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. 2019 Dec;39(12):2608-2624.
doi: 10.1111/risa.13389. Epub 2019 Sep 16.

A Case Study Evaluating the Risk of Infection from Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) in a Hospital Setting Through Bioaerosols

Umesh Adhikari  1 , Alexandre Chabrelie  1 , Mark Weir  2 , Kevin Boehnke  3 , Erica McKenzie  4 , Luisa Ikner  5 , Meng Wang  6 , Qing Wang  7 , Kyana Young  8 , Charles N Haas  9 , Joan Rose  8 , Jade Mitchell  1
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A Case Study Evaluating the Risk of Infection from Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) in a Hospital Setting Through Bioaerosols

Umesh Adhikari et al. Risk Anal. 2019 Dec.

Abstract

Middle Eastern respiratory syndrome, an emerging viral infection with a global case fatality rate of 35.5%, caused major outbreaks first in 2012 and 2015, though new cases are continuously reported around the world. Transmission is believed to mainly occur in healthcare settings through aerosolized particles. This study uses Quantitative Microbial Risk Assessment to develop a generalizable model that can assist with interpreting reported outbreak data or predict risk of infection with or without the recommended strategies. The exposure scenario includes a single index patient emitting virus-containing aerosols into the air by coughing, leading to short- and long-range airborne exposures for other patients in the same room, nurses, healthcare workers, and family visitors. Aerosol transport modeling was coupled with Monte Carlo simulation to evaluate the risk of MERS illness for the exposed population. Results from a typical scenario show the daily mean risk of infection to be the highest for the nurses and healthcare workers (8.49 × 10-4 and 7.91 × 10-4 , respectively), and the lowest for family visitors and patients staying in the same room (3.12 × 10-4 and 1.29 × 10-4 , respectively). Sensitivity analysis indicates that more than 90% of the uncertainty in the risk characterization is due to the viral concentration in saliva. Assessment of risk interventions showed that respiratory masks were found to have a greater effect in reducing the risks for all the groups evaluated (>90% risk reduction), while increasing the air exchange was effective for the other patients in the same room only (up to 58% risk reduction).

Keywords: Hospital; MERS-CoV; QMRA; mitigation; risk characterization.

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Figures

Figure 1
Figure 1
Exposure scenario and QMRA outline steps. QMRA = Quantitative Microbial Risk Assessment; MERS = Middle Eastern respiratory syndrome virus; HCW = healthcare worker.
Figure 2
Figure 2
Boxplots of daily risk of MERS infection with 6 ACH air exchange rate illustrating the p‐values calculated for pairwise t‐tests between groups. ACH = air change per hour; HCW = healthcare worker.
Figure 3
Figure 3
Aggregated mean risk of infection rate with six air changes over days exposed. Vertical bars denote standard error. HCW = healthcare worker.
Figure 4
Figure 4
Parameter sensitivity of the daily risk. ACH = air change per hour; HCW = healthcare worker.
Figure 5
Figure 5
Effect of risk management strategies on average daily risk of infection. ACH = air change per hour; HCW = healthcare worker.
See this image and copyright information in PMC

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