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PostPosted: Wed Aug 27, 2014 6:28 pm 
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NEJM paper describes mild MERS cases in family contacts of confirmed cases.

http://www.nejm.org/doi/full/10.1056/NE ... tured_home

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PostPosted: Wed Aug 27, 2014 6:30 pm 
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Transmission of MERS-Coronavirus in Household Contacts
Christian Drosten, M.D., Benjamin Meyer, M.Sc., Marcel A. Müller, Ph.D., Victor M. Corman, M.D., Malak Al-Masri, R.N., Raheela Hossain, M.D., Hosam Madani, M.Sc., Andrea Sieberg, B.Sc., Berend Jan Bosch, Ph.D., Erik Lattwein, Ph.D., Raafat F. Alhakeem, M.D., Abdullah M. Assiri, M.D., Waleed Hajomar, M.Sc., Ali M. Albarrak, M.D., Jaffar A. Al-Tawfiq, M.D., Alimuddin I. Zumla, M.D., and Ziad A. Memish, M.D.
N Engl J Med 2014; 371:828-835August 28, 2014DOI: 10.1056/NEJMoa1405858

SOURCE INFORMATION
From the Institute of Virology, University of Bonn Medical Center, Bonn (C.D., B.M., M.A.M., V.M.C., A.S.), and Euroimmun, Lübeck (E.L.) — both in Germany; Global Center for Mass Gatherings Medicine, Ministry of Health (M.A.-M., R.F.A., A.M. Assiri, A.I.Z., Z.A.M.), Prince Sultan Military Medical City (A.M. Albarrak), and Alfaisal University (Z.A.M.), Riyadh, Johns Hopkins Aramco Healthcare, Dhahran (J.A.A.-T.), and Regional Laboratory, Ministry of Health, Jeddah (R.H., H.M.) and Riyadh (W.H.) — all in Saudi Arabia; Indiana University School of Medicine, Indianapolis (J.A.A.-T.); the Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands (B.J.B.); and the Division of Infection and Immunity, University College London (UCL), and National Institute for Health Research Biomedical Research Centre, UCL Hospitals, London (A.I.Z.).
Address reprint requests to Dr. Memish at Alfaisal University, P.O. Box 54146, Riyadh 11514, Saudi Arabia, or at zmemish@yahoo.com; or to Dr. Drosten at the Institute of Virology, University of Bonn Medical Center, 53105 Bonn, Germany, or at drosten@virology-bonn.de.

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PostPosted: Wed Aug 27, 2014 6:32 pm 
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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.

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PostPosted: Wed Aug 27, 2014 6:33 pm 
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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.

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PostPosted: Wed Aug 27, 2014 6:33 pm 
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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.

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PostPosted: Wed Aug 27, 2014 6:33 pm 
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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.
Dr. Drosten reports receiving grant support from the European Commission EMPERIE program (contract no. 223498) and ANTIGONE program (contract no. 278976) and from the German Center for Infection Research, the German Ministry for Research and Education, and the German Research Council (grants 01KIO701 and DR 772/3-1); and Dr. Zumla, receiving support from the University College London (UCL) Hospitals NHS Foundation Trust, the National Institute of Health Research, Biomedical Research Centre, UCL Hospitals, the European and Developing Countries Clinical Trials Partnership, and the Seventh Framework Program of the European Commission for Rapid Identification of Respiratory Tract Infections. No other potential conflict of interest relevant to this article was reported.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
We thank all the staff members at the Saudi Arabian Ministry of Health.

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