Comparative Analysis of Eleven Healthcare-Associated Outbreaks of Middle East Respiratory Syndrome Coronavirus (Mers-Cov) from 2015 to 2017

Bernard-Stoecklin, Sibylle; Nikolay, Birgit; Assiri, Abdullah; Bin Saeed, Abdul Aziz; Ben Embarek, Peter Karim; El Bushra, Hassan; Ki, Moran; Malik, Mamunur Rahman; Fontanet, Arnaud; Cauchemez, Simon; Van Kerkhove, Maria D.

While more than half of the laboratory confirmed MERS-CoV infections reported globally to date are associated with human-to-human transmission in healthcare settings 27 , there has been little human-to-human transmission reported in household settings 28 . Outbreak investigations and scientific studies conducted during or after MERS hospital outbreaks have identified that aerosol-generating medical procedures with improper or inadequate personal protective equipment place medical personnel and patients sharing wards with MERS patients and family visitors at higher risk for MERS-CoV infection 29, 30 , with exposure to infectious droplets being the likely source of contamination. Although close unprotected contact with a MERS patient is generally considered necessary for human-to-human transmission 31 , several studies have revealed that MERS-CoV particles can persist on surfaces as long as several days, raising the possibility of a role of fomites in transmission 32, 33 . Fomite transmission is further supported by observed viral spreading between rooms that were clearly separated 15, 18 and outbreaks that occurred in hemodialysis units 14, 15 .