#Asymptomatic Middle East Respiratory Syndrome #Coronavirus (#MERS-CoV) #infection: Extent and implications for infection control: A systematic review (Travel Med Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Travel Med Infect Dis. 2018 Dec 11. pii: S1477-8939(18)30343-0. doi: 10.1016/j.tmaid.2018.12.003. [Epub ahead of print]

Asymptomatic Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: Extent and implications for infection control: A systematic review.

Al-Tawfiq JA1, Gautret P2.

Author information: 1 Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: jaffar.tawfiq@jhah.com. 2 Aix Marseille Univ, Institut de Recherche pour le Développement (IRD), Assistance Publique-Hôpitaux de Marseille (AP-HM), Service de Santé des Armées (SSA), Microbes Vecteurs Infections Tropicales et Méditerranéennes (VITROME), Institut Hospitalo-Universitaire-Méditerranée Infection (IHU-Méditerranée Infection), Marseille, France.

 

Abstract

BACKGROUND:

The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) emerged in 2012 and attracted an international attention as the virus caused multiple healthcare associated outbreaks. There are reports of the role of asymptomatic individuals play in the transmission of MERS-CoV, however, the exact role is now known.

METHOD:

The MEDLINE/PubMed and Scopus databases were searched for relevant papers published till August 2018 describing asymptomatic MERS-CoV infection.

RESULTS:

A total of 10 papers were retrieved and included in the final analysis and review. The extent of asymptomatic MERS infection had increased with change in the policy of testing asymptomatic contacts. In early cases in April 2012-October 2013, 12.5% were asymptomatic among 144 PCR laboratory-confirmed MERS-CoV cases while in 2014 the proportion rose to 25.1% among 255 confirmed cases. The proportion of asymptomatic cases reported among pediatric confirmed MERS-CoV cases were higher (41.9%-81.8%). Overall, the detection rate of MERS cases among asymptomatic contacts when screened was less than 1% in the available studies included in this review. Asymptomatic individuals were less likely to have underlying condition compared to fatal cases. Of particular interest is that most of the identified pediatric cases were asymptomatic with no clear explanation.

CONCLUSIONS:

The proportion of asymptomatic MERS cases were detected with increasing frequency as the disease progressed overtime. Those patients were less likely to have comorbid disease and contributed to the transmission of the virus.

Copyright © 2018. Published by Elsevier Ltd.

KEYWORDS: Healthcare associated outbreaks; MERS; Middle East Respiratory Syndrome Coronavirus

PMID: 30550839 DOI: 10.1016/j.tmaid.2018.12.003

Keywords: MERS-CoV.

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#Replication of #MERS and #SARS #coronaviruses in #bat cells offers insights to their ancestral origins (Emerg Microbes Infect., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Emerg Microbes Infect. 2018 Dec 10;7(1):209. doi: 10.1038/s41426-018-0208-9.

Replication of MERS and SARS coronaviruses in bat cells offers insights to their ancestral origins.

Lau SKP1,2,3,4, Fan RYY5, Luk HKH5, Zhu L5, Fung J5, Li KSM5, Wong EYM5, Ahmed SS5, Chan JFW6,5,7,8, Kok RKH6,5,7,8, Chan KH6,5,7,8, Wernery U9, Yuen KY6,5,7,8, Woo PCY10,11,12,13.

Author information: 1 State Key Laboratory of Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. skplau@hku.hk. 2 Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. skplau@hku.hk. 3 Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. skplau@hku.hk. 4 Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. skplau@hku.hk. 5 Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. 6 State Key Laboratory of Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. 7 Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. 8 Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. 9 Central Veterinary Research Laboratory, Dubai, United Arab Emirates. 10 State Key Laboratory of Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. pcywoo@hku.hk. 11 Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. pcywoo@hku.hk. 12 Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. pcywoo@hku.hk. 13 Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. pcywoo@hku.hk.

