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.

The variation in outbreak size and duration is also affected by superspreading events early in some outbreaks, during which a limited number of cases generated a disproportionately large proportion of the secondary cases under specific conditions in hospitals, occurring in some outbreaks [48] [49] [50] . Two super spreading events have been documented in KSA and in the Republic of Korea. In the Republic of Korea, the practice of "doctor shopping", extended stays in overcrowded emergency departments, cultural practices of large numbers of family members visiting sick relatives, and environmental contamination amplified transmission from some patients to others 14, 17, 18, 51 . During the outbreak in KSA in 2015 at the Ministry of the National Guard Hospital, a high number of secondary cases were among HCP very quickly after the hospitalization and a surgical procedure of the index case 16 . These events triggered comprehensive review IPC in hospitals, emergency department layout, movements of patients, triage of respiratory visits, duration of emergency department stay, training of hospital staff and disinfection of healthcare facilities.