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1.
Emerg Infect Dis ; 25(5): 927-935, 2019 05.
Article in English | MEDLINE | ID: mdl-31002068

ABSTRACT

Camel contact is a recognized risk factor for Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Because specific camel exposures associated with MERS-CoV seropositivity are not fully understood, we investigated worker-camel interactions and MERS-CoV seroprevalence. We assessed worker seroprevalence in 2 slaughterhouses and 1 live-animal market in Abu Dhabi, United Arab Emirates, during 2014-2017 and administered an epidemiologic survey in 2016 and 2017. Across 3 sampling rounds during 2014-2017, we sampled 100-235 workers, and 6%-19% were seropositive for MERS-CoV at each sampling round. One (1.4%) of 70 seronegative workers tested at multiple rounds seroconverted. On multivariable analyses, working as a camel salesman, handling live camels or their waste, and having diabetes were associated with seropositivity among all workers, whereas handling live camels and either administering medications or cleaning equipment was associated with seropositivity among market workers. Characterization of high-risk exposures is critical for implementation of preventive measures.

2.
Emerg Infect Dis ; 25(4): 753-766, 2019 04.
Article in English | MEDLINE | ID: mdl-30882305

ABSTRACT

Middle East respiratory syndrome coronavirus (MERS-CoV) shedding and antibody responses are not fully understood, particularly in relation to underlying medical conditions, clinical manifestations, and mortality. We enrolled MERS-CoV-positive patients at a hospital in Saudi Arabia and periodically collected specimens from multiple sites for real-time reverse transcription PCR and serologic testing. We conducted interviews and chart abstractions to collect clinical, epidemiologic, and laboratory information. We found that diabetes mellitus among survivors was associated with prolonged MERS-CoV RNA detection in the respiratory tract. Among case-patients who died, development of robust neutralizing serum antibody responses during the second and third week of illness was not sufficient for patient recovery or virus clearance. Fever and cough among mildly ill patients typically aligned with RNA detection in the upper respiratory tract; RNA levels peaked during the first week of illness. These findings should be considered in the development of infection control policies, vaccines, and antibody therapeutics.


Subject(s)
Antibodies, Viral/immunology , Coronavirus Infections/immunology , Coronavirus Infections/virology , Host-Pathogen Interactions/immunology , Middle East Respiratory Syndrome Coronavirus/physiology , Adult , Aged , Antibodies, Neutralizing , Antibodies, Viral/blood , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Female , Genes, Viral , Humans , Male , Middle Aged , Middle East Respiratory Syndrome Coronavirus/classification , Public Health Surveillance , RNA, Viral , Saudi Arabia/epidemiology , Symptom Assessment , Viral Load
3.
Sci Rep ; 9(1): 1390, 2019 02 04.
Article in English | MEDLINE | ID: mdl-30718599

ABSTRACT

Known human coronaviruses (hCoV) usually cause mild to moderate upper-respiratory tract illnesses, except SARS-CoV and MERS-CoV, which, in addition to mild illness can also be associated with severe respiratory diseases and high mortality rates. Well-characterized multiplexed serologic assays are needed to aid in rapid detection and surveillance of hCoVs. The present study describes development and evaluation of a multiplexed magnetic microsphere immunoassay (MMIA) to simultaneously detect immunoglobulin G (IgG) antibodies specific for recombinant nucleocapsid proteins (recN) from hCoVs 229E, NL63, OC43, HKU1, SARS-CoV, and MERS-CoV. We used paired human sera to screen for IgG with reactivity against six hCoVs to determine assay sensitivity, specificity and reproducibility. We found no signal interference between monoplex and multiplex assay formats (R2 range = 0.87-0.97). Screening of paired human sera using MMIA, resulted in 92 of 106 (sensitivity: 86%) as positive and 68 of 80 (specificity: 84%) as negative. This study serves as a proof of concept that it is feasible to develop and use a multiplexed microsphere immunoassay as a next generation screening tool for use in large scale seroprevalence studies of hCoVs.


