Transmission of Middle East Respiratory Syndrome Coronavirus Infections in Healthcare Settings, Abu Dhabi
Jennifer C. Hunter
, Duc T. Nguyen, Bashir Aden, Zyad Al Bandar, Wafa Al Dhaheri, Kheir Abu Elkheir, Ahmed Khudair, Mariam Al Mulla, Feda El Saleh, Hala Imambaccus, Nawal Al Kaabi, Farrukh Amin Sheikh, Jurgen Sasse, Andrew Turner, Laila Abdel Wareth, Stefan Weber, Asma Al Ameri, Wesal Abu Amer, Negar N. Alami, Sudhir Bunga, Lia M. Haynes, Aron J. Hall, Alexander J. Kallen, David T. Kuhar, Huong T. Pham, Kimberly Pringle, Suxiang Tong, Brett L. Whitaker, Susan I. Gerber, and Farida Ismail Al Hosani
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (J.C. Hunter, D. Nguyen, N.N. Alami, S. Bunga, L.M. Haynes, A.J. Hall, A.J. Kallen, D. Kuhar, H. Pham, K. Pringle, S. Tong, B.L. Whitaker, S.I. Gerber); Health Authority—Abu Dhabi, Abu Dhabi, United Arab Emirates (B. Aden, Z. Al Bandar, W. Al Dhaheri, K. Abu Elkheir, A. Khudair, M. Al Mulla, F. El Saleh, F.I. Al Hosany); Abu Dhabi Health Services Company, Abu Dhabi (H. Imambaccus, N. Al Kaabi, F. Amin Sheikh, J. Sasse, A. Turner, L. Abdel Wareth, S. Weber); Molecular Diagnostic Laboratory of Sheikh Khalifa Medical City, Abu Dhabi (A. Al Ameri, W. Abu Amer)
Figure 1. Transmission of Middle East respiratory syndrome coronavirus (MERS-CoV) infections in 3 healthcare setting clusters, Abu Dhabi, January 2013–May 2014. A) Cluster I; B) cluster II; C) cluster III. Individual patients are identified by cluster and a letter indicating the order in which cases occurred (e.g., I-A indicates the source case-patient for cluster I). Figure panels illustrate suspected chains of transmission of MERS-CoV infection within the 3 clusters. Each circle represents a case-patient. Arrows connect case-patients with likely source of MERS-CoV infection, with arrows pointing in the direction of transmission (i.e., from source case-patient to secondary case-patient). Descriptions adjacent to arrows indicate the timing or location of confirmed (shown with solid arrows) and probable (shown with broken arrows) exposures between the case-patients. Asterisks (*) indicate case-patients who reported no fever or symptoms of respiratory disease; underlining indicates cases for which isolates underwent genetic sequencing. †Dates of exposure and symptom onset for case-patients III-B–III-L are summarized in Figure 2. ‡After identification of MERS-CoV in case-patient V, healthcare workers in unit A were screened beginning March 24, 2014. MERS-CoV was not detected from a sputum specimen collected from case-patient III-S at this time. The MERS-CoV–positive specimen was collected on April 24, after identification of case-patient III-Q on the same ward. HCA, healthcare-associated; HCW, healthcare worker.
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