Waterpipe smoking as a public health risk: Potential risk for transmission of MERS-CoV

Alagaili, Abdulaziz N.; Briese, Thomas; Amor, Nabil M.S.; Mohammed, Osama B.; Lipkin, W. Ian

Like most coronaviruses, the nature of MERS-CoV transmission and infection is thought to be through the respiratory secretions, mainly droplet nuclei of an infected person (i.e. coughing). Human-to-human transmission is evident by the occurrence of clusters seen for cases from many countries including Italy, Jordan, France, Tunisia, the United Kingdom, South Korea and Saudi Arabia supporting the ability of the virus to transmit amongst humans (Hijawi et al., 2013; Chan et al., 2013; Drosten et al., , 2015 Assiri et al., 2013; Guery et al., 2013; Abroug et al., 2014; Raj et al., 2014; Park et al., 2015) . Secondary cases of infection also occur among healthcare workers which is attributed to weaknesses in infection control measures at these facilities (WHO, 2014; Park et al., 2015) . Interestingly, due to infrequent direct contact between humans and camels, several recorded primary cases in Saudi Arabia were classified as primary cases with unknown exposure or source of infection; thus, the route of transmission of the virus have not been ruled out. While airborne and droplet transmission have been suggested, a role of tools, instruments, and appliances associated with respiratory secretions that are shared or re-used by several individuals should not be eliminated.