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Al Knawy BA, Al-Kadri HMF, Elbarbary M, Arabi Y, Balkhy HH, Clark A. Perceptions of postoutbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study. BMJ Open 2019; 9:e017476. [PMID: 31061009 PMCID: PMC6502063 DOI: 10.1136/bmjopen-2017-017476] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES This study examines perceptions of the operational and organisational management of a major outbreak of Middle East Respiratory Syndrome (MERS) caused by a novel coronavirus (MERS-CoV) in the Kingdom of Saudi Arabia (KSA). Perspectives were sought from key decision-makers and clinical staff about the factors perceived to promote and inhibit effective and rapid control of the outbreak. SETTING A large teaching tertiary healthcare centre in KSA; the outbreak lasted 6 weeks from June 2015. PARTICIPANTS Data were collected via individual and focus group interviews with 28 key informant participants (9 management decision-makers and 19 frontline healthcare workers). DESIGN We used qualitative methods of process evaluation to examine perceptions of the outbreak and the factors contributing to, or detracting from successful management. Data were analysed using qualitative thematic content analysis. RESULTS Five themes and 15 subthemes were found. The themes were related to: (1) the high stress of the outbreak, (2) factors perceived to contribute to outbreak occurrence, (3) factors perceived to contribute to success of outbreak control, (4) factors inhibiting outbreak control and (5) long-term institutional gains in response to the outbreak management. CONCLUSION Management of the MERS-CoV outbreak at King Abdulaziz Medical City-Riyadh was widely recognised by staff as a serious outbreak of local and national significance. While the outbreak was controlled successfully in 6 weeks, progress in management was inhibited by a lack of institutional readiness to implement infection control (IC) measures and reduce patient flow, low staff morale and high anxiety. Effective management was promoted by greater involvement of all staff in sharing learning and knowledge of the outbreak, developing trust and teamwork and harnessing collective leadership. Future major IC crises could be improved via measures to strengthen these areas, better coordination of media management and proactive staff counselling and support.
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Affiliation(s)
| | - Hanan M F Al-Kadri
- College of Medicine, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mahmoud Elbarbary
- College of Public Health, King Abdulla International Research Center and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yaseen Arabi
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hanan H Balkhy
- Department of Pediatrics, King Abdullah International Medical Research Centre and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Alex Clark
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Zumla A, Alagaili AN, Cotten M, Azhar EI. Infectious diseases epidemic threats and mass gatherings: refocusing global attention on the continuing spread of the Middle East Respiratory syndrome coronavirus (MERS-CoV). BMC Med 2016; 14:132. [PMID: 27604081 PMCID: PMC5015245 DOI: 10.1186/s12916-016-0686-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/06/2016] [Indexed: 01/09/2023] Open
Abstract
Media and World Health Organization (WHO) attention on Zika virus transmission at the 2016 Rio Olympic Games and the 2015 Ebola virus outbreak in West Africa diverted the attention of global public health authorities from other lethal infectious diseases with epidemic potential. Mass gatherings such as the annual Hajj pilgrimage hosted by Kingdom of Saudi Arabia attract huge crowds from all continents, creating high-risk conditions for the rapid global spread of infectious diseases. The highly lethal Middle Eastern respiratory syndrome coronavirus (MERS-CoV) remains in the WHO list of top emerging diseases likely to cause major epidemics. The 2015 MERS-CoV outbreak in South Korea, in which 184 MERS cases including 33 deaths occurred in 2 months, that was imported from the Middle East by a South Korean businessman was a wake-up call for the global community to refocus attention on MERS-CoV and other emerging and re-emerging infectious diseases with epidemic potential. The international donor community and Middle Eastern countries should make available resources for, and make a serious commitment to, taking forward a "One Health" global network for proactive surveillance, rapid detection, and prevention of MERS-CoV and other epidemic infectious diseases threats.
