Middle East Respiratory Syndrome Coronavirus Cases Research Articles

Spatial examination of social and environmental drivers of Middle East respiratory syndrome coronavirus (MERS-CoV) across Kenya.

Climate and agricultural land-use change has increased the likelihood of infectious disease emergence and transmissions, but these drivers are often examined separately as combined effects are ignored. Further, seldom are the influence of climate and agricultural land use on emerging infectious diseases examined in a spatially explicit way at regional scales. Our objective in this study was to spatially examine the climate, agriculture, and socio-demographic factors related to agro-pastoralism, and especially the combined effects of these variables that can influence the prevalence of Middle East respiratory syndrome coronavirus (MERS-CoV) in dromedary camels across northern Kenya. Our research questions focused on: (1) How MERS-CoV in dromedary camels has varied across geographic regions of northern Kenya, and (2) what climate, agriculture, and socio-demographic factors of agro-pastoralism were spatially related to the geographic variation of MERS-CoV cases in dromedary camels. To answer our questions, we analyzed the spatial distribution of historical cases based on serological evidence of MERS-CoV at the county level and applied spatial statistical analysis to examine the spatial relationships of the MERS-CoV cases between 2016 and 2018 to climate, agriculture, and socio-demographic factors of agro-pastoralism. Regional differences in MERS-CoV cases were spatially correlated with both social and environmental factors, and particularly ethno-religious camel practices, which highlight the complexity in the distribution of MERS-CoV in dromedary camels across Kenya.

Global concerns about camel flu: outbreak, etiology, genomic structure, transmission, symptoms, diagnostic tests, prevention, and treatment - correspondence.

Global concerns about camel flu: outbreak, etiology, genomic structure, transmission, symptoms, diagnostic tests, prevention, and treatment - correspondence.

Global research trends in MERS-CoV: A comprehensive bibliometric analysis from 2012 to 2021.

BackgroundThe Middle East respiratory syndrome coronavirus (MERS-CoV) was first reported in Saudi Arabia in 2012. So far, the cases of MERS-CoV have been reported in 27 countries. The virus causes severe health complications, resulting high mortality.AimThe current study aimed to evaluate the global research trends and key bibliometric indices in MERS-CoV research from 2012 to 2021.MethodsA retrospective bibliometric and visualized study was conducted. The Science Citation Index Expanded Edition of Web of Science Core Collection database was utilized to retrieve published scientific literature on MERS-CoV. The retrieved publications were assessed for a number of bibliometric attributes. The data were imported into HistCiteTM and VOSviewer software to calculate the citations count and perform the visualization mapping, respectively. In addition, countries or regions collaboration, keywords analysis, and trend topics in MERS-CoV were assessed using the Bibliometrix: An R-tool.ResultsA total of 1,587 publications, published in 499 journals, authored by 6,506 authors from 88 countries or regions were included in the final analysis. Majority of these publications were published as research article (n = 1,143). Globally, these publications received 70,143 citations. The most frequent year of publication was 2016 (n = 253), while the most cited year was 2014 (11,517 citations). The most prolific author was Memish ZA (n = 94), while the most published journal was Emerging Infectious Diseases (n = 80). The United States of America (USA) (n = 520) and Saudi Arabia (n = 432) were the most influential and largest contributors to the MERS-CoV publications. The extensively studied research area was infectious diseases. The most frequently used author keywords other than search keywords were Saudi Arabia, SARS-CoV-2, COVID-19, epidemiology, transmission, spike protein, vaccine, outbreak, camel, and pneumonia.ConclusionThis study provides an insight into MERS-CoV-related research for scientific community (researchers, academicians) to understand and expand the basic knowledge structure, potential collaborations, and research trend topics. This study can also be useful for policy makers. After the emergence of MERS-CoV, a significant increase in scientific production was observed in the next 4 years (2013–2016). In 2021, the trend topics in MERS-CoV-related research were COVID-19, clinical characteristics, and cytokine storm. Saudi Arabia had the strongest collaboration with the USA, while the USA had the highest collaboration with China.

MERS-CoV Confirmation among 6,873 suspected persons and relevant Epidemiologic and Clinical Features, Saudi Arabia - 2014 to 2019.

