Risk Factors for Middle East Respiratory Syndrome Coronavirus Infection Among Healthcare Personnel

Basem M. Alraddadi; Hanadi S. Al-Salmi; Kara Jacobs-Slifka; Rachel B. Slayton; Concepcion F. Estivariz; Andrew I. Geller; Hanan H. Al-Turkistani; Sanaa S. Al-Rehily; Haleema A. Alserehi; Ghassan Y. Wali; Abeer N. Alshukairi; Esam I. Azhar; Lia Haynes; David L. Swerdlow; John A. Jernigan; Tariq A. Madani


Emerging Infectious Diseases. 2016;22(11):1915-1920. 

In This Article

Abstract and Introduction


Healthcare settings can amplify transmission of Middle East respiratory syndrome coronavirus (MERS-CoV), but knowledge gaps about the epidemiology of transmission remain. We conducted a retrospective cohort study among healthcare personnel in hospital units that treated MERS-CoV patients. Participants were interviewed about exposures to MERS-CoV patients, use of personal protective equipment, and signs and symptoms of illness after exposure. Infection status was determined by the presence of antibodies against MERS-CoV. To assess risk factors, we compared infected and uninfected participants. Healthcare personnel caring for MERS-CoV patients were at high risk for infection, but infection most often resulted in a relatively mild illness that might be unrecognized. In the healthcare personnel cohort reported here, infections occurred exclusively among those who had close contact with MERS-CoV patients.


Middle East respiratory syndrome coronavirus (MERS-CoV), first identified in 2012, has emerged as a cause of severe acute respiratory illness in humans. As of May 1, 2016, a total of 1,728 laboratory-confirmed cases, including 624 deaths, have been reported globally.[1] All reported cases have been directly or indirectly linked to countries in or near the Arabian Peninsula, including a recent outbreak in South Korea resulting from a single imported case in a person with history of travel to the Middle East.[2,3] Increasing evidence suggests that dromedary camels are a natural host for MERS-CoV and that camel-to-human transmission can occur, initiating short chains of human-to-human transmission.[4–7] Numerous questions about the epidemiology of MERS-CoV remain unanswered.

Healthcare settings are important amplifiers of transmission.[6,8,9] A 2014 case series of 255 MERS-CoV infections in Saudi Arabia found that 31% of cases occurred among healthcare personnel (HCP), and among case-patients who were not HCP, 87.5% had recent healthcare exposure.[9] Current MERS-CoV infection control recommendations are based on experience with other viruses rather than on a complete understanding of the epidemiology of MERS-CoV transmission.[10,11]

The World Health Organization recently issued an urgent call for studies to better understand risk factors for infection and transmission.[12] Published case series of healthcare-associated MERS-CoV infections have major limitations, including lack of control groups and lack of serologic confirmation of infection status, leaving wide knowledge gaps, such as mode of and risk factors for transmission in healthcare settings, attack rate among HCP, and spectrum of illness for MERS-CoV infection.[13] To address these gaps, we retrospectively studied MERS-CoV infection among a cohort of HCP in a hospital in Saudi Arabia.