Subject(s)
Antibodies, Viral/blood , Coronavirus/immunology , Immunoassay/methods , Immunoglobulin G/blood , Antigens, Viral/immunology , Cross Reactions/immunology , Fluorescence , Humans , Microspheres , ROC Curve , Reproducibility of Results , Sensitivity and Specificity
4.
Infect Control Hosp Epidemiol ; 40(1): 79-88, 2019 01.
Article in English | MEDLINE | ID: mdl-30595141

ABSTRACT

OBJECTIVE: To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications. DESIGN: Outbreak investigation. SETTING: Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit. METHODS: Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases. RESULTS: In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive. CONCLUSIONS: We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Cross Infection/transmission , Middle East Respiratory Syndrome Coronavirus/isolation & purification , Adult , Aged , Aged, 80 and over , Base Sequence , Contact Tracing , Cross Infection/epidemiology , Cross Infection/virology , Disease Outbreaks , Female , Health Personnel , Humans , Infection Control/methods , Male , Middle Aged , Middle East Respiratory Syndrome Coronavirus/genetics , RNA, Viral/genetics , Saudi Arabia/epidemiology
5.
Open Forum Infect Dis ; 5(5): ofy095, 2018 May.
Article in English | MEDLINE | ID: mdl-30294616

ABSTRACT

BACKGROUND: An outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in Jordan in 2015 involved a variant virus that acquired distinctive deletions in the accessory open reading frames. We conducted a molecular and seroepidemiologic investigation to describe the deletion variant's transmission patterns and epidemiology. METHODS: We reviewed epidemiologic and medical chart data and analyzed viral genome sequences from respiratory specimens of MERS-CoV cases. In early 2016, sera and standardized interviews were obtained from MERS-CoV cases and their contacts. Sera were evaluated by nucleocapsid and spike protein enzyme immunoassays and microneutralization. RESULTS: Among 16 cases, 11 (69%) had health care exposure and 5 (31%) were relatives of a known case; 13 (81%) were symptomatic, and 7 (44%) died. Genome sequencing of MERS-CoV from 13 cases revealed 3 transmissible deletions associated with clinical illness during the outbreak. Deletion variant sequences were epidemiologically clustered and linked to a common transmission chain. Interviews and sera were collected from 2 surviving cases, 23 household contacts, and 278 health care contacts; 1 (50%) case, 2 (9%) household contacts, and 3 (1%) health care contacts tested seropositive. CONCLUSIONS: The MERS-CoV deletion variants retained human-to-human transmissibility and caused clinical illness in infected persons despite accumulated mutations. Serology suggested limited transmission beyond that detected during the initial outbreak investigation.

6.
Open Forum Infect Dis ; 5(6): ofy111, 2018 Jun.
Article in English | MEDLINE | ID: mdl-30294617

ABSTRACT

Middle East respiratory syndrome coronavirus (MERS-CoV) is associated with a wide range of clinical presentations, from asymptomatic or mildly ill to severe respiratory illness including death. We describe isolation of infectious MERS-CoV from the upper respiratory tract of a mildly ill 27-year-old female in Saudi Arabia 15 days after illness onset.

7.
J Med Virol ; 90(2): 367-371, 2018 02.
Article in English | MEDLINE | ID: mdl-28906003

ABSTRACT

The Centers for Disease Control and Prevention (CDC) algorithm for detecting presence of serum antibodies against Middle East Respiratory Syndrome coronavirus (MERS-CoV) in subjects with potential infections with the virus has included screening by indirect ELISA against recombinant nucleocapsid (N) protein and confirmation by immunofluorescent staining of infected monolayers and/or microneutralization titration. Other international groups include indirect ELISA assays using the spike (S) protein, as part of their serological determinations. In the current study, we describe development and validation of an indirect MERS-CoV S ELISA to be used as part of our serological determination for evidence of previous exposure to the virus.


Subject(s)
Antibodies, Viral/blood , Coronavirus Infections/diagnosis , Enzyme-Linked Immunosorbent Assay/methods , Middle East Respiratory Syndrome Coronavirus/immunology , Serologic Tests/methods , Spike Glycoprotein, Coronavirus/immunology , Algorithms , Humans
8.
Emerg Infect Dis ; 20(12): 2148-51, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25418612

ABSTRACT

To investigate potential transmission of Middle East respiratory syndrome coronavirus (MERS-CoV) to health care workers in a hospital, we serologically tested hospital contacts of the index case-patient in Saudi Arabia, 4 months after his death. None of the 48 contacts showed evidence of MERS-CoV infection.


