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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Second U.S. MERS case another Saudi health care worker, contacts under 'voluntary' quarantine

Though unrelated to the recent MERS case in Indiana, the second U.S. case of the emerging coronavirus is also a health care worker who was apparently infected while working in a hospital in Jeddah, Saudi Arabia. The 44-year-old man is in good condition and under full MERS isolation measures at Orlando Health’s Dr. P. Phillips Hospital, officials announced Monday.

The Florida man was identified as a visitor from Saudi Arabia, where continuing hospital outbreaks have been “amplifying” MERS transmission and a quarter of the cases have been health care workers, according to a World Health Organization report. The Indiana MERS case who was recently discharged from Community Hospital in Munsey also had been working at a Saudi hospital.

“We don't have exact numbers for individuals from the U.S. who work in the region,” Tom Frieden, MD, MPH, director of the Centers for Disease Control and Prevention, said at press conference Monday. “We do know it's not rare -- one of the things that Saudi Arabia and other countries often do is to have [foreign] health care workers provide care. That's not just U.S. health care workers but health care workers from around the world. So this is an issue that is relevant for the World Health Organization and relevant for many countries that have, as we do, health care professionals working in the region.”

The recent WHO report cited infection control breakdowns as a factor in MERS transmission to health care workers in Saudi hospitals. In contrast, the infection control measures in the two U.S. hospitals that have admitted MERS cases have been effective in blocking subsequent transmission.

“What we're seeing is the importance of two key concepts [for] MERS,” Frieden said. “The first is the need for meticulous infection control in hospitals. And what has been done in Indiana and is being done in Florida is exactly what's needed to minimize the risk of spread. Rapid detection of a patient who's infected, rapid isolation and appropriate isolation of that individual, and then a furlough of health care workers who have had contact with that individual …so that if they become ill they will not create another chain of transmission.”

Health care contacts and family members of the Florida MERS patient were placed under “voluntary home quarantine” for the 14-day incubation period, the same measures the CDC enacted for the Indiana case. “The protocol that we have followed for both Indiana and Florida is that the very close contacts -- such as household contacts -- will be staying home, away from others, monitoring their health until the end of the 14-day exposure period,” Anne Schuchat, MD, director of CDC’s National Center for Immunization and Respiratory Diseases, said at the press conference. “If they're going out they’re wearing a mask.”

Florida patient ill while traveling

According to the CDC, on May 1st, the Florida patient departed Jeddah, Saudi Arabia, where hospital outbreaks of MERS have recently been reported. He flew to London and then on to Boston. The patient then traveled from Boston to Atlanta, and finally on to Orlando.

“The patient began feeling unwell during the flight from Jeddah to London and continued to feel unwell on the subsequent flights with reported symptoms including fever, chills and a slight cough,” Schuchat said.

Though the CDC said transmission was still unlikely, symptomatic patients are generally more likely to spread infection than those that are asymptomatic. The CDC is notifying some 500 passengers who may have been exposed during the patient’s flights, she added. The CDC is individually contacting passengers on the flights rather than publically announcing the flight numbers.

On May 8th, the patient went to the emergency department of Phillips Hospital in Orlando and was admitted the same day. The Florida hospital is using the CDC recommended standard, contact and airborne isolation precautions, meaning health care workers entering the patient’s room should be donning N95 respirators. "Public health and hospital officials are investigating and responding to the situation by reviewing appropriate infection control measures taken by the hospital, interviewing the healthcare staff and family members and others who had very close contact with the patient to obtain detailed information on their exposures,” Schuchat said.

Orlando Health's Phillips Hospital is also contacting any emergency room staff and patients who may have been exposed to the MERS case before he was placed in isolation. In an unusual twist, the MERS patient had recently “accompanied [another] patient undergoing a medical procedure at Orlando Regional Medical Center,” Phillips hospital stated. The hospitals are apparently affiliated, as both issued the same press release. Staff, patients and other contacts of the patient at both hospitals are being advised to take precautions that include voluntary quarantine and reporting to an emergency room at the first sign of symptoms.