respiratory Infections in Travelers Returning from MERS-CoV–Affected Areas - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

FULL-TEXT ►

Acute Respiratory Infections in Travelers Returning from MERS-CoV–Affected Areas - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 9—September 2015

Dispatch

Acute Respiratory Infections in Travelers Returning from MERS-CoV–Affected Areas

On This Page

• The Study
• Conclusions
• Suggested Citation

Figures

• Figure

Tables

• Table

Downloads

• PDF [575 KB - 3 pgs]
• RIS [TXT - 2 KB]

Matthew German1 , Romy Olsha, Erik Kristjanson, Alex Marchand-Austin, Adriana Peci, Anne-Luise Winter, and Jonathan B. Gubbay

Author affiliations: Public Health Ontario, Toronto, Ontario, Canada

Suggested citation for this article

Abstract

We examined which respiratory pathogens were identified during screening for Middle East respiratory syndrome coronavirus in 177 symptomatic travelers returning to Ontario, Canada, from regions affected by the virus. Influenza A and B viruses (23.1%) and rhinovirus (19.8%) were the most common pathogens identified among these travelers.

Middle East respiratory syndrome coronavirus (MERS-CoV) was originally described in 2012 in a patient with severe pneumonia in Saudi Arabia (1). The virus has been detected in several countries of the Middle East, causing acute respiratory disease and having a case-fatality rate of ≈35% (2). Although the exact epidemiology and mode of transmission remains ill-defined, MERS-CoV appears to be transmitted through respiratory droplets and most likely has zoonotic reservoirs in dromedary camels and possible origin in bats (1). Recent evidence suggests human infection results from repeated introduction of the virus from camels to humans, and less severe human-to-human transmission probably requires close contact with infected persons (2,3).

As of June 16, 2015, the World Health Organization (WHO) reported 1,293 laboratory-confirmed cases of MERS-CoV, of which 458 (35.4%) were fatal, with ongoing transmission in Saudi Arabia, an outbreak in South Korea and an imported case in Thailand (2). Reported cases are centralized in and around the Arabian Peninsula (Saudi Arabia, United Arab Emirates [UAE], Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, and Yemen); Saudi Arabia and UAE account for ≈95.8% of cases (2). Internationally, imported cases have been reported outside this zone (United Kingdom, France, Germany, Tunisia, Italy, Malaysia, Philippines, Greece, Egypt, United States, the Netherlands, Algeria, Austria, and Turkey) (2). Within Saudi Arabia and UAE, cases are predominantly localized to Jeddah, Riyadh, and Abu Dhabi, each of which operates a high-traffic airport that serves 17–26 million international travelers each year (4,5). To detect imported MERS-CoV cases, public health authorities in Ontario, Canada, advise testing of persons who have acute respiratory infection (ARI; i.e., symptoms and signs consistent with acute upper or lower respiratory tract infections) of any severity and recent travel to MERS-CoV–affected areas or of persons with ARI and recent close contact with ill travelers from affected areas (6).

Peak travel periods to Saudi Arabia (e.g., Ramadan, Umrah, or the Hajj) are of particular concern, although after the 2012 and 2013 Hajj, no MERS-CoV cases were identified in persons returning to France (7). High incidences of other respiratory diseases in pilgrims varied by year. In this study, we aimed to explore the array of respiratory pathogens in travelers with ARI returning to Ontario from MERS-CoV–affected areas or in their close symptomatic contacts.

Mr. German is an infectious disease epidemiologist at St. Michael’s Hospital in Toronto, Ontario. His research interests include global migration and emerging and re-emerging infectious disease.

Acknowledgments

We are thankful to Public Health Ontario and PHOL technical staff for support and help with data collection.

This work was funded by Public Health Ontario.

