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TO THE EDITOR—First identified in April 2012, Middle East respiratory syndrome (MERS) usually derives from individuals in close contact with camels. The infection may then spread to close contacts, including healthcare workers (HCWs) who are exposed to the patient through droplet and contact transmission. To date, no other transmission method has been definitively identified [1]. However, evidence exists that a number of those infected by South Korea’s index MERS case resided in the same hospital but on different wards or floors, making droplet or contact transmission highly unlikely. As a result of this and other examples, it seems increasingly possible that MERS may also spread through fomites [1–3]. The 2003 severe acute respiratory syndrome (SARS) epidemic in Taiwan offers a well-documented example of transmission via fomites [4]. Shortly after the index SARS case entered Hoping Hospital in Taipei, a nosocomial SARS outbreak occurred. Similar to the South KoreanMERS case, in the initial phase 17 HCWs contracted SARS despite working in separate sectors of the hospital and having no direct contact with the index patient. Within 2 weeks, the hospital suffered 150 SARS cases and was sealed off. Many patients and contacts who had unknowingly contracted the disease and who had not been quarantined moved to other hospitals where nosocomial spread recurred, eventually spreading throughout Taiwan [4]. Evidence of fomite transmission derived from a post facto environmental survey of one hospital where SARS coronavirus (CoV) RNA was found on drinking water fountains in the triage and observation units, in designated SARS areas, and in supposedly clean areas [5]. As SARSCoV proved capable of surviving in the environment for 1–3 days [6], HCWs were unwittingly spreading the virus throughout the hospital via fomite transmission [7]. We anticipate that an environmental survey of the Samsung hospital in Seoul will likely find similar transmission paths. Further research revealed that when caring for patients with highly contagious SARS, personal protective equipment and negative pressure isolation rooms prevented contact and droplet transmission. However, HCWs and citizens remained vulnerable to fomite transmission from the moment undiagnosed SARS patients arrived at emergency departments, until they were placed in isolation [7]. The Taiwan Center for Disease Control (TCDC) response to fomite transmission was to implement traffic control bundling (TCB) [7]. TCB includes “triage before hospital” (divert patients to outdoor fever screening stations); “zones of risk” (delineate zones of risk between

Controlling Middle East Respiratory Syndrome: Lessons Learned From Severe Acute Respiratory Syndrome: Figure 1.