American Journal of Infection Control
Volume 42, Issue 12, p1255-1346 December 2014
http://www.ajicjournal.org/current

Commentary
Nebraska Biocontainment Unit perspective on disposal of Ebola medical waste
John J. Lowe, Shawn G. Gibbs, Shelly S. Schwedhelm, John Nguyen, Philip W. Smith
p1256–1257
Preview
Clinical practices surrounding the current Ebola epidemic have been center stage in discourse concerning research and practice of care. As the medical community becomes more sophisticated in understanding the many facets of treating and containing this virus, the Nebraska Biocontainment Unit has identified Ebola medical waste disposal as a key area of concern for U.S. hospitals. The requirements for processing Ebola medical waste stand to impact most U.S. hospitals currently preparing readiness plans to receive and treat patients with suspected or confirmed Ebola virus disease (EVD).

Middle East respiratory syndrome coronavirus infection control: The missing piece?
Ziad A. Memish, Jaffar A. Al-Tawfiq
p1258–1260
Preview
Since the initial occurrence of Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012,1,2 the disease had caused 837 cases, with a case fatality rate of 34.7%.3 As with any emerging infectious diseases of pandemic potential there is a concern of the global spread of the disease. It is therefore the first priority of the global public health community to develop and implement the required infection control practices to prevent the dissemination of these emerging organisms within health care facilities (HCFs) and worldwide based on the best available evidence and previous experience with similar or related groups of pathogens.

Middle East respiratory syndrome coronavirus: Implications for health care facilities
Helena C. Maltezou, MD, PhD, Sotirios Tsiodras, MD, PhD
DOI: http://dx.doi.org/10.1016/j.ajic.2014.06.019
Highlights
:: Health care–associated transmission plays a pivotal role in the Middle East respiratory syndrome coronavirus epidemic.
:: Gaps in infection control were noted in all health care–associated events.
:: There is a need to increase infection control capacity.
:: Studies about the effectiveness of infection control measures are needed.
:: Vaccines and antiviral agents against Middle East respiratory syndrome coronavirus are urgently needed.
Abstract
Background
Middle East respiratory syndrome coronavirus (MERS-CoV) is a novel coronavirus that causes a severe respiratory disease with high case fatality rate. Starting in March 2014, a dramatic increase of cases has occurred in the Arabian Peninsula, many of which were acquired in health care settings. As of May 9, 2014, 536 laboratory-confirmed cases and 145 deaths have been reported globally.
Methods
Review of publicly available data about MERS-CoV health care–associated transmission.
Results
We identified 11 events of possible or confirmed health care–associated transmission with high morbidity and mortality, mainly among patients with comorbidities. Health care workers are also frequently affected; however, they tend to have milder symptoms and better prognosis. Gaps in infection control were noted in all events. Currently, health care–associated outbreaks are playing a pivotal role in the evolution of the MERS-CoV epidemic in countries in the Arabian Peninsula.
Conclusion
There is a need to increase infection control capacity in affected areas and areas at increased risk of being affected to prevent transmission in health care settings. Vaccines and antiviral agents are urgently needed. Overall, our knowledge about the epidemiologic characteristics of MERS-CoV that impact health care transmission is very limited. As the MERS-CoV epidemic continues to evolve, issues concerning best infection control measures will arise, and studies to better define their effectiveness in real life are needed.

Environmental sampling for respiratory pathogens in Jeddah airport during the 2013 Hajj season
Ziad A. Memish, MD, Malak Almasri, RN, Abdullah Assirri, MD, Ali M. Al-Shangiti, PhD, Gregory C. Gray, MD, John A. Lednicky, PhD, Saber Yezli, PhD
DOI: http://dx.doi.org/10.1016/j.ajic.2014.07.027
Abstract
Background
Respiratory tract infections (RTIs) are common during the Hajj season and are caused by a variety of organisms, which can be transmitted via the air or contaminated surfaces. We conducted a study aimed at sampling the environment in the King Abdul Aziz International (KAAI) Airport, Pilgrims City, Jeddah, during Hajj season to detect respiratory pathogens.
Methods
Active air sampling was conducted using air biosamplers, and swabs were used to sample frequently touched surfaces. A respiratory multiplex array was used to detect bacterial and viral respiratory pathogens.
Results
Of the 58 environmental samples, 8 were positive for at least 1 pathogen. One air sample (1 of 18 samples, 5.5%) tested positive for influenza B virus. Of the 40 surface samples, 7 (17.5%) were positive for pathogens. These were human adenovirus (3 out of 7, 42.8%), human coronavirus OC43/HKU1 (3 out of 7, 42.8%), Haemophilus influenzae (1 out of 7, 14.2%), and Moraxella catarrhalis (1 out of 7, 14.2%). Chair handles were the most commonly contaminated surfaces. The handles of 1 chair were cocontaminated with coronavirus OC43/HKU1 and H influenzae.
Conclusion
Respiratory pathogens were detected in the air and on surfaces in the KAAI Airport in Pilgrims City. Larger-scale studies based on our study are warranted to determine the role of the environment in transmission of respiratory pathogens during mass gathering events (eg, Hajj) such that public health preventative measures might be better targeted.