Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) is a great public health concern globally. Although 83% of the globally confirmed cases have emerged in Saudi Arabia, the spatiotemporal clustering of MERS-CoV incidence has not been investigated. This study analysed the spatiotemporal patterns and clusters of laboratory-confirmed MERS-CoV cases reported in Saudi Arabia between June 2012 and March 2019. Temporal, seasonal, spatial and spatiotemporal cluster analyses were performed using Kulldorff’s spatial scan statistics to determine the time period and geographical areas with the highest MERS-CoV infection risk. A strongly significant temporal cluster for MERS-CoV infection risk was identified between April 5 and May 24, 2014. Most MERS-CoV infections occurred during the spring season (41.88%), with April and May showing significant seasonal clusters. Wadi Addawasir showed a high-risk spatial cluster for MERS-CoV infection. The most likely high-risk MERS-CoV annual spatiotemporal clusters were identified for a group of cities (n = 10) in Riyadh province between 2014 and 2016. A monthly spatiotemporal cluster included Jeddah, Makkah and Taif cities, with the most likely high-risk MERS-CoV infection cluster occurring between April and May 2014. Significant spatiotemporal clusters of MERS-CoV incidence were identified in Saudi Arabia. The findings are relevant to control the spread of the disease. This study provides preliminary risk assessments for the further investigation of the environmental risk factors associated with MERS-CoV clusters.
Highlights
Middle East respiratory syndrome coronavirus (MERS-CoV) is an emerging human viral respiratory infectious disease caused by a novel coronavirus
This study aimed to examine the spatiotemporal clustering of the MERS-CoV incidence in Saudi Arabia between 2012 and 2019 using spatial scan statistics and Geographic information systems (GIS)
A suspected case is defined as either (i) an adult patient presenting with severe pneumonia or acute respiratory distress syndrome, based on clinical or radiological evidence, or (ii) an adult patient presenting with an unexplained deterioration of a chronic condition, such as congestive heart failure or chronic kidney disease being treated with hemodialysis, or (iii) a child or an adult patient exposed to a confirmed case of MERS-CoV or who has visited a healthcare facility where a MERS-CoV
Summary
Middle East respiratory syndrome coronavirus (MERS-CoV) is an emerging human viral respiratory infectious disease caused by a novel coronavirus. It was first reported in Saudi Arabia in 2012 [1], and since it has spread to several other countries, resulting in global public health implications. The risk assessment of MERS-CoV infection, transmission and severity is crucial in predicting and preventing further outbreaks of human infections and in enhancing control measures. Recent studies have advised that dromedary camels (Camelus dromedarius) serve as a reservoir host for MERS-CoV, and camel-to-human transmission can occur through sporadic zoonotic infections associated with exposure to infected dromedary camels and their products [3,4,5]. Public Health 2019, 16, 2520; doi:10.3390/ijerph16142520 www.mdpi.com/journal/ijerph
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