 

Abstract

Previous findings of Middle East Respiratory Syndrome coronavirus (MERS-CoV)-related viruses in bats, and the ability of Tylonycteris-BatCoV HKU4 spike protein to utilize MERS-CoV receptor, human dipeptidyl peptidase 4 hDPP4, suggest a bat ancestral origin of MERS-CoV. We developed 12 primary bat cell lines from seven bat species, including Tylonycteris pachypus, Pipistrellus abramus and Rhinolophus sinicus (hosts of Tylonycteris-BatCoV HKU4, Pipistrellus-BatCoV HKU5, and SARS-related-CoV respectively), and tested their susceptibilities to MERS-CoVs, SARS-CoV, and human coronavirus 229E (HCoV-229E). Five cell lines, including P. abramus and R. sinicus but not T. pachypus cells, were susceptible to human MERS-CoV EMC/2012. However, three tested camel MERS-CoV strains showed different infectivities, with only two strains capable of infecting three and one cell lines respectively. SARS-CoV can only replicate in R. sinicus cells, while HCoV-229E cannot replicate in any bat cells. Bat dipeptidyl peptidase 4 (DPP4) sequences were closely related to those of human and non-human primates but distinct from dromedary DPP4 sequence. Critical residues for binding to MERS-CoV spike protein were mostly conserved in bat DPP4. DPP4 was expressed in the five bat cells susceptible to MERS-CoV, with significantly higher mRNA expression levels than those in non-susceptible cells (P = 0.0174), supporting that DPP4 expression is critical for MERS-CoV infection in bats. However, overexpression of T. pachypus DPP4 failed to confer MERS-CoV susceptibility in T. pachypus cells, suggesting other cellular factors in determining viral replication. The broad cellular tropism of MERS-CoV should prompt further exploration of host diversity of related viruses to identify its ancestral origin.

PMID: 30531999 DOI: 10.1038/s41426-018-0208-9

Keywords: Coronavirus; MERS-CoV; SARS; Bats.

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#Infection #control influence of #MERS #coronavirus: A #hospital-based analysis (Am J Infect Control, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Infect Control. 2018 Nov 27. pii: S0196-6553(18)30944-1. doi: 10.1016/j.ajic.2018.09.015. [Epub ahead of print]

Infection control influence of Middle East respiratory syndrome coronavirus: A hospital-based analysis.

Al-Tawfiq JA1, Abdrabalnabi R2, Taher A2, Mathew S2, Rahman KA2.

Author information: 1 Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: jaltawfi@yahoo.com. 2 Infection Control Unit, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.

 

Abstract

BACKGROUND:

Middle East respiratory syndrome coronavirus (MERS-CoV) caused multiple outbreaks. Such outbreaks increase economic and infection control burdens. We studied the infection control influence of MERS-CoV using a hospital-based analysis.

METHODS:

Our hospital had 17 positive and 82 negative cases of MERS-CoV between April 1, 2013, and June 3, 2013. The study evaluated the impact of these cases on the use of gloves, surgical masks, N95 respirators, alcohol-based hand sanitizer, and soap, as well as hand hygiene compliance rates.

RESULTS:

During the study, the use of personal protective equipment during MERS-CoV compared with the period before MERS-CoV increased dramatically from 2,947.4 to 10,283.9 per 1,000 patient-days (P <.0000001) for surgical masks and from 22 to 232 per 1,000 patient-days (P <.0000001) for N95 masks. The use of alcohol-based hand sanitizer and soap showed a significant increase in utilized amount (P <.0000001). Hand hygiene compliance rates increased from 73% just before the occurrence of the first MERS case to 88% during MERS cases (P = .0001). The monthly added cost was $16,400 for included infection control items.

CONCLUSIONS:

There was a significant increase in the utilization of surgical masks, respirators, soap and alcohol-based hand sanitizers. Such an increase is a challenge and adds cost to the health care system.

Copyright © 2018. Published by Elsevier Inc.

KEYWORDS: Cost; Economic impact; Healthcare; MERS; Personal Protective Equipment

PMID: 30502108 DOI: 10.1016/j.ajic.2018.09.015

Keywords: MERS-CoV; Nosocomial Outbreaks.

