MERS-COV outbreak: the first report of nosocomial transmission in Oman

ABSTRACT

Objectives: The first confirmed case of Middle East respiratory syndrome (MERS) in Oman was in 2013. This report describes the nosocomial spread of MERS-coronavirus (CoV) in two regional hospitals in Oman (2019) and highlights opportunities for rapid containment in the future. Method(s) An outbreak epidemiological description and analysis of contributing factors was undertaken, with infection prevention and control challenges highlighted. A transmission map was created to trace hospital contacts and symptomatic contacts were screened using RT-PCR. Environment decontamination was carried out. Awareness programmes including training and education were augmented and infection prevention and control guidelines were revised, especially those related to the implementation of risk assessment for contact screenings. Result(s) Between 23 January and 16 February 2019, 13 confirmed cases were reported from two hospitals. Seven out of 13 were secondary transmitted cases, including two healthcare workers. Symptoms included fever in six (46%) patients, respiratory symptoms in six (46%), and gastrointestinal symptoms in four (31%). Four out of 13 patients died. High traffic in affected wards, poor adherence to infection control measures, lack of awareness, delay in the diagnosis of primary cases, and inadequate terminal cleaning were identified as contributory factors to the outbreak. Both affected healthcare workers and two secondary patients were missed during contact screenings. Conclusion(s) Lapses in the implementation of infection control measures within a facility can facilitate nosocomial transmission of MERS-CoV. There is a need to revise risk assessment tools for contacts within hospitals so that positive cases can be detected earlier.