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.

Prevention of large HCA outbreaks since 2014 (Fig. 1A) , may be, in part, explained by improvements in contact tracing policies implemented in 2015. In 2015, contact tracing became more systematic with the identification and follow up of high (close, unprotected contact) and low risk contacts (protected HCW). In affected countries, National Ministries of Health and hospital staff comprehensively list all contacts of known MERS patients, including healthcare workers at all facilities/departments the patient visited, patients who shared wards/ rooms with MERS patients, family and visitors and occupational contacts. Follow up of contacts includes the testing of all high-risk contacts, regardless of the development of symptoms. Recommendations stated that positive contacts are placed in quarantine (home or hospital isolation for asymptomatic or symptomatic secondary cases, respectively) until they test negative 41, [44] [45] [46] . Additionally, affected countries enhanced infection prevention and control procedures education, and training, and implemented visual triage systems 41 to reduce delays in testing, isolation and care of suspected MERS-CoV patients. This has again been recently illustrated by the lack of secondary cases following the identification of a confirmed case of MERS in Korea in September 2018 47 was due to the rapid and comprehensive isolation, treatment and management of contacts of the patient.