BackgroundOf the three lethal coronaviruses, in addition to the ongoing pandemic-causing SARS-CoV 2, Middle East Respiratory Syndrome Coronavirus (MERS-CoV) remains in circulation. Information on MERS-CoV has relied on small sample of patients. We updated the epidemiology, laboratory and clinical characteristics, and survival patterns of MERS-CoV retrospectively with the largest sample of followed patients.MethodsWe conducted a retrospective review of line-listed records of non-random, continuously admitted patients who were suspected (6,873) or confirmed with MERS-CoV (501) admitted to one of the four MERS-CoV referral hospitals in Saudi Arabia, 2014-2019.FindingsOf the 6,873 MERS-CoV suspected persons, the majority were male (56%) and Saudi nationals (83%) and 95% had no known history that increased their risk of exposure to MERS-CoV patients or vectors (95%). More confirmed cases reported history that increased their risk of MERS-CoV infection (41%). Among the suspected, MERS-CoV confirmation (7.4% overall) was independently associated with being male, known transmission link to MERS-CoV patients or vectors, fever, symptoms for 7 days, admission through intensive care unit, and diabetes. Among persons with confirmed MERS-CoV, single symptoms were reported by 20%, 3-symptom combinations (fever, cough and dyspnea) reported by 21% and 2-symptom combinations (fever, cough) reported by 16%. Of the two-thirds (62%) of MERS-CoV confirmed patients who presented with co-morbidity, 32% had 2-"comorbidities (diabetes, hypertension). More than half of the MERS-CoV patents showed abnormal chest X-ray, elevated aspartate aminotransferase, and creatinine kinase. About a quarter of MERS-CoV patients had positive cultures on blood, urine, or respiratory secretions. During an average hospital stay of 18 days (range 11 to 30), 64% developed complications involving liver, lungs, or kidneys. Ventilation requirement (29% of MERS-CoV cases) was independently associated with abnormal chest X-ray, viremia (Ct value <30), elevated creatinine, and prothrombin time. Death (21% overall) was independently associated with older age, dyspnea and abnormal chest X-ray on admission, and low hemoglobulin levels.InterpretationsWith two-thirds of the symptomatic persons developing multiorgan complications MERS-CoV remains the coronavirus with the highest severity (29%) and case fatality rate (21%) among the three lethal coronaviruses. Metabolic abnormalities appear to be an independent risk factor for sustained MERS-CoV transmission. The poorly understood transmission dynamics and non-specific clinical and laboratory features call for high index of suspicion among respiratory disease experts to help early detection of outbreaks. We reiterate the need for case control studies on transmission.FundingNo special funding to declare.

Role of chest radiograph in MERS-Cov pneumonia: a single tertiary referral center experience in the United Arab Emirates

BackgroundThe Middle East respiratory syndrome coronavirus (MERS-Cov) continues to be a source of concern due to intermittent outbreaks. Serial chest radiographic changes in MERS-Cov patients were analyzed for various variables that could be compared to the patients’ final outcomes in a cluster of MERS-Cov patients and to identify a predictor of mortality in the United Arab Emirates.ResultsA total of 44 MERS-Cov cases were reviewed. The mean age of the patients was 43.7 ± 14.7 years. The chest radiograph was abnormal in 14/44 (31.8%). The commonest radiology features include ground-glass opacities (seven of 14, 50%), ground-glass and consolidation (seven of 14, 50%), pleural effusion (eight of 14, 57.1%), and air bronchogram (three of 14, 21.4%). The mortality rate was 13.6% (six of 44); the deceased group (6 of 44, 13.6%) was associated with significantly higher incidence of mechanical ventilation (p < 0.001), pleural effusion (p < 0.001), chest radiographic score (8.90 ± 6.31, p < 0.001), and type 4 radiographic progression of disease (p < 0.001). A chest radiographic score at presentation was seen to be an independent and strong predictor of mortality (OR [95% confidence interval] 3.20 [1.35, 7.61]). The Cohen κ coefficient for the interobserver agreement was k = 0.89 (p = 0.001).ConclusionThe chest radiographic score, associated with a higher degree of disease progression (type 4), particularly in patients with old age or with comorbidity, may indicate a poorer prognosis in MERS-Cov infection, necessitating intensive care unit management or predicting impending death.

Diagnosing MERS-CoV using dempster-shafer method

&lt;span lang="EN-US"&gt;MERS-CoV (Middle East Respiratory Syndrome-Coronavirus) is a respiratory syndrome disease caused by the coronavirus which attacks the respiratory tract from mild to severe. MERS-CoV was first reported in Saudi Arabia; total cases of MERS-CoV have continued to increase. In Indonesia, the MERS-CoV enters through the pilgrimage of Hajj and Umrah. But not many people know about this disease and its symptoms. For this reason, an expert system was developed to diagnose MERS-CoV using the Dempster-Shafer method. The system can detect the disease from the symptoms inputted by user. The output of the system is the value of the probability of the disease, the level of the disease and the suggested. The levels of the disease are Stage 1, Stage 2, and Stage 3 where each has a different treatment based on the level of the disease. The system contains information about MERS-CoV in the form of videos and text. The system was built using the PHP programming language. The testing result shows that all system functionalities have been fulfilled. The expert validation testing had obtained at 76.7%, which prove that the system is good enough in diagnosing MERS-CoV and the results obtained from the questionnaire is at an average of 84.13% which is very good in helping users in diagnosing disease. The expert system that has been developed can help people in diagnosing the disease before consulting with a doctor.&lt;/span&gt;MERS-CoV (Middle East Respiratory Syndrome-Coronavirus) is arespiratory syndrome disease caused by the coronavirus which attacks therespiratory tract from mild to severe. MERS-CoV was first reported in SaudiArabia; total cases of MERS-CoV have continued to increase. In Indonesia,the MERS-CoV enters through the pilgrimage of Hajj and Umrah. But notmany people know about this disease and its symptoms. For this reason, anexpert system was developed to diagnose MERS-CoV using the DempsterShafer method. The system can detect the disease from the symptomsinputted by user. The output of the system is the value of the probability ofthe disease, the level of the disease and the suggested. The levels of thedisease are Stage 1, Stage 2, and Stage 3 where each has a different treatmentbased on the level of the disease. The system contains information aboutMERS-CoV in the form of videos and text. The system was built using thePHP programming language. The testing result shows that all systemfunctionalities have been fulfilled. The expert validation testing had obtainedat 76.7%, which prove that the system is good enough in diagnosing MERSCoV and the results obtained from the questionnaire is at an average of84.13% which is very good in helping users in diagnosing disease. Theexpert system that has been developed can help people in diagnosing thedisease before consulting with a doctor.&lt;div&gt; &lt;/div&gt;

