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. 2017 Aug 15;65(4):675-679.
doi: 10.1093/cid/cix352.

Identified Transmission Dynamics of Middle East Respiratory Syndrome Coronavirus Infection During an Outbreak: Implications of an Overcrowded Emergency Department

Thamer H Alenazi  1   2 , Hussain Al Arbash  3 , Aiman El-Saed  1   2 , Majid M Alshamrani  1   2 , Henry Baffoe-Bonnie  1 , Yaseen M Arabi  2   4 , Sameera M Al Johani  2   5 , Ra'ed Hijazi  6 , Adel Alothman  2   7 , Hanan H Balkhy  1   2
Affiliations

Identified Transmission Dynamics of Middle East Respiratory Syndrome Coronavirus Infection During an Outbreak: Implications of an Overcrowded Emergency Department

Thamer H Alenazi et al. Clin Infect Dis. .

Abstract

A total 130 cases of Middle East respiratory syndrome coronavirus were identified during a large hospital outbreak in Saudi Arabia; 87 patients and 43 healthcare workers. The majority (80%) of transmission was healthcare-acquired (HAI) infection, with 4 generations of HAI transmission. The emergency department was the main location of exposure.

Keywords: Middle East respiratory syndrome; Saudi Arabia; coronavirus; outbreak; transmission.

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Figures

Figure 1.
Figure 1.
Types of transmission of Middle East respiratory syndrome infection during the outbreak. Primary (N = 26) is a community transmission, while secondary (N = 44), tertiary (N = 25), quaternary (N = 13), and quinary (N = 3) are healthcare-associated infection (HAI) transmissions. The number of cases (circles) represents the chronological sequence of onset of symptoms, not the hospital presentation. Red lines indicate identified transmission from lower to higher generation. Tertiary, quaternary, and quinary HAI transmissions were assigned only when the source patients and their generations were identified. In some secondary HAI cases, lack of connection to primary cases indicates that a source patient could not be confirmed. Unknown (violet) HAI cases indicate that the source and the generation of HAI transmission could not be identified and were mainly healthcare workers. Abbreviations: HAI, healthcare-associated infection; MERS-CoV, Middle East respiratory syndrome coronavirus.
Figure 2.
Figure 2.
Track of movements of hospitalized cases inside the King Abdulaziz Medical City-Riyadh during the outbreak. The stars and circles show the symptoms and death status, respectively. The number of cases represents the chronological sequence of onset of symptoms. Home isolation cases were not included in the figure.
See this image and copyright information in PMC

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