Travel-related MERS-CoV cases: an assessment of exposures and risk factors in a group of Dutch travellers returning from the Kingdom of Saudi Arabia, May 2014

Emerging Themes in Epidemiology

Arianne B van Gageldonk-Lafeber²  Jolande W Bouwhuis⁶  Luc Gelinck⁸  Jet van der Heuvel³  Charlie van der Weijden⁹  Gerard Sonder^1,11  Douwe van der Werf^1,10  Marion PG Koopmans⁷  Wim van der Hoek²  Marcel Jonges²  Kees Dirksen⁴  Marleen Kraaij-Dirkzwager²  Marianne AB van der Sande⁵  Ewout B Fanoy¹ 

[1] Public Health Service region of Utrecht, Zeist, The Netherlands;National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands;Public Health Service Hart voor Brabant’s, Hertogenbosch, The Netherlands;Public Health Service Haaglanden, Den Haag, The Netherlands;Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands;Isalaklinieken, Zwolle, The Netherlands;Erasmus Medical Center, Rotterdam, The Netherlands;Medical Centre Haaglanden, The Hague, The Netherlands;Public Health Service Flevoland, Lelystad, The Netherlands;Public Health Service IJsselland, Zwolle, The Netherlands;Public Health Service Amsterdam, Amsterdam, The Netherlands

关键词: Epidemiology;    Risk factors;    Exposure;    MERS-CoV;    MERS;    Middle East respiratory syndrome coronavirus;   

Others  :  1092969
DOI  :  10.1186/1742-7622-11-16

 received in 2014-06-30, accepted in 2014-10-02,  发布年份 2014

【 摘 要 】

Background

In May 2014, Middle East respiratory syndrome coronavirus (MERS-CoV) infection, with closely related viral genomes, was diagnosed in two Dutch residents, returning from a pilgrimage to Medina and Mecca, Kingdom of Saudi Arabia (KSA). These patients travelled with a group of 29 other Dutch travellers. We conducted an epidemiological assessment of the travel group to identify likely source(s) of infection and presence of potential risk factors.

Methods

All travellers, including the two cases, completed a questionnaire focussing on potential human, animal and food exposures to MERS-CoV. The questionnaire was modified from the WHO MERS-CoV questionnaire, taking into account the specific route and activities of the travel group.

Results

Twelve non-cases drank unpasteurized camel milk and had contact with camels. Most travellers, including one of the two patients (Case 1), visited local markets, where six of them consumed fruits. Two travellers, including Case 1, were exposed to coughing patients when visiting a hospital in Medina. Four travellers, including Case 1, visited two hospitals in Mecca. All travellers had been in contact with Case 1 while he was sick, with initially non-respiratory complaints. The cases were found to be older than the other travellers and both had co-morbidities.

Conclusions

This epidemiological study revealed the complexity of MERS-CoV outbreak investigations with multiple potential exposures to MERS-CoV reported such as healthcare visits, camel exposure, and exposure to untreated food products. Exposure to MERS-CoV during a hospital visit is considered a likely source of infection for Case 1 but not for Case 2. For Case 2, the most likely source could not be determined. Exposure to MERS-CoV via direct contact with animals or dairy products seems unlikely for the two Dutch cases. Furthermore, exposure to a common but still unidentified source cannot be ruled out. More comprehensive research into sources of infection in the Arabian Peninsula is needed to strengthen and specify the prevention of MERS-CoV infections.

【 授权许可】

   
2014 Fanoy et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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