新英格兰医学杂志2014-01-02 10:22 PM

Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus — NEJM 医院爆发中东呼吸综合症冠状病毒

Abstract
Background
In September 2012, the World Health Organization reported the first cases of pneumonia caused by the novel Middle East respiratory syndrome coronavirus (MERS-CoV). We describe a cluster of health care–acquired MERS-CoV infections. 背景 2012年9月,世界卫生组织报告了第一例中东中东呼吸综合症冠状病毒引起的肺炎( MERS冠状病毒)。 我们描述了健康护理的集群-MERS冠状病毒的感染。
Methods
Medical records were reviewed for clinical and demographic information and determination of potential contacts and exposures. Case patients and contacts were interviewed. The incubation period and serial interval (the time between the successive onset of symptoms in a chain of transmission) were estimated. Viral RNA was sequenced. 方法 我们回顾了病历以获取临床信息,人口统计学信息以及潜在的接触和暴露的测定。我们访问了病人及其家属。 我们估计了潜伏期和序列区间(一个链传动的连续发作的症状之间的时间)。我们还对病毒RNA进行了测序。
Results
Between April 1 and May 23, 2013, a total of 23 cases of MERS-CoV infection were reported in the eastern province of Saudi Arabia. Symptoms included fever in 20 patients (87%), cough in 20 (87%), shortness of breath in 11 (48%), and gastrointestinal symptoms in 8 (35%); 20 patients (87%) presented with abnormal chest radiographs. As of June 12, a total of 15 patients (65%) had died, 6 (26%) had recovered, and 2 (9%) remained hospitalized. The median incubation period was 5.2 days (95% confidence interval [CI], 1.9 to 14.7), and the serial interval was 7.6 days (95% CI, 2.5 to 23.1). A total of 21 of the 23 cases were acquired by person-to-person transmission in hemodialysis units, intensive care units, or in-patient units in three different health care facilities. Sequencing data from four isolates revealed a single monophyletic clade. Among 217 household contacts and more than 200 health care worker contacts whom we identified, MERS-CoV infection developed in 5 family members (3 with laboratory-confirmed cases) and in 2 health care workers (both with laboratory-confirmed cases). 结果 在2013年4月1号到5月23号这段时间,沙特阿拉伯东部省一共报告了23例MERS冠状病毒感染。 症状包括发热20例( 87 % ),咳嗽20例( 87 % ),呼吸急促11例( 48 % ),胃肠道症状8例( 35 %), 胸部X光片异常20例( 87 % )。截至6月12日,共有15例(65 %)死亡, 6例( 26 % )恢复,2例( 9 %)仍住院治疗。平均潜伏期为5.2天(95 %可信区间[CI] , 1.9〜 14.7 ) ,串行间隔时间为7.6天(95 %CI , 2.5〜 23.1 )。23例中一共有21例被要求在血液透析房,重症监护病房,或者病人病房通过三种不同健康护理设备进行人对人的输液。 四组测序数据显示单一的分支。 在我们检测的217个家庭接触者和大于200个健康护理接触者中,5个家庭成员和2个医护人员感染了MERS冠状病毒(3个家庭成员为实验室确诊病例,2个医护人员为实验室确诊病例)。
Conclusions
Person-to-person transmission of MERS-CoV can occur in health care settings and may be associated with considerable morbidity. Surveillance and infection-control measures are critical to a global public health response. 结论 人对人MERS冠状病毒感染可以发生在医疗环境,并且这可以说导致了相当大的发病率。 监测和传染控制措施对全球公共健康反应都至关重要。

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