Hospital outbreak of Middle East respiratory syndrome coronavirus. Assiri, A., McGeer, A., Perl, T. M., Price, C. S., Al Rabeeah, A. A., Cummings, D. A. T., Alabdullatif, Z. N., Assad, M., Almulhim, A., Makhdoom, H., Madani, H., Alhakeem, R., Al-Tawfiq, J. A., Cotten, M., Watson, S. J., Kellam, P., Zumla, A. I., & Memish, Z. A. The New England journal of medicine, 369(5):407–416, August, 2013.
doi  abstract   bibtex   
BACKGROUND: In September 2012, the World Health Organization reported the first cases of pneumonia caused by the novel Middle East respiratory syndrome coronavirus (MERS-CoV). We describe a cluster of health care-acquired MERS-CoV infections. METHODS: Medical records were reviewed for clinical and demographic information and determination of potential contacts and exposures. Case patients and contacts were interviewed. The incubation period and serial interval (the time between the successive onset of symptoms in a chain of transmission) were estimated. Viral RNA was sequenced. RESULTS: Between April 1 and May 23, 2013, a total of 23 cases of MERS-CoV infection were reported in the eastern province of Saudi Arabia. Symptoms included fever in 20 patients (87%), cough in 20 (87%), shortness of breath in 11 (48%), and gastrointestinal symptoms in 8 (35%); 20 patients (87%) presented with abnormal chest radiographs. As of June 12, a total of 15 patients (65%) had died, 6 (26%) had recovered, and 2 (9%) remained hospitalized. The median incubation period was 5.2 days (95% confidence interval [CI], 1.9 to 14.7), and the serial interval was 7.6 days (95% CI, 2.5 to 23.1). A total of 21 of the 23 cases were acquired by person-to-person transmission in hemodialysis units, intensive care units, or in-patient units in three different health care facilities. Sequencing data from four isolates revealed a single monophyletic clade. Among 217 household contacts and more than 200 health care worker contacts whom we identified, MERS-CoV infection developed in 5 family members (3 with laboratory-confirmed cases) and in 2 health care workers (both with laboratory-confirmed cases). CONCLUSIONS: Person-to-person transmission of
@article{assiri_hospital_2013,
	title = {Hospital outbreak of {Middle} {East} respiratory syndrome coronavirus.},
	volume = {369},
	issn = {1533-4406 0028-4793},
	doi = {10.1056/NEJMoa1306742},
	abstract = {BACKGROUND: In September 2012, the World Health Organization reported the first cases of pneumonia caused by the novel Middle East respiratory syndrome coronavirus (MERS-CoV). We describe a cluster of health care-acquired MERS-CoV infections. METHODS: Medical records were reviewed for clinical and demographic information and determination of potential contacts and exposures. Case patients  and contacts were interviewed. The incubation period and serial interval (the time between the successive onset of symptoms in a chain of transmission) were estimated. Viral RNA was sequenced. RESULTS: Between April 1 and May 23, 2013, a  total of 23 cases of MERS-CoV infection were reported in the eastern province of  Saudi Arabia. Symptoms included fever in 20 patients (87\%), cough in 20 (87\%), shortness of breath in 11 (48\%), and gastrointestinal symptoms in 8 (35\%); 20 patients (87\%) presented with abnormal chest radiographs. As of June 12, a total  of 15 patients (65\%) had died, 6 (26\%) had recovered, and 2 (9\%) remained hospitalized. The median incubation period was 5.2 days (95\% confidence interval  [CI], 1.9 to 14.7), and the serial interval was 7.6 days (95\% CI, 2.5 to 23.1). A total of 21 of the 23 cases were acquired by person-to-person transmission in hemodialysis units, intensive care units, or in-patient units in three different  health care facilities. Sequencing data from four isolates revealed a single monophyletic clade. Among 217 household contacts and more than 200 health care worker contacts whom we identified, MERS-CoV infection developed in 5 family members (3 with laboratory-confirmed cases) and in 2 health care workers (both with laboratory-confirmed cases). CONCLUSIONS: Person-to-person transmission of},
	language = {eng},
	number = {5},
	journal = {The New England journal of medicine},
	author = {Assiri, Abdullah and McGeer, Allison and Perl, Trish M. and Price, Connie S. and Al Rabeeah, Abdullah A. and Cummings, Derek A. T. and Alabdullatif, Zaki N. and Assad, Maher and Almulhim, Abdulmohsen and Makhdoom, Hatem and Madani, Hossam and Alhakeem, Rafat and Al-Tawfiq, Jaffar A. and Cotten, Matthew and Watson, Simon J. and Kellam, Paul and Zumla, Alimuddin I. and Memish, Ziad A.},
	month = aug,
	year = {2013},
	pmid = {23782161},
	pmcid = {PMC4029105},
	keywords = {*Disease Outbreaks, Adult, Aged, Aged, 80 and over, Base Sequence, Coronavirus Infections/epidemiology/*transmission/virology, Coronavirus/*genetics/isolation \& purification, Cross Infection/epidemiology/*transmission/virology, DNA, Viral/analysis, Disease Transmission, Infectious, Female, Humans, Infectious Disease Incubation Period, Infectious Disease Transmission, Patient-to-Professional, Intensive Care Units, Male, Middle Aged, Phylogeny, Pneumonia, Viral/*epidemiology/transmission/virology, Renal Dialysis, Saudi Arabia/epidemiology},
	pages = {407--416},
}
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