Abstract
Purpose: To examine virulence (severity of disease and/or symptoms) and response to therapy (medications, supportive measures) between confirmed cases of MERS-CoV animal-to-human transmission compared with cases resulting from human-to-human transmission.Methods: The records for laboratory-confirmed MERS-CoV infections that were diagnosed at King Fahad Hofuf Hospital (Al-Ahsa, Saudi Arabia) from April 1, 2012 to November 30, 2016 were reviewed retrospectively.Results: There were 107 laboratory-confirmed MERS-CoV cases. Transmission of the virus from animal-to-human was less common (21.4 vs 78.6 %). The human-to-human transmission group had a higher mortality rate (53.57 vs 39.13 %). Patients in this group also had higher APACHEE II (11.2 vs 23, p = 0.043), SOFA scores (10.9 vs 12.55, p = 0.076), and higher rates of sepsis (17.39 vs 26.19 %, p = 0.582) and septic shock (13.04 vs 20.23 %, p = 0.555). The infections were more severe in the humanto- human transmission group; patients had increased rates of intensive care unit (ICU) admission (43.47 vs 51.19 %), decreased time from symptom onset until ICU admission, and greater need for mechanical ventilation (8 days vs 4 days, p = 0.041, and 6 days vs 4 days, respectively), longer time to respond to antiviral treatment and resolve the infection (5 days vs 11 days and 7 days vs 13 days, respectively) and a shorter time from the beginning of symptoms until death (11 days vs 5 days, p = 0.048).Conclusion: MERS-CoV transmitted from human-to-human was more virulent, resulted in higher casemortality rates and required more ICU treatment.Keywords: Animal-to-human, Human-to-human, MERS-CoV, Outcomes, Primary infection, Secondary infection, Virulence
Highlights
Infection with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was diagnosed first in patients from the Kingdom of Saudi Arabia (KSA) in April 2012. [1]
The variables for which data were collected included patients’ information, mode of MERSCoV transmission, co-morbid conditions, complications related to MERS-CoV infection, time of symptom onset, clinical symptoms, laboratory abnormalities, medications, and supportive measures offered to the patient and treatment outcomes
We examined between-group differences in demographic characteristics, comorbidities, symptoms, laboratory findings, screening for microbial coinfections, use of antibacterials, antiviral agents and supportive measures, complications related to MERS-CoV infection, MERS-CoV infection severities, and treatment outcomes for 107 patients infected with MERSCoV via animal-to-human transmission or human-to-human transmission of the virus
Summary
Infection with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was diagnosed first in patients from the Kingdom of Saudi Arabia (KSA) in April 2012. [1]. MERS-CoV infection has been diagnosed in individuals from at least 26 other countries who visited the Middle East, but most reported cases of the infection have been in residents of the KSA [2]. Lack of adherence to infection control and prevention measures has resulted in infections in groups of individuals who are in close contact and in healthcare settings [5,9]. This evidence supports the theory of human-to-human transmission. No transmission at the community level of MERSCoV has yet been detected
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