References

1. Sharif-Yakan A, Kanj SS. Emergence of MERS-CoV in the Middle East: origins, transmission, treatment, and perspectives. PLoS Pathog.2014;10:e1004457. DOIPubMed
2. World Health Organization. Global Alert and Response (GAR). Middle East respiratory syndrome coronavirus [cited 2015 Mar 10].http://www.who.int/csr/disease/coronavirus_infections/en/
3. World Health Organization. Update on MERS-CoV transmission from animals to humans, and interim recommendations for at-risk groups [cited 2014 Dec 23]. http://www.who.int/csr/disease/coronavirus_infections/MERS_CoV_RA_20140613.pdf?ua=1
4. The Kingdom of Saudi Arabia General Authority of Civil Aviation. Statistical yearbook, 2013 [cited 2014 Jul 15].http://www.gaca.gov.sa/GACA/Attachments/020/A835/1/The_report_of_2013_En.pdf
5. Abu Dhabi Airports. Traffic data—2013 [cited 2014 Jul 16]. http://www.adac.ae/english/doing-business-with-us/airline-development/traffic-data/traffic-data-2013
6. Provincial Infectious Diseases Advisory Committee. Tools for preparedness: triage, screening and patient management for Middle East respiratory syndrome coronavirus (MERS-CoV) infections in acute care settings; 4th ed [cited 2015 May 1].http://www.publichealthontario.ca/en/eRepository/PIDAC-IPC_Preparedness_Tools_MERS_CoV_2013.pdf
7. Benkouiten S, Charrel R, Belhouchat K, Drali T, Nougairede A, Salez N, Respiratory viruses and bacteria among pilgrims during the 2013 Hajj. Emerg Infect Dis. 2014;20:1821–7 and. DOIPubMed
8. Corman VM, Eckerle I, Bleicker T, Zaki A, Landt O, Eschbach-Bludau M, Detection of a novel human coronavirus by real-time reverse-transcription polymerase chain reaction. Euro Surveill. 2012;17:20285 .PubMed
9. Duncan C, Guthrie JL, Tijet N, Elgngihy N, Turenne C, Seah C, Analytical and clinical validation of novel real-time reverse transcriptase–polymerase chain reaction assays for the clinical detection of swine-origin H1N1 influenza viruses. Diagn Microbiol Infect Dis. 2011;69:167. DOIPubMed
10. Yang G, Benson R, Pelish T, Brown E, Winchell JM, Fields B. Dual detection of Legionella pneumophila and Legionella species by real-time PCR targeting the 23S–5S rRNA gene spacer region. Clin Microbiol Infect. 2010;16:255. DOIPubMed
11. Khan K, Sears J, Hu VW, Brownstein JS, Hay S, Kossowsky D, Potential for the international spread of Middle East respiratory syndrome in association with mass gatherings in Saudi Arabia. PLoS Curr. 2013;5:pii: ecurrents.outbreaks.a7b70897ac2fa4f79b59f90d24c860b8.
12. Statistics Canada. Table 427-0006. Number of non resident travellers entering Canada, by selected country of residence, excluding the United States, seasonally adjusted monthly (persons) [cited 2015 Mar 12]. http://www5.statcan.gc.ca/cansim/a26?lang=eng&id=4270006&p2=17
13. Drosten C, Meyer B, Marcel MA, Corman VM, Al-Masri M, Hossain R, Transmission of MERS-coronavirus in household contacts. N Engl J Med.2014;371:828–35. DOIPubMed
14. Lessler J, Reich NG, Brookmeyer R, Perl TM, Nelson KE, Cummings DA. Incubation periods of acute respiratory viral infections: a systematic review.Lancet Infect Dis. 2009;9:291–300. DOIPubMed

Figure

• Figure. PUIs and counts of major respiratory pathogens identified in travelers returning to Ontario, Canada, from countries affected with Middle East respiratory virus coronavirus, December 2012–June 2014. PUI, persons under investigation....

Table

• Table. Respiratory pathogens detected among 177 persons tested for MERS Co-V at Public Health Ontario Laboratories, Ontario, Canada, November 2012–June 2014

Suggested citation for this article: German M, Olsha R, Kristjanson E, Marchand-Austin A, Peci A, Winter AL, et al. Acute respiratory infections in travelers returning from MERS-CoV–affected areas. Emerg Infect Dis. 2015 Sep [date cited]. http://dx.doi.org/10.3201/eid2109.150472

DOI: 10.3201/eid2109.150472

1Current affiliation: St. Michael’s Hospital, Toronto, Ontario, Canada.