Abstract
OBJECTIVESThe rates of asymptomatic infection with Middle East Respiratory Syndrome (MERS) coronavirus vary. A serologic study was conducted to determine the asymptomatic MERS infection rate in healthcare workers and non-healthcare workers by exposure status.METHODSStudy participants were selected from contacts of MERS patients based on a priority system in 4 regions strongly affected by the 2015 MERS outbreak. A sero-epidemiological survey was performed in 1,610 contacts (average duration from exposure to test, 4.8 months), and the collected sera were tested using an enzyme-linked immunespecific assay (ELISA), immunofluorescence assay (IFA), and plaque reduction neutralization antibody test (PRNT). Among the 1,610 contacts, there were 7 ELISA-positive cases, of which 1 exhibited positive IFA and PRNT results.RESULTSThe asymptomatic infection rate was 0.060% (95% confidence interval, 0.002 to 0.346). The asymptomatic MERS case was a patient who had been hospitalized with patient zero on the same floor of the hospital at the same time. The case was quarantined at home for 2 weeks after discharge, and had underlying diseases, including hypertension, angina, and degenerative arthritis.CONCLUSIONSThe asymptomatic infection was acquired via healthcare-associated transmission. Thus, it is necessary to extend serologic studies to include inpatient contacts who have no symptoms.
Highlights
Middle East Respiratory Syndrome (MERS) is a severe respiratory infection caused by a novel beta coronavirus (MERS-CoV) [1-3]
According to data reported to the World Health Organization, the rates of asymptomatic or mild infection were 44 of 398 (28.60%) in Saudi Arabia, the United Arab Emirates, and the Islamic Republic of Iran between April and June 2014, and 32 of 113 (28.31%) in Saudi Arabia in June 2014 [12,13]
We categorized the subjects according to their exposure intensity, as follows: inpatients or outpatients at a MERS-affected hospital, cohabiting family members or paid caregivers of the MERS case, visitors of the hospitalized MERS case, healthcare workers employed at a MERS-affected hospital, and colleague of the MERS case
Summary
Middle East Respiratory Syndrome (MERS) is a severe respiratory infection caused by a novel beta coronavirus (MERS-CoV) [1-3]. The symptoms of MERS include fever, chills, cough, shortness of breath, gastrointestinal symptoms, expectoration, wheezing, chest pain, hemoptysis, sore throat, headache, myalgia, abdominal pain, vomiting, and diarrhea; it can cause death in severe cases [3-6]. The causative pathogen of MERS is transmitted via 4 modes: animal-to-human, intra-familial, healthcare-associated, and travel-related [7,8]. The 186 cases that occurred in South Korea (hereafter Korea) were predominantly caused by healthcare-associated It is necessary to identify the rate of asymptomatic MERS infections in healthcare workers and non-healthcare workers
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