Thursday, February 18, 2016

MMWR: A Large Nosocomial Outbreak Of MERS In Riyadh - Summer 2015


Last summer, during much of July and August, we were heavily occupied following reports of serious nosocomial MERS outbreaks in one or more hospitals in Riyadh, Saudi Arabia.

Although day-to-day details were sketchy, in late August in a Saudi MOH Statement On The Riyadh MERS Outbreak – Aug 23rd, the MOH cited 53 cases & 17 deaths at Riyadh’s National Guard Hospital. 

As I noted at the time, that statement appeared to only cover part of the outbreak, as we'd seen more than 80 cases reported from Riyadh during the month of August alone.

Today the MMWR carries a Notes From The Field, describing last summer's outbreak at King Abulaziz Medical City, a large hospital complex which lies nearly adjacent to Riyadh's National Guard Hospital (see map below).

The report describes a fast moving, nosocomial outbreak with 81 confirmed cases and 49 probable cases, including 43 health care workers. Twenty-one of the cases (16%) were asymptomatic, including 18 HCWs.

The report details the arrival and treatment of several community cases, the rapid explosion of hospital acquired infections (primarily linked to the ER), and describes the outbreak as:

Although data are still limited, this occurrence is considered a more intense transmission than has been previously described in similar outbreaks (6). Although the outbreak was associated with considerable patient mortality, no deaths occurred among health care workers, who were younger, healthier, and had fewer comorbidities compared with patients who were not health care workers.
The hospital initiated their preexisting Infectious Disease Epidemic Plan (IDEP) on August 2nd. The report describes some of the drastic steps the facility had to take in order to break the chain of transmission, including:

Because cases continued to be identified despite the hospital’s status of being in level II IDEP, on August 18, the plan was escalated to the highest level, IDEP level III, which included closure of the emergency department, postponement of elective surgical procedures, and suspension of all outpatient appointments and visits. Complete evacuation of the emergency department was achieved on August 22, and was associated with a rapid decline in the number of new cases.

Follow the link to read the full account: 

Weekly / February 19, 2016 / 65(6);163–164

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