Abstract
To date, 1841 cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported worldwide, with 652 deaths. We used a publically available case line list to explore the effect of relevant factors, notably underlying comorbidities, on fatal outcome of Middle East respiratory syndrome (MERS) cases up to the end of October 2016. A Bayesian Weibull proportional hazards regression model was used to assess the effect of comorbidity, age, epidemic period and sex on the fatality rate of MERS cases and its variation across countries. The crude fatality rate of MERS cases was 32.1% (95% credibility interval (CI): 29.9%, 34.3%). Notably, the incremental change of daily death rate was most prominent during the first week since disease onset with an average increase of 13%, but then stabilized in the remaining two weeks when it only increased 3% on average. Neither sex, nor country of infection were found to have a significant impact on fatality rates after taking into account the age and comorbidity status of patients. After adjusting for age, epidemic period, MERS patients with comorbidity had around 4 times the risk for fatal infection than those without (adjusted hazard ratio of 3.74 (95% CI: 2.57, 5.67)).
Highlights
According to previous studies, the emerging disease has only modest transmissibility[9, 12]
The fatality rate of Middle East respiratory syndrome (MERS) cases based on the data till the end of October, 2016 was 32.1%
We quantified the effect of comorbidity on fatality rate of MERS cases by using a multilevel Weibull proportional hazards regression model
Summary
The emerging disease has only modest transmissibility[9, 12]. A genomic study has revealed the genetic diversity in case clusters, suggesting sporadic virus introduction from an animal reservoir[13] This epidemiological evidence indicates that MERS-CoV probably has low pandemic potential, adaptation towards improved human-to-human transmission remains a concern[9, 14]. The outbreak of MERS in South Korea and China in 2015 only underlined the importance of disease surveillance and disease control strategies, especially in hospitals[10] This is reminiscent of the 2003 outbreak of severe acute respiratory syndrome (SARS)[15, 17], caused by a coronavirus, with a case fatality rate around 10%, which was even higher at 46% in cases with comorbidities[15]. The case fatality rate may vary from country to country due to the difference in disease surveillance system and health care system[12, 21]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
