Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) shedding and antibody responses are not fully understood, particularly in relation to underlying medical conditions, clinical manifestations, and mortality. We enrolled MERS-CoV–positive patients at a hospital in Saudi Arabia and periodically collected specimens from multiple sites for real-time reverse transcription PCR and serologic testing. We conducted interviews and chart abstractions to collect clinical, epidemiologic, and laboratory information. We found that diabetes mellitus among survivors was associated with prolonged MERS-CoV RNA detection in the respiratory tract. Among case-patients who died, development of robust neutralizing serum antibody responses during the second and third week of illness was not sufficient for patient recovery or virus clearance. Fever and cough among mildly ill patients typically aligned with RNA detection in the upper respiratory tract; RNA levels peaked during the first week of illness. These findings should be considered in the development of infection control policies, vaccines, and antibody therapeutics.
Highlights
Middle East respiratory syndrome coronavirus (MERS-CoV) shedding and antibody responses are not fully understood, in relation to underlying medical conditions, clinical manifestations, and mortality
Investigations of virus shedding in MERS patients have demonstrated that MERS-CoV RNA can be detected in the respiratory tract for >1 month from illness onset [16,17]; lower respiratory tract (LRT) specimens have higher [18,19,20,21,22,23] and often more prolonged RNA levels [17,18] than upper respiratory tract (URT) specimens; more severely ill patients typically have higher [18,21] and more prolonged [18] RNA levels; and MERS-CoV RNA is detected in the blood [17,22,24], serum [18,19,24], plasma [22,25,26], stool [19,23,27], and urine [17,19,23] of some patients
To assess MERS-CoV infection status, we retrospectively reviewed 3 data sources containing information on clinical diagnostic testing: 1) reverse transcription PCR (rRT-PCR) request forms submitted to a regional testing facility; 2) hospital copies of corresponding results; and 3) if the hospital’s clinical series was incomplete, rRT-PCR results from the Health Electronic Surveillance Network [33], a national platform for reporting notifiable diseases in Saudi Arabia
Summary
Middle East respiratory syndrome coronavirus (MERS-CoV) shedding and antibody responses are not fully understood, in relation to underlying medical conditions, clinical manifestations, and mortality. Fever and cough among mildly ill patients typically aligned with RNA detection in the upper respiratory tract; RNA levels peaked during the first week of illness. These findings should be considered in the development of infection control policies, vaccines, and antibody therapeutics. Our aim was to characterize MERS-CoV infection dynamics and antibody responses in relation to outcome, clinical manifestations, underlying medical conditions, and preillness exposures
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