MERS Spreads in Saudi Hospitals

MERS hospital outbreak in Saudi Arabia investigated for person to person spread

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) There has been concern in the news lately about viruses spreading at large public gatherings. But these viruses might just as easily spread right in the hospital.

A new study examined an outbreak of the Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabian hospitals. Results showed that the virus seemed to spread from person-to-person and caused a high rate of deaths. 

"Cough into a tissue to help prevent the spread of germs."

For this study, Abdullah Assiri, MD, of the King Fahad Medical City in Riyadh, Saudi Arabia, and team looked at four hospitals in Al-Ahsa, an eastern province of Saudi Arabia. 

According to the authors, between April 1 and May 23, 2013, there were 23 confirmed cases of MERS in the province, and 11 additional probable cases, all of which were tied to a single outbreak involving the four hospitals studied.

The average age for the 23 confirmed patients in this study was 56 years old, and 74 percent of the patients were male. Most of the patients had underlying health conditions, and 74 percent had diabetes. 

The MERS symptoms seen were largely respiratory, with some gastrointestinal issues. A cough was seen in 87 percent of the patients, fever in 87 percent and vomiting or diarrhea in 35 percent. The study authors estimated an average of four days between when the patients were exposed to MERS and when they became ill. 

In the 18 patients who needed to be transferred to an intensive care unit (ICU), the average time between the development of symptoms and admission to the ICU was five days. The average time between symptom development and death was 11 days. Fifteen of the 23 confirmed patients (65 percent) died. 

The researchers also completed a surveillance of 217 family members of the MERS patients and 124 healthcare workers at the hospitals studied. Infection was found in five of the family members and two of the healthcare workers.

The researchers observed that the virus seemed to have passed from person to person in the studied cases. "One patient transmitted the infection to seven persons, one patient transmitted the infection to three persons, and four patients transmitted the infection to two persons each," Dr. Assiri and team wrote. 

However, the authors stressed that much about MERS remains unknown, including how exactly transmission occurs. The study authors reported that they were not able to determine if the virus was spread among patients through direct or indirect contact, or through respiratory droplets in the air (like from sneezing or coughing).

Dr. Assiri and team also stressed the importance of continuing investigations into the source of MERS in the larger community.

"The repeated introduction of the infection into the community, the ongoing detection of new illness, and the substantial impact of hospital transmission in this outbreak underscore the importance of investigations into the community source of MERS-CoV. Without the ability to prevent community infection, prevention of health care transmission will remain a challenge," the study authors wrote.

As of August 1, the World Health Organization (WHO) reported a total of 94 cases of MERS around the globe since September 2012. Of these cases, 46 have resulted in deaths. 

This study was published in The New England Journal of Medicine on August 1. No conflicts of interest were reported. 

Review Date: 
August 1, 2013
Last Updated:
August 4, 2013