Transmission of MERS-Coronavirus in Household Contacts

BACKGROUND: Strategies to contain the Middle East respiratory syndrome coronavirus (MERS-CoV) depend on knowledge of the rate of human-to-human transmission, including subclinical infections. A lack of serologic tools has hindered targeted studies of transmission. METHODS: We studied 26 index patients with MERS-CoV infection and their 280 household contacts. The median time from the onset of symptoms in index patients to the latest blood sampling in contact patients was 17.5 days (range, 5 to 216; mean, 34.4). Probable cases of secondary transmission were identified on the basis of reactivity in two reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assays with independent RNA extraction from throat swabs or reactivity on enzyme-linked immunosorbent assay against MERS-CoV S1 antigen, supported by reactivity on recombinant S-protein immunofluorescence and demonstration of neutralization of more than 50% of the infectious virus seed dose on plaque-reduction neutralization testing. RESULTS: Among the 280 household contacts of the 26 index patients, there were 12 probable cases of secondary transmission (4%; 95% confidence interval, 2 to 7). Of these cases, 7 were identified by means of RT-PCR, all in samples obtained within 14 days after the onset of symptoms in index patients, and 5 were identified by means of serologic analysis, all in samples obtained 13 days or more after symptom onset in index patients. Probable cases of secondary transmission occurred in 6 of 26 clusters (23%). Serologic results in contacts who were sampled 13 days or more after exposure were similar to overall study results for combined RT-PCR and serologic testing. CONCLUSIONS: The rate of secondary transmission among household contacts of patients with MERS-CoV infection has been approximately 5%. Our data provide insight into the rate of subclinical transmission of MERS-CoV in the home

Transmission characteristics of MERS and SARS in the healthcare setting: a comparative study

Background: The Middle East respiratory syndrome (MERS) coronavirus has caused recurrent outbreaks in the Arabian Peninsula since 2012. Although MERS has low overall human-to-human transmission potential, there is occasional amplification in the healthcare setting, a pattern reminiscent of the dynamics of the severe acute respiratory syndrome (SARS) outbreaks in 2003. Here we provide a head-to-head comparison of exposure patterns and transmission dynamics of large hospital clusters of MERS and SARS, including the most recent South Korean outbreak of MERS in 2015. Methods: To assess the unexpected nature of the recent South Korean nosocomial outbreak of MERS and estimate the probability of future large hospital clusters, we compared exposure and transmission patterns for previously reported hospital clusters of MERS and SARS, based on individual-level data and transmission tree information. We carried out simulations of nosocomial outbreaks of MERS and SARS using branching process models rooted in transmission tree data, and inferred the probability and characteristics of large outbreaks. Results: A significant fraction of MERS cases were linked to the healthcare setting, ranging from 43.5 % for the nosocomial outbreak in Jeddah, Saudi Arabia, in 2014 to 100 % for both the outbreak in Al-Hasa, Saudi Arabia, in 2013 and the outbreak in South Korea in 2015. Both MERS and SARS nosocomial outbreaks are characterized by early nosocomial super-spreading events, with the reproduction number dropping below 1 within three to five disease generations. There was a systematic difference in the exposure patterns of MERS and SARS: a majority of MERS cases occurred among patients who sought care in the same facilities as the index case, whereas there was a greater concentration of SARS cases among healthcare workers throughout the outbreak. Exposure patterns differed slightly by disease generation, however, especially for SARS. Moreover, the distributions of secondary cases per single primary case varied highly across individual hospital outbreaks (Kruskal–Wallis test; P \u3c 0.0001), with significantly higher transmission heterogeneity in the distribution of secondary cases for MERS than SARS. Simulations indicate a 2-fold higher probability of occurrence of large outbreaks (\u3e100 cases) for SARS than MERS (2 % versus 1 %); however, owing to higher transmission heterogeneity, the largest outbreaks of MERS are characterized by sharper incidence peaks. The probability of occurrence of MERS outbreaks larger than the South Korean cluster (n = 186) is of the order of 1 %. Conclusions: Our study suggests that the South Korean outbreak followed a similar progression to previously described hospital clusters involving coronaviruses, with early super-spreading events generating a disproportionately large number of secondary infections, and the transmission potential diminishing greatly in subsequent generations. Differences in relative exposure patterns and transmission heterogeneity of MERS and SARS could point to changes in hospital practices since 2003 or differences in transmission mechanisms of these coronaviruses

Old World cutaneous leishmaniasis treatment response varies depending on parasite species, geographical location and development of secondary infection

