State of the Science ReviewMiddle East respiratory syndrome coronavirus: Implications for health care facilities

- Health care-associated transmission plays a pivotal role in the Middle East respiratory syndrome coronavirus epidemic.
- Gaps in infection control were noted in all health care-associated events.
- There is a need to increase infection control capacity.
- Studies about the effectiveness of infection control measures are needed.
- Vaccines and antiviral agents against Middle East respiratory syndrome coronavirus are urgently needed.

BackgroundMiddle East respiratory syndrome coronavirus (MERS-CoV) is a novel coronavirus that causes a severe respiratory disease with high case fatality rate. Starting in March 2014, a dramatic increase of cases has occurred in the Arabian Peninsula, many of which were acquired in health care settings. As of May 9, 2014, 536 laboratory-confirmed cases and 145 deaths have been reported globally.MethodsReview of publicly available data about MERS-CoV health care-associated transmission.ResultsWe identified 11 events of possible or confirmed health care-associated transmission with high morbidity and mortality, mainly among patients with comorbidities. Health care workers are also frequently affected; however, they tend to have milder symptoms and better prognosis. Gaps in infection control were noted in all events. Currently, health care-associated outbreaks are playing a pivotal role in the evolution of the MERS-CoV epidemic in countries in the Arabian Peninsula.ConclusionThere is a need to increase infection control capacity in affected areas and areas at increased risk of being affected to prevent transmission in health care settings. Vaccines and antiviral agents are urgently needed. Overall, our knowledge about the epidemiologic characteristics of MERS-CoV that impact health care transmission is very limited. As the MERS-CoV epidemic continues to evolve, issues concerning best infection control measures will arise, and studies to better define their effectiveness in real life are needed.