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Middle East respiratory syndrome #coronavirus (#MERS-CoV): #Impact on #Saudi Arabia, 2015 (Saudi J Biol Sci., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Saudi J Biol Sci. 2018 Nov;25(7):1402-1405. doi: 10.1016/j.sjbs.2016.09.020. Epub 2016 Oct 1.

Middle East respiratory syndrome coronavirus (MERS-CoV): Impact on Saudi Arabia, 2015.

Faridi U1.

Author information: 1 Department of Biochemistry, Tabuk University, Tabuk, Saudi Arabia.

 

Abstract

Middle East respiratory syndrome is the acute respiratory syndrome caused by betacoronavirus MERS-CoV. The first case of this disease was reported from Saudi Arabia in 2012. This virus is lethal and is a close relative of a severe acute respiratory syndrome (SARS), which is responsible for more than 3000 deaths in 2002-2003. According to Ministry of Health, Saudi Arabia. The number of new cases is 457 in 2015. Riyadh has the highest number of reports in comparison to the other cities. According to this report, males are more susceptible than female, especially after the age of 40. Because of the awareness and early diagnosis the incidence is falling gradually. The pre-existence of another disease like cancer or diabetic etc. boosts the infection. MERS is a zoonotic disease and human to human transmission is low. The MERS-CoV is a RNA virus with protein envelope. On the outer surface, virus has spike like glycoprotein which is responsible for the attachment and entrance inside host cells. There is no specific treatment for the MERS-CoV till now, but drugs are in pipeline which bind with the spike glycoprotein and inhibit its entrance host cells. MERS-CoV and SAR-CoV are from the same genus, so it was thought that the drugs which inhibit the growth of SARS-CoV can also inhibit the growth of MERS-CoV but those drugs are not completely inhibiting virus activity. Until we don’t have proper structure and the treatment of MERS-CoV, We should take precautions, especially the health care workers, Camel owners and Pilgrims during Hajj and Umrah, because they are at a higher risk of getting infected.

KEYWORDS: Betacoronavirus; MERS-CoV; SARS; Saudi Arabia

PMID: 30505188 PMCID: PMC6252006  DOI: 10.1016/j.sjbs.2016.09.020

Keywords: Coronavirus; Betacoronavirus; MERS-CoV; SARS; Saudi Arabia; Human; Camels.

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Co-localization of #MERS #Coronavirus and #DPP4 in the #respiratory tract and #lymphoid tissues of #pigs and #llamas (Transbound Emerg Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Transbound Emerg Dis. 2018 Dec 6. doi: 10.1111/tbed.13092. [Epub ahead of print]

Co-localization of Middle East respiratory syndrome coronavirus (MERS-CoV) and dipeptidyl peptidase-4 in the respiratory tract and lymphoid tissues of pigs and llamas.

Te N1, Vergara-Alert J1, Lehmbecker A2, Pérez M1, Haagmans BL3, Baumgärtner W2, Bensaid A1, Segalés J4,5.

Author information: 1 IRTA, Centre de Recerca en Sanitat Animal (CReSA, IRTA-UAB), Campus de la Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain. 2 Department of Pathology, University of Veterinary Medicine, Hannover, Germany. 3 Department of Viroscience, Erasmus Medical Center, 3015 CN, Rotterdam, The Netherlands. 4 UAB, Centre de Recerca en Sanitat Animal (CReSA, IRTA-UAB), Campus de la Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain. 5 Departament de Sanitat i Anatomia Animals, Facultat de Veterinària, UAB, 08193, Bellaterra, Barcelona, Spain.

