Lack of Transmission among Close Contacts of Patient with Case of Middle East Respiratory Syndrome Imported into the United States, 2014

Lucy Breakwell,Nora Chea,Lixia Liu,Eileen Schneider,Daniel R Feikin,Marlene Madrigal,Kimberly Pringle,Pam Pantones,Craig Conover,Steve Allen,Minal Kapoor,Susan I Gerber,David L Swerdlow,Sandra Smole,Lia M Haynes,Michelle Sandoval,Alfred Demaria,Shawn Richards,Donna Allen,Rashmi Chugh,Nicole J Cohen ,Alan Kumar ,Rachel J Burns ,Michael O Vernon ,David T Kuhar

doi:10.3201/eid2107.150054

Abstract

In May 2014, a traveler from the Kingdom of Saudi Arabia was the first person identified with Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the United States. To evaluate transmission risk, we determined the type, duration, and frequency of patient contact among health care personnel (HCP), household, and community contacts by using standard questionnaires and, for HCP, global positioning system (GPS) tracer tag logs. Respiratory and serum samples from all contacts were tested for MERS-CoV. Of 61 identified contacts, 56 were interviewed. HCP exposures occurred most frequently in the emergency department (69%) and among nurses (47%); some HCP had contact with respiratory secretions. Household and community contacts had brief contact (e.g., hugging). All laboratory test results were negative for MERS-CoV. This contact investigation found no secondary cases, despite case-patient contact by 61 persons, and provides useful information about MERS-CoV transmission risk. Compared with GPS tracer tag recordings, self-reported contact may not be as accurate.

Highlights

IntroductionIn May 2014, a traveler from the Kingdom of Saudi Arabia was the first person identified with Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the United States
Lucy Breakwell,1 Kimberly Pringle,1 Nora Chea,1 Donna Allen, Steve Allen, Shawn Richards, Pam Pantones, Michelle Sandoval, Lixia Liu, Michael Vernon, Craig Conover, Rashmi Chugh, Alfred DeMaria, Rachel Burns, Sandra Smole, Susan I
We reviewed hospital global positioning system (GPS) records to determine the exposure time and number of patient visits for attending registered nurses (RNs) and certified nursing assistants (CNAs)

Summary

Introduction

In May 2014, a traveler from the Kingdom of Saudi Arabia was the first person identified with Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the United States. Middle East respiratory syndrome coronavirus (MERS-CoV) is a lineage C betacoronavirus that was first reported in September 2012 in a patient from the Kingdom of Saudi Arabia [1]. Contact investigations around imported cases in the United Kingdom, France, and Tunisia identified cases among household and healthcare contacts, suggesting person-to-person transmission [7,8,9]. The case-patient, a physician and resident of Saudi Arabia, traveled by airplane to Chicago, Illinois, USA, via London, United Kingdom, by bus to Indiana, USA He stayed with his family in Indiana for 4 days, during which time he twice met with a business

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