COMMENTARY: Protecting health workers from airborne MERS-CoV—learning from SARS

Monday, May 19, 2014
By Paul Martin

Lisa M Brosseau, ScD, and Rachael Jones, PhD
Cid Rap
May 19, 2014

Although US and European officials recommend airborne precautions for the routine care of MERS-CoV (Middle East respiratory syndrome coronavirus) patients, the World Health Organization (WHO) does not, and that needs to change.

Compelling evidence and prudence dictate higher levels of respiratory protection, and even guidance from the US Centers for Disease Control and Prevention (CDC) falls short. And the example 2 days ago of likely MERS transmission in Indiana after contact in a business setting illustrates that recommendations need to lean toward conservative measures for this unpredictable virus.

MERS perils for health workers
As of May 6, 96 (19%) of the 495 known Middle East respiratory syndrome coronavirus (MERS-CoV) cases, including a number of fatalities, were in healthcare workers (HCWs), and the number of infected HCWs continues to climb.

The vast majority of HCW cases—74%—have occurred in the Kingdom of Saudi Arabia, with 24% in the United Arab Emirates. Sixty-three HCW cases—or almost two thirds—were reported last month alone, and more than 60% of the 128 recent MERS patients in Jeddah were infected in a hospital, including 39 HCWs, 6 of whom required intensive care or died.1

On May 12, a second US case of MERS was reported, this one in Florida. Both US cases have been in HCWs who were working in healthcare facilities in Saudi Arabia before traveling to the United States.

The CDC on May 17 reported that the first US patient—an HCW who had traveled from Saudi Arabia—likely passed the virus to a colleague in Indiana after two business meetings in which they were in close proximity and shook hands. The HCW said he had muscle aches and a fever but no respiratory symptoms at the time. In Florida, emergency department HCWs were reportedly not wearing masks while caring for the MERS patient there before MERS was suspected.

Just as with the severe acute respiratory syndrome (SARS) coronovirus outbreaks in Asia and Canada in 2003, it is clear that HCWs are at high risk of infection, disease, and death from MERS-CoV. Even if HCWs are more likely to be asymptomatic or develop mild disease because they tend to be young and healthy, their work brings them into contact with patients who are at high risk of serious disease. Protecting HCWs is an important factor for limiting nosocomial outbreaks.

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