 

Abstract

The present study investigated the co-localization of the Middle East respiratory syndrome coronavirus (MERS-CoV) and its receptor dipeptidyl peptidase-4 (DPP4) across respiratory and lymphoid organs of experimentally MERS-CoV infected pigs and llamas by immunohistochemistry (IHC). Also, scanning electron microscopy (SEM) was performed to assess the ciliary integrity of respiratory epithelial cells in both species. In pigs, on day 2 post-inoculation (p.i.), DPP4-MERS-CoV co-localization was detected in medial turbinate epithelium. On day 4 p.i., the virus/receptor co-localized in frontal and medial turbinate epithelial cells in pigs, and epithelial cells distributed unevenly through the whole nasal cavity and in the cervical lymph node in llamas. MERS-CoV viral nucleocapsid was mainly detected in upper respiratory tract sites on days 2 and 4 p.i. in pigs and day 4 p.i. in llamas. No MERS-CoV was detected on day 24 p.i. in any tissue by IHC. While pigs showed severe ciliary loss in the nasal mucosa both on days 2 and 4 p.i. and moderate loss in the trachea on days 4 and 24 p.i., ciliation of respiratory organs in llamas was not significantly affected. Obtained data confirm the role of DPP4 for MERS-CoV entry in respiratory epithelial cells of llamas. Notably, several nasal epithelial cells in pigs were found to express viral antigen but not DPP4, suggesting the possible existence of other molecule/s facilitating virus entry or down regulation of DPP4 upon infection.

This article is protected by copyright. All rights reserved.

KEYWORDS: Middle East respiratory syndrome coronavirus (MERS-CoV); dipeptidyl peptidase-4 (DPP4); immunohistochemistry; llama; pig; scanning electron microscopy

PMID: 30520548 DOI: 10.1111/tbed.13092

Keywords: MERS-CoV; Pigs; Llamas; Animal models; Viral pathogenesis.

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Neutralizing #Monoclonal #Antibodies as Promising #Therapeutics against #MERS #Coronavirus Infection (Viruses, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Viruses. 2018 Nov 30;10(12). pii: E680. doi: 10.3390/v10120680.

Neutralizing Monoclonal Antibodies as Promising Therapeutics against Middle East Respiratory Syndrome Coronavirus Infection.

Han HJ1, Liu JW2, Yu H3, Yu XJ4.

Author information: 1 School of Health Sciences, and State Key Laboratory of Virology,  Wuhan University, Wuhan 430071, China. nikihuijuhan@163.com. 2 School of Health Sciences, and State Key Laboratory of Virology, Wuhan University, Wuhan 430071, China. liujw_2012@163.com. 3 Fudan University School of Medicine, Shanghai 200032, China. howardyu89@163.com. 4 School of Health Sciences, and State Key Laboratory of Virology, Wuhan University, Wuhan 430071, China. yuxuejie@whu.edu.cn.

 

Abstract

Since emerging in 2012, Middle East Respiratory Syndrome Coronavirus (MERS-CoV) has been a global public health threat with a high fatality rate and worldwide distribution. There are no approved vaccines or therapies for MERS until now. Passive immunotherapy with neutralizing monoclonal antibodies (mAbs) is an effective prophylactic and therapeutic reagent against emerging viruses. In this article, we review current advances in neutralizing mAbs against MERS-CoV. The receptor-binding domain (RBD) in the spike protein of MERS-CoV is a major target, and mouse, camel, or human-derived neutralizing mAbs targeting RBD have been developed. A major problem with neutralizing mAb therapy is mutant escape under selective pressure, which can be solved by combination of neutralizing mAbs targeting different epitopes. Neutralizing mAbs are currently under preclinical evaluation, and they are promising candidate therapeutic agents against MERS-CoV infection.

KEYWORDS: MERS-CoV; Middle East Respiratory Syndrome Virus; neutralizing monoclonal antibodies

PMID: 30513619 DOI: 10.3390/v10120680

Keywords: MERS-CoV; Monoclonal antibodies.

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Critically ill #HCWs with the #MERS: A multicenter study (PLoS One, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

PLoS One. 2018 Nov 15;13(11):e0206831. doi: 10.1371/journal.pone.0206831. eCollection 2018.

Critically ill healthcare workers with the middle east respiratory syndrome (MERS): A multicenter study.