Background: In the Kingdom of Saudi Arabia (KSA), Leishmania major and L. tropica are the main causative agents of Old World cutaneous leishmaniasis (CL). The national CL treatment regimen consists of topical 1% clotrimazole/2% fusidic acid cream followed by 1–2 courses of intralesional sodium stibogluconate (SSG); however, treatment efficacy is highly variable and the reasons for this are not well understood. In this study, we present a complete epidemiological map of CL and determined the efficacy of the standard CL treatment regime in several endemic regions of KSA. Results: Overall, three quarters of patients in all CL-endemic areas studied responded satisfactorily to the current treatment regime, with the remaining requiring only an extra course of SSG. The majority of unresponsive cases were infected with L. tropica. Furthermore, the development of secondary infections (SI) around or within the CL lesion significantly favoured the treatment response of L. major patients but had no effect on L. tropica cases. Conclusions: The response of CL patients to a national treatment protocol appears to depend on several factors, including Leishmania parasite species, geographical location and occurrences of SI. Our findings suggest there is a need to implement alternative CL treatment protocols based on these parameters

Some Biochemical Changes In Postmenopausal Women With And Without Metabolic Syndrome

Women with the metabolic syndrome are known to be at especially high risk for cardiovascular disease (CVD). The prevalence of metabolic syndrome increases dramatically with menopause and may partially explain the apparent increase CVD after menopause. This study was performed to investigate the relationships between metabolic syndrome (MS) related parameters and the cardiovascular risk factors in Saudi postmenopausal women. Subjects with MS had significantly higher plasma levels of glucose, uric acid, TC, LDL-c, triacylglycerol and atherogenic index, and lower levels of HDL-c and zinc compared to subjects without MS. Also, the subjects with MS had significantly higher levels of plasma ALT, AST, transferrin, TIBC and ferritin in comparison to those without MS. Postmenopausal women with MS had significantly higher levels of plasma iron compared with control group and premenopausal women with MS. Plasma ALT was positively correlated with ferritin level, waist circumference, body mass index, iron, and AST in postmenopausal women with MS. On other hand, ferritin level was associated with the variables of metabolic syndrome (positive correlation with systolic blood pressure, triacylglycerol, LDL-c), and also was positively correlated with iron, and ALT. In conclusion, there is an association between postmenopausal status, MS and cardiovascular risk. Furthermore, levels of plasma ferritin are correlated with the levels of LDL-c, ALT & AST as well as with the components of metabolic syndrome in Saudi postmenopausal women. Because of the severe implications of cardiovascular diseases, counseling programs directed towards high-risk populations should be endorsed. Keywords: Postmenopausal women, Metabolic syndrome, Cardiovascular diseases, Iron, Ferritin, Uric acid, Zinc. Egyptian Journal of Biochemistry and Molecular Biology Vol. 26 (2) 2008: pp. 67-8

Correlating Salivary Levels of Immunoglobin E and Human Eosinophil Cationic Protein in the Aseer Cohort with Recurrent Apthous Stomatitis

Khalil Assiri,1 Jagadish Hosmani,1 Sandeepa Nuchilakath Chalikkandy,1 Abdullah M Alkahtani,2 Raghad Mohammed Alhanif,3 Sarah Ahmed Alsarh,3 Shankargouda Patil,4 Rodolfo Reda,5 Luca Testarelli5 1Department of Diagnostic Dental Sciences, College of Dentistry, King Khalid University, Abha, 62529, Saudi Arabia; 2Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha, Saudi Arabia; 3College of Dentistry, King Khalid University, Abha, Saudi Arabia; 4College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, 84095, USA; 5Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, 00161, ItalyCorrespondence: Jagadish Hosmani, Department of Diagnostic Dental Sciences, College of Dentistry, King Khalid University, Abha, 62529, Saudi Arabia, Tel +966532529838, Email [email protected] Rodolfo Reda, Department of Oral and Maxillo-Facial Science, Sapienza University of Rome, Via Caserta 06, Rome, 00161, Italy, Email [email protected]: Repeated Aphthous Stomatitis (RAS) is the most prevalent inflammatory disorder of the oral mucosa, characterized by recurrent emergence of single or numerous painful ulcers. RAS usually affects healthy people without systemic illnesses. There is evidence linking atopy to the progression of this illness. Immunoglobulin E (IgE) and human eosinophil cationic protein (HECP) levels in the saliva of individuals with aphthous stomatitis were assessed as allergy-related indicators.Materials and Methods: Sixty people were assessed for this study. 30 patients with RAS were included in the patient group, while 30 healthy individuals made up for the control group. Sixty participants’ non-stimulated saliva was taken and IgE and HECP were evaluated using enzyme-linked immunosorbent assay (ELISA). Data were analyzed in SPSS 20 through the Mann–Whitney test and p< 0.05 was considered significant.Results: The salivary level of HECP was significantly (p 0.05) higher among cases (0.83 0.70) compared to controls (0.170 0.15), whereas the salivary level of IgE was not significantly (p = 0.41) higher among cases (35.60 11.19) compared to controls (67.42 18.34).Conclusion: Even though this study found a positive correlation between elevated HECP levels and RAS, additional research with larger sample sizes is required to identify the biological mechanisms responsible for the observed associations and to include salivary HECP levels in the RAS patient’s evaluation.Keywords: recurrent aphthous stomatitis, saliva, immunoglobulin E, human eosinophil cationic protei