Subject(s)
Coronavirus Infections/transmission , Cross Infection , Health Personnel , Middle East Respiratory Syndrome Coronavirus , Adult , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Female , Humans , Male , Middle Aged , Young Adult
9.
PLoS One ; 8(12): e83075, 2013.
Article in English | MEDLINE | ID: mdl-24376637

ABSTRACT

Respiratory syncytial virus (RSV) is a high priority target for vaccine development. One concern in RSV vaccine development is that a non-live virus vaccine would predispose for enhanced disease similar to that seen with the formalin inactivated RSV (FI-RSV) vaccine. Since a mAb specific to RSV G protein can reduce pulmonary inflammation and eosinophilia seen after RSV infection of FI-RSV vaccinated mice, we hypothesized that RSV G peptides that induce antibodies with similar reactivity may limit enhanced disease after subunit or other non-live RSV vaccines. In support of this hypothesis, we show that FI-RSV vaccinated mice administered RSV G peptide vaccines had a significant reduction in enhanced disease after RSV challenge. These data support the importance of RSV G during infection to RSV disease pathogenesis and suggest that use of appropriately designed G peptide vaccines to reduce the risk of enhanced disease with non-live RSV vaccines merits further study.


Subject(s)
Antibodies, Viral/blood , Peptides/immunology , Respiratory Syncytial Virus Infections/prevention & control , Respiratory Syncytial Virus Vaccines/immunology , Respiratory Syncytial Viruses/immunology , Viral Fusion Proteins/immunology , Amino Acid Sequence , Animals , Formaldehyde , Immunization , Lung/drug effects , Lung/immunology , Lung/virology , Mice , Mice, Inbred BALB C , Molecular Sequence Data , Peptides/administration & dosage , Peptides/chemistry , Respiratory Syncytial Virus Infections/immunology , Respiratory Syncytial Virus Infections/virology , Respiratory Syncytial Virus Vaccines/administration & dosage , Respiratory Syncytial Viruses/chemistry , Vaccines, Inactivated , Viral Fusion Proteins/chemistry
10.
J Food Prot ; 70(3): 635-40, 2007 Mar.
Article in English | MEDLINE | ID: mdl-17388052

ABSTRACT

Small and very small meat-processing facilities in the United States are in need of a pathogen reduction technology that would be both effective and economical. In the present study, the effectiveness of a commercial household steam cleaner for reducing naturally occurring bacterial populations on freshly slaughtered beef and hog carcasses was evaluated in four small or very small meat-processing plants. Three anatomical sites on the right half of each carcass were exposed to a 60-s steam treatment, and the corresponding left half of the carcass remained untreated. Samples were collected from 72 beef and 72 hog carcasses before, immediately after, and 24 h after the steam treatment. The mean populations of total aerobes, coliforms, and Enterobacteriaceae recovered from three anatomical sites on the beef carcasses were 1.88, 1.89, and 1.36 log CFU/cm2, respectively, before the steam treatment, 1.00, 0.71, and 0.52 log CFU/cm2, respectively, immediately after the steam treatment, and 1.10, 0.95, and 0.50 log CFU/cm2, respectively, 24 h after the steam treatment. On hog carcasses, the mean populations of total aerobes, coliforms, and Enterobacteriaceae recovered from the three anatomical sites were 2.50, 2.41, and 1.88 log CFU/cm2, respectively, before the steam treatment, 0.50, 0.94, and 0.21 log CFU/cm2, respectively, immediately after the steam treatment, and 0.91, 1.56, and 0.44 log CFU/cm2, respectively, 24 h after the steam treatment. The steam treatment significantly reduced the total aerobes, coliforms, and Enterobacteriaceae at all three anatomical locations on both types of carcasses (P < 0.05). The order of mean bacterial populations recovered before steam treatment was midline > neck > rump for beef carcasses and belly > jowl > ham for hog carcasses except for the total coliform counts at the midline and neck areas on the beef carcasses. Of the 144 carcasses evaluated, 5 (3.47%) were positive for Salmonella before steam treatment, but all carcasses tested negative for Salmonella after the treatment. Results indicate that the household steam cleaner can effectively reduce overall bacterial populations on freshly slaughtered beef and hog carcasses in small and very small meat-processing facilities.


Subject(s)
Bacteria/growth & development , Cattle/microbiology , Enterobacteriaceae/growth & development , Food-Processing Industry/methods , Steam , Swine/microbiology , Animals , Colony Count, Microbial , Food Contamination/analysis , Food Contamination/prevention & control , Food Microbiology , Humans , Time Factors
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