Dataset Information

Multihospital Outbreak of a Middle East Respiratory Syndrome Coronavirus Deletion Variant, Jordan: A Molecular, Serologic, and Epidemiologic Investigation.

ABSTRACT: Background:An outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in Jordan in 2015 involved a variant virus that acquired distinctive deletions in the accessory open reading frames. We conducted a molecular and seroepidemiologic investigation to describe the deletion variant's transmission patterns and epidemiology. Methods:We reviewed epidemiologic and medical chart data and analyzed viral genome sequences from respiratory specimens of MERS-CoV cases. In early 2016, sera and standardized interviews were obtained from MERS-CoV cases and their contacts. Sera were evaluated by nucleocapsid and spike protein enzyme immunoassays and microneutralization. Results:Among 16 cases, 11 (69%) had health care exposure and 5 (31%) were relatives of a known case; 13 (81%) were symptomatic, and 7 (44%) died. Genome sequencing of MERS-CoV from 13 cases revealed 3 transmissible deletions associated with clinical illness during the outbreak. Deletion variant sequences were epidemiologically clustered and linked to a common transmission chain. Interviews and sera were collected from 2 surviving cases, 23 household contacts, and 278 health care contacts; 1 (50%) case, 2 (9%) household contacts, and 3 (1%) health care contacts tested seropositive. Conclusions:The MERS-CoV deletion variants retained human-to-human transmissibility and caused clinical illness in infected persons despite accumulated mutations. Serology suggested limited transmission beyond that detected during the initial outbreak investigation.

SUBMITTER: Payne DC

PROVIDER: S-EPMC5965092 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Multihospital Outbreak of a Middle East Respiratory Syndrome Coronavirus Deletion Variant, Jordan: A Molecular, Serologic, and Epidemiologic Investigation.

Payne Daniel C DC Biggs Holly M HM Al-Abdallat Mohammad Mousa MM Alqasrawi Sultan S Lu Xiaoyan X Abedi Glen R GR Haddadin Aktham A Iblan Ibrahim I Alsanouri Tarek T Al Nsour Mohannad M Sheikh Ali Sami S Rha Brian B Trivedi Suvang U SU Rasheed Mohammed Ata Ur MAU Tamin Azaibi A Lamers Mart M MM Haagmans Bart L BL Erdman Dean D DD Thornburg Natalie J NJ Gerber Susan I SI

Open forum infectious diseases 20180428 5

<h4>Background</h4>An outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in Jordan in 2015 involved a variant virus that acquired distinctive deletions in the accessory open reading frames. We conducted a molecular and seroepidemiologic investigation to describe the deletion variant's transmission patterns and epidemiology.<h4>Methods</h4>We reviewed epidemiologic and medical chart data and analyzed viral genome sequences from respiratory specimens of MERS-CoV cases. In early 20 ...[more]

PMID: 30294616

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Project description:BackgroundEpidemiologic parameters are important in planning infection control policies during the outbreak of emerging infections. Korea experienced an outbreak of Middle East Respiratory Syndrome coronavirus (MERS-CoV) infection in 2015, which was characterized by superspreading events in healthcare settings. We aimed to estimate the epidemiologic parameters over time during the outbreak to assess the effectiveness of countermeasures.Materials and methodsPublicly available data pertaining to the MERS outbreak in Korea were collected. We estimated the incubation periods of 162 cases whose sources of exposure were identified and the temporal trend was evaluated. Factors influencing incubation duration were analyzed. The generational reproduction number (Rg ) and case reproduction number (R(c) ) were estimated over time.ResultsThe estimated median incubation period was 7.4 days (95% CI, 6.9-8.0). Median incubation periods tended to be longer over time as the disease generation progressed: 6.16 days (95% CI, 5.38-6.97), 7.68 days (95% CI, 7.04-8.44), and 7.95 days (95% CI, 6.25-9.88) in the first, second, and third generations, respectively. The number of days of illness in the source cases at the time of exposure inversely correlated with the incubation periods in the receiving cases (HR 0.91 [95% CI, 0.84-0.99] per one illness day increase; P=0.026). This relationship was consistent (HR 0.83 [95% CI, 0.74-0.93] per one illness day increase) in the multivariable analysis incorporating clinical characteristics, the order of generation, and a link to superspreaders. Because the third generation cases were exposed to their source cases in the early stage (median one day) compared to the second generation cases (median 6 days), the temporal trend of incubation periods appears to be influenced by early isolation of symptomatic cases and reduction of potential exposure to source cases in the later stage. Rg declined rapidly from 28 to 0.23 in two generations. R(c) dropped below the epidemic threshold at one on May 31, 2015, which approximately coincided with the initiation of the stringent countermeasures.ConclusionsDespite the initial delay, the stringent countermeasures targeted towards second generation cases appeared to effectively contain the MERS outbreak in Korea as suggested by the decline of R(c) shortly after implementation. Except for superspreading events, the transmission potential for MERS-CoV seems to be low. Further research should be focused on characterizing superspreaders in comparison to non-transmitting cases with regard to environmental, behavioral, and virologic and host genetic factors in order to better prepare for future outbreaks of MERS-CoV.

Dataset Information

Multihospital Outbreak of a Middle East Respiratory Syndrome Coronavirus Deletion Variant, Jordan: A Molecular, Serologic, and Epidemiologic Investigation.

Publications

Multihospital Outbreak of a Middle East Respiratory Syndrome Coronavirus Deletion Variant, Jordan: A Molecular, Serologic, and Epidemiologic Investigation.

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