Since 2012, the Middle East respiratory syndrome coronavirus
(MERS-CoV) has infected almost 300 people, many of them healthcare workers
including nurses and doctors. Infections of health care workers and patients that
take place within or are associated with a hospital or health care facility are
referred to as nosocomial infections. A large number of MERS cases can be
classified as nosocomial infections. For the purposes of this discussion, localized
geographic clusters of MERS-CoV cases that appear to represent
hospital-acquired infections are referred to as nosocomial MERS clusters. Under
this definition, there has been at least 10 separate nosocomial clusters of MERS
cases.
Of these clusters, only two have been reported in the
literature [1,2]. The remaining nosocomial clusters are identified based on
media reports, ministry of health reports, and World Health Organization
reports. The quality of this data is uncertain but trends are clear and
speculations can be advanced.
The table below identifies these nosocomial clusters by
location, month of outbreak for the cluster, the putative number of MERS cases
within the cluster, and the number of infected health care workers reportedly associated
with the cluster. The case counts include both confirmed and suspected/probable
cases. The map below depicts the general locations of these clusters throughout
the Arabian Peninsula.
Map
Discussion
Health care workers represent about 44% of the nosocomial cluster
cases. In addition to the health care workers included in the clusters, another
21 health care workers are reported as sporadic or isolated MERS cases. The
source of infection for these other health care workers is not identified, but
it is likely that there have been additional nosocomial clusters that are not
reported.
Based on these data, it is clear that infection of
healthcare workers with the MERS coronavirus is not a rare or random event.
More than 2 years after initial hospital cluster in Jordan, health care workers
continue to become infected while treating patients. We can assume that health care
workers in the Arabian Peninsula region, are now familiar with, and aware of,
the dangers of MERS. The fact that MERS is still infecting health care workers and
possibly other patients within a hospital setting strongly suggests that MERS is
highly infectious among individuals who have close contact with each other. The fact that about 25% of all reported MERS infections are
doctors, nurses, and other health care workers is indicative of the infectious
nature of this novel coronavirus.
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