Corona Center, Infectious Diseases Division, Department of Pediatric, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia; University of British Columbia, Vancouver, BC, Canada.
Indiana University School of Medicine, Indianapolis, IN; Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
Am J Infect Control. 2018 Feb;46(2):165-168. doi: 10.1016/j.ajic.2017.08.010. Epub 2017 Sep 25.
Many outbreaks of Middle East respiratory syndrome coronavirus (MERS-CoV) have occurred in health care settings and involved health care workers (HCWs). We describe the occurrence of an outbreak among HCWs and attempt to characterize at-risk exposures to improve future infection control interventions.
This study included an index case and all HCW contacts. All contacts were screened for MERS-CoV using polymerase chain reaction.
During the study period in 2015, the index case was a 30-year-old Filipino nurse who had a history of unprotected exposure to a MERS-CoV-positive case on May 15, 2015, and had multiple negative tests for MERS-CoV. Weeks later, she was diagnosed with pulmonary tuberculosis and MERS-CoV infection. A total of 73 staff were quarantined for 14 days, and nasopharyngeal swabs were taken on days 2, 5, and 12 postexposure. Of those contacts, 3 (4%) were confirmed positive for MERS-CoV. An additional 18 staff were quarantined and had MERS-CoV swabs. A fourth case was confirmed positive on day 12. Subsequent contact investigations revealed a fourth-generation transmission. Only 7 (4.5%) of the total 153 contacts were positive for MERS-CoV.
The role of HCWs in MERS-CoV transmission is complex. Although most MERS-CoV-infected HCWs are asymptomatic or have mild disease, fatal infections can occur and HCWs can play a major role in propagating health care facility outbreaks. This investigation highlights the need to continuously review infection control guidance relating to the role of HCWs in MERS-CoV transmission in health care outbreaks, especially as it relates to the complex questions on definition of risky exposures, who to test, and the frequency of MERS-CoV testing; criteria for who to quarantine and for how long; and clearance and return to active duty criteria.
中东呼吸综合征冠状病毒（MERS-CoV）已在多个医疗机构暴发，涉及医护人员（HCWs）。我们描述了一起发生在 HCWs 中的暴发事件，并尝试对高危接触进行特征描述，以改进未来的感染控制干预措施。
本研究包括一名索引病例和所有 HCW 接触者。所有接触者均采用聚合酶链反应（PCR）进行 MERS-CoV 筛查。
在 2015 年的研究期间，索引病例是一名 30 岁的菲律宾护士，她曾于 2015 年 5 月 15 日有过一次对 MERS-CoV 阳性病例的无保护接触史，且多次检测 MERS-CoV 均为阴性。数周后，她被诊断为肺结核和 MERS-CoV 感染。共有 73 名员工被隔离 14 天，在接触后第 2、5 和 12 天采集鼻咽拭子。其中 3 名（4%）接触者被确诊为 MERS-CoV 阳性。另有 18 名员工被隔离并进行了 MERS-CoV 拭子检测。第 12 天确诊第 4 例阳性病例。随后的接触者调查显示发生了四代传播。在总共 153 名接触者中，只有 7 名（4.5%）检测出 MERS-CoV 阳性。
医护人员在 MERS-CoV 传播中的作用很复杂。虽然大多数感染 MERS-CoV 的 HCWs 无症状或仅有轻症，但也可能发生致命感染，且 HCWs 可能在传播医疗机构暴发中发挥重要作用。本研究强调需要不断审查与 HCWs 在医疗机构暴发中的 MERS-CoV 传播作用相关的感染控制指南，特别是在涉及高危接触的定义、检测对象、MERS-CoV 检测频率、隔离对象和隔离时长、解除隔离和重返工作岗位的标准等复杂问题上。
