J Korean Med Assoc.  2015 Jul;58(7):647-654. 10.5124/jkma.2015.58.7.647.

Healthcare workers infected with Middle East respiratory syndrome coronavirus and infection control

• Kim SG

• KMID: 2064921
• DOI: http://doi.org/10.5124/jkma.2015.58.7.647

Abstract

The outbreak of Middle East respiratory syndrome coronavirus(MERS-CoV) infection in South Korea has become a public health threat. There are many confirmed cases of MERS in healthcare workers. Understanding the nature of the infection and the mechanismof transmission will be a useful lesson. This paper gathers data from the press records in KCDC from May 20thto June 26th 2015to identify the age, sex, occupation and etiologic exposure of exposed healthcare workersin order to come up with a response plan. By June 26th, 2015, there were 181 confirmed cases of MERS-CoV infection in Korea. 36 (19.9%) of them were healthcare workers. These healthcare workers were exposed to MERS-CoV across 12 healthcare facilities, including Samsung Medical Center and Dae-Chung Hospital;threewere infected inside ambulances. Their occupational categories are as follows: 7 doctors (19.4%), 12 nurses (33.3%), 9 caregivers orgeriatric care assistants(25.0%), and 8 others (22.2%). These healthcare workers were infected by 12 super-spreaders. 30 of the workers(83.3%) were infected without being aware of their contact withMERS patients, while 6 (16.7%) were aware of this contact at the time of infection. The high number of confirmed cases of MERS-CoV inhealthcare workers is direct proof of the failure of crisis communication in South Korea, and the delay in the diagnosis of the index case was due to the lack of risk communication regardingthe threatof a MERS outbreak. Because the spread of MERS usually occursvia healthcare-associated transmission, infection control inhealthcare facilities must be strengthened.

Keyword

Health care associated; Health care workers; Middle East respiratory syndrome coronavirus; Disease outbreaks; Infection control

MeSH Terms

Ambulances
Caregivers
Coronavirus*
Delivery of Health Care*
Diagnosis
Disease Outbreaks
Disease Transmission, Infectious
Humans
Infection Control*
Korea
Middle East*
Occupations
Public Health

Reference

1. World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV): update [Internet]. Geneva: World Health Organization;2014. cited 2015 Jun 28. Available from: http://www.who.int/csr/don/2014_04_11_mers/en/.

2. Korea Centers for Disease Control and Prevention. Guideline for management of MERS. 3rd ed. Cheongju: Korea Centers for Disease Control and Prevention;2015.

3. Korea Centers for Disease Control and Prevention. Middle East respiratory syndrome information [Internet]. Cheongju: Korea Centers for Disease Control and Prevention;2015. cited 2015 Jun 12. Available from: http://www.mers.go.kr/mers/html/jsp/main.jsp.

4. Choi JW, Kim KH, Cho YM, Kim SH. Current epidemiological situation of Middle East respiratory syndrome coronavirus clusters and implications for public health response in South Korea. J Korean Med Assoc. 2015; 58:487–497.

5. Shin JH. The doctor cured of MERS said, "If pain from flu is 7, pain from MERS is around 3~4"[Internet]. Seoul: KBS;2015. cited 2015 Jun 12. Available from: http://news.kbs.co.kr/news/NewsView.do?SEARCH_NEWS_CODE=3091312&ref=A.

6. Bialek SR, Allen D, Alvarado-Ramy F, Arthur R, Balajee A, Bell D, Best S, Blackmore C, Breakwell L, Cannons A, Brown C, Cetron M, Chea N, Chommanard C, Cohen N, Conover C, Crespo A, Creviston J, Curns AT, Dahl R, Dearth S, DeMaria A, Echols F, Erdman DD, Feikin D, Frias M, Gerber SI, Gulati R, Hale C, Haynes LM, Heberlein-Larson L, Holton K, Ijaz K, Kapoor M, Kohl K, Kuhar DT, Kumar AM, Kundich M, Lippold S, Liu L, Lovchik JC, Madoff L, Martell S, Matthews S, Moore J, Murray LR, Onofrey S, Pallansch MA, Pesik N, Pham H, Pillai S, Pontones P, Pringle K, Pritchard S, Rasmussen S, Richards S, Sandoval M, Schneider E, Schuchat A, Sheedy K, Sherin K, Swerdlow DL, Tappero JW, Vernon MO, Watkins S, Watson J. Centers for Disease Control and Prevention (CDC).First confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the United States, updated information on the epidemiology of MERS-CoV infection, and guidance for the public, clinicians, and public health authorities: May 2014. MMWR Morb Mortal Wkly Rep. 2014; 63:431–436.

7. Assiri A, McGeer A, Perl TM, Price CS, Al Rabeeah AA, Cummings DA, Alabdullatif ZN, Assad M, Almulhim A, Makhdoom H, Madani H, Alhakeem R, Al-Tawfiq JA, Cotten M, Watson SJ, Kellam P, Zumla AI, Memish ZA. KSA MERS-CoV Investigation Team. Hospital outbreak of Middle East respiratory syndrome coronavirus. N Engl J Med. 2013; 369:407–416.

8. Al-Abdallat MM, Payne DC, Alqasrawi S, Rha B, Tohme RA, Abedi GR, Al Nsour M, Iblan I, Jarour N, Farag NH, Haddadin A, Al-Sanouri T, Tamin A, Harcourt JL, Kuhar DT, Swerdlow DL, Erdman DD, Pallansch MA, Haynes LM, Gerber SI. Jordan MERS-CoV Investigation Team. Hospital-associated outbreak of Middle East respiratory syndrome coronavirus: a serologic, epidemiologic, and clinical description. Clin Infect Dis. 2014; 59:1225–1233.

9. Oboho IK, Tomczyk SM, Al-Asmari AM, Banjar AA, Al-Mugti H, Aloraini MS, Alkhaldi KZ, Almohammadi EL, Alraddadi BM, Gerber SI, Swerdlow DL, Watson JT, Madani TA. 2014 MERS-CoV outbreak in Jeddah: a link to health care facilities. N Engl J Med. 2015; 372:846–854.

10. Drosten C, Muth D, Corman VM, Hussain R, Al Masri M, HajOmar W, Landt O, Assiri A, Eckerle I, Al Shangiti A, Al-Tawfiq JA, Albarrak A, Zumla A, Rambaut A, Memish ZA. An observational, laboratory-based study of outbreaks of middle East respiratory syndrome coronavirus in Jeddah and Riyadh, kingdom of Saudi Arabia, 2014. Clin Infect Dis. 2015; 60:369–377.

11. Maltezou HC, Tsiodras S. Middle East respiratory syndrome coronavirus: implications for health care facilities. Am J Infect Control. 2014; 42:1261–1265.

12. Centers for Disease Control and Prevention. Update: severe respiratory illness associated with Middle East respiratory syndrome coronavirus (MERS-CoV)-worldwide, 2012-2013 [Internet]. Atlanta: Centers for Disease Control and Prevention;cited 2015 Jul 6. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6223a6.htm?s_cid=mm6223a6_w.

13. Centers for Disease Control and Prevention. Middle East respiratory syndrome (MERS): interim guidance for health professionals [Internet]. Atlanta: Centers for Disease Control and Prevention;2015. cited 2015 Jul 6. Available from: http://www.cdc.gov/coronavirus/mers/interim-guidance.html.

14. Memish ZA, Zumla AI, Assiri A. Middle East respiratory syndrome coronavirus infections in health care workers. N Engl J Med. 2013; 369:884–886.