Shalhoub S1, Al-Hameed F2, Mandourah Y3, Balkhy HH4, Al-Omari A5, Al Mekhlafi GA3, Kharaba A6, Alraddadi B7, Almotairi A8, Al Khatib K9, Abdulmomen A10, Qushmaq I7, Mady A11, Solaiman O12, Al-Aithan AM13, Al-Raddadi R14, Ragab A15, Al Harthy A11, Al Qasim E16, Jose J16, Al-Ghamdi G16, Merson L17, Fowler R18, Hayden FG19, Arabi YM16.

Author information: 1 Department of Medicine, Division of Infectious Diseases, University of Western Ontario, London, Canada, Department of Medicine, Division of Infectious Diseases, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. 2 Department of Intensive Care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia. 3 Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia. 4 Department of Infection Prevention and Control, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia. 5 Department of Intensive Care, Alfaisal University, Dr Sulaiman Al-Habib Group Hospitals, Riyadh, Saudi Arabia. 6 Department of Critical Care, King Fahad Hospital, Ohoud Hospital, Al-Madinah Al-Monawarah, Saudi Arabia. 7 Department of Medicine, Alfaisal University, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia. 8 Department of Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia. 9 Intensive Care Department, Al-Noor Specialist Hospital, Makkah, Saudi Arabia. 10 Department of Critical Care Medicine, King Saud University, Riyadh, Saudi Arabia. 11 Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia. 12 Intensive Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. 13 Intensive Care Department, King Abdulaziz Hospital, Al Ahsa, Saudi Arabia. 14 Department of Family and Community Medicine, King Abdulaziz University Hospital, Ministry of Health, Jeddah, Saudi Arabia. 15 Intensive Care Department, King Fahd Hospital, Jeddah, Saudi Arabia. 16 Department of intensive care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia. 17 Infectious Diseases Data Observatory, Oxford University, Headiington, United Kingdom. 18 Department of Critical Care Medicine and Department of Medicine, Sunnybrook Hospital, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. 19 Department of Medicine, Division of Infectious Diseases and International Health University of Virginia School of Medicine, Charlottesville, Virginia, United States of America.

 

Abstract

BACKGROUND:

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) leads to healthcare-associated transmission to patients and healthcare workers with potentially fatal outcomes.

AIM:

We aimed to describe the clinical course and functional outcomes of critically ill healthcare workers (HCWs) with MERS.

METHODS:

Data on HCWs was extracted from a multi-center retrospective cohort study on 330 critically ill patients with MERS admitted between (9/2012-9/2015). Baseline demographics, interventions and outcomes were recorded and compared between survivors and non-survivors. Survivors were approached with questionnaires to elucidate their functional outcomes using Karnofsky Performance Status Scale.

FINDINGS:

Thirty-Two HCWs met the inclusion criteria. Comorbidities were recorded in 34% (11/32) HCW. Death resulted in 8/32 (25%) HCWs including all 5 HCWs with chronic renal impairment at baseline. Non-surviving HCW had lower PaO2/FiO2 ratios 63.5 (57, 116.2) vs 148 (84, 194.3), p = 0.043, and received more ECMO therapy compared to survivors, 9/32 (28%) vs 4/24 (16.7%) respectively (p = 0.02).Thirteen of the surviving (13/24) HCWs responded to the questionnaire. Two HCWs confirmed functional limitations. Median number of days from hospital discharge until the questionnaires were filled was 580 (95% CI 568, 723.5) days.

CONCLUSION:

Approximately 10% of critically ill patients with MERS were HCWs. Hospital mortality rate was substantial (25%). Patients with chronic renal impairment represented a particularly high-risk group that should receive extra caution during suspected or confirmed MERS cases clinical care assignment and during outbreaks. Long-term repercussions of critical illness due to MERS on HCWs in particular, and patients in general, remain unknown and should be investigated in larger studies.

PMID: 30439974 DOI: 10.1371/journal.pone.0206831

Keywords: MERS-CoV; Nosocomial Outbreaks; HCWs.

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