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Affiliation(s)
- Alimuddin Zumla
- Division of Infection and Immunity, University College London, London, UK. .,NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK.
| | - Abdulaziz N Alagaili
- KSU Mammals Research Chair, Zoology Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Matthew Cotten
- Viroscience Department, Erasmus Medical Center, Rotterdam, Netherlands
| | - Esam I Azhar
- Special Infectious Agents Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia.,Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Zumla A, Dar O, Kock R, Muturi M, Ntoumi F, Kaleebu P, Eusebio M, Mfinanga S, Bates M, Mwaba P, Ansumana R, Khan M, Alagaili AN, Cotten M, Azhar EI, Maeurer M, Ippolito G, Petersen E. Taking forward a 'One Health' approach for turning the tide against the Middle East respiratory syndrome coronavirus and other zoonotic pathogens with epidemic potential. Int J Infect Dis 2016; 47:5-9. [PMID: 27321961 PMCID: PMC7128966 DOI: 10.1016/j.ijid.2016.06.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/08/2016] [Indexed: 01/01/2023] Open
Abstract
The appearance of novel pathogens of humans with epidemic potential and high mortality rates have threatened global health security for centuries. Over the past few decades new zoonotic infectious diseases of humans caused by pathogens arising from animal reservoirs have included West Nile virus, Yellow fever virus, Ebola virus, Nipah virus, Lassa Fever virus, Hanta virus, Dengue fever virus, Rift Valley fever virus, Crimean-Congo haemorrhagic fever virus, severe acute respiratory syndrome coronavirus, highly pathogenic avian influenza viruses, Middle East Respiratory Syndrome Coronavirus, and Zika virus. The recent Ebola Virus Disease epidemic in West Africa and the ongoing Zika Virus outbreak in South America highlight the urgent need for local, regional and international public health systems to be be more coordinated and better prepared. The One Health concept focuses on the relationship and interconnectedness between Humans, Animals and the Environment, and recognizes that the health and wellbeing of humans is intimately connected to the health of animals and their environment (and vice versa). Critical to the establishment of a One Health platform is the creation of a multidisciplinary team with a range of expertise including public health officers, physicians, veterinarians, animal husbandry specialists, agriculturalists, ecologists, vector biologists, viral phylogeneticists, and researchers to co-operate, collaborate to learn more about zoonotic spread between animals, humans and the environment and to monitor, respond to and prevent major outbreaks. We discuss the unique opportunities for Middle Eastern and African stakeholders to take leadership in building equitable and effective partnerships with all stakeholders involved in human and health systems to take forward a 'One Health' approach to control such zoonotic pathogens with epidemic potential.
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Affiliation(s)
- Alimuddin Zumla
- Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
| | - Osman Dar
- Public Health England, London, Chatham House Centre on Global Health Security, Royal Institute of International Affairs, London, UK
| | - Richard Kock
- Department of Pathology and Pathogen Biology, The Royal Veterinary College, Hertfordshire, UK
| | | | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale, Brazzaville, Republic of Congo; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Pontiano Kaleebu
- Medical Research Council/Uganda Virus Research Institute Research Unit on AIDS, Entebbe, Uganda
| | - Macete Eusebio
- Centro de Investigação em Saude de Manhiça, and National Directorate of Public Health, Ministry of Health, Maputo, Mozambique
| | - Sayoki Mfinanga
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Matthew Bates
- UNZA-UCLMS Project, University Teaching Hospital, Lusaka, Zambia
| | - Peter Mwaba
- UNZA-UCLMS Project, University Teaching Hospital, Lusaka, Zambia
| | - Rashid Ansumana
- Mercy Hospital Research Laboratory, Kulanda Town, Bo, Sierra Leone
| | - Mishal Khan
- London School of Hygiene and Tropical Medicine, London, UK; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Abdulaziz N Alagaili
- KSU Mammals Research Chair, Zoology Department, College of Science, King Saud University, Saudi Arabia
| | | | - Esam I Azhar
- Special Infectious Agents Unit, King Fahd Medical Research Centre, and Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Markus Maeurer
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Giuseppe Ippolito
- "Lazzaro Spallanzani" National Institute for Infectious Diseases - IRCCS, Rome, Italy
| | - Eskild Petersen
- University of Aarhus, Aarhus, Denmark; The Royal Hospital, Muscat, Oman.
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Arabi YM, Fowler R, Balkhy HH. Proceedings of the Middle East Respiratory Syndrome (MERS) Coronavirus research initiative workshop, September 9-10 2015 in Riyadh, KSA. J Infect Public Health 2016; 9:205-7. [PMID: 27036308 PMCID: PMC7128850 DOI: 10.1016/j.jiph.2016.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Yaseen M Arabi
- Intensive Care Department, MC 1425, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
| | - Rob Fowler
- University of Toronto, Department Medicine, Sunnybrook Health Sciences Centre, Canada; University of Toronto, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Canada.
| | - Hanan H Balkhy
- Paediatric Infectious Diseases, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Infection Prevention and Control, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
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