Determining the correlation between comorbidities and MERS-CoV mortality in Saudi Arabia

ObjectiveAs of January 2020, there were 2,519 confirmed Middle East respiratory syndrome coronavirus (MERS-CoV) cases with 866 deaths across 27 countries. Most of these cases (2,121) were reported in Saudi Arabia. Since the initial identification of MERS, few studies have investigated the role of comorbidities that could potentially lead to mortality in cases of the infectious disease. This study aimed to examine the association between comorbidities and MERS mortality in Saudi Arabia. MethodsThis is a retrospective descriptive study. We retrieved the data published by the World Health Organization (WHO) between January 2017 and November 2019, and analysed the association between comorbidities and mortality. ResultsWe found 572 MERS-CoV cases reported by WHO in Saudi Arabia during the defined period. Of these, 387 (68%) had a history of chronic illness. The overall mortality rate was found to be 25%. Diabetes mellitus was the most prevalent comorbidity—the mortality rate in the diabetics was 32% as opposed to 12% in the non-diabetics (p-value <0.01). Hypertension was second, with a mortality rate of 35%, as opposed to 15% in the non-hypertensive patients (p-value <0.001). The mortality rate in cases with cardiovascular disease was 39% as opposed to 21% in those without cardiovascular disease (p-value <0.05). ConclusionOur study shows that MERS-CoV had a significant case fatality rate in patients with comorbidities. Thus, it will be beneficial if future clinical trials for MERS-CoV examine the impact of improved societal infection control measures such as social distancing and masks, in the context of the coronavirus disease 2019 pandemic, on the prevalence and incidence of MERS and its clinical outcomes.

Zoonotic MERS-CoV transmission: modeling, backward bifurcation and optimal control analysis.

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) can cause mild to severe acute respiratory illness with a high mortality rate. As of January 2020, more than 2500 cases of MERS-CoV resulting in around 860 deaths were reported globally. In the absence of neither effective treatment nor a ready-to-use vaccine, control measures can be derived from mathematical models of disease epidemiology. In this manuscript, we propose and analyze a compartmental model of zoonotic MERS-CoV transmission with two co-circulating strains. The human population is considered with eight compartments while the zoonotic camel population consist of two compartments. The expression of basic reproduction numbers are obtained for both single strain and two strain version of the proposed model. We show that the disease-free equilibrium of the system with single stain is globally asymptotically stable under some parametric conditions. We also demonstrate that both models undergo backward bifurcation phenomenon, which in turn indicates that only keeping R_0 below unity may not ensure eradication. To the best of the authors knowledge, backward bifurcation was not shown in a MERS-CoV transmission model previously. Further, we perform normalized sensitivity analysis of important model parameters with respect to basic reproduction number of the proposed model. Furthermore, we perform optimal control analysis on different combination interventions with four components namely preventive measures such as use of masks, isolation of strain-1 infected people, strain-2 infected people and infected camels. Optimal control analysis suggests that combination of preventive measures and isolation of infected camels will eventually eradicate the disease from the community.

A meta-analysis of comorbidities in COVID-19: Which diseases increase the susceptibility of SARS-CoV-2 infection?

Comorbidities in COVID-19 patients often lead to more severe outcomes. The disease-specific molecular events, which may induce susceptibility to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, are being investigated. To assess this, we retrieved array-based gene expression datasets from patients of 30 frequently occurring acute, chronic, or infectious diseases. Comparative analyses of the datasets were performed after quantile normalization and log2 transformation. Among the 78 host genes prominently implicated in COVID-19 infection, ACE2 (receptor for SARS-CoV-2) was positively regulated in several cases, namely, leukemia, psoriasis, lung cancer, non-alcoholic fatty liver disease (NAFLD), breast cancer, and pulmonary arterial hypertension (PAH). FURIN was positively regulated in some cases, such as leukemia, psoriasis, NAFLD, lung cancer, and type II diabetes (T2D), while TMPRSS2 was positively regulated in only 3 cases, namely, leukemia, lung cancer, and T2D. Genes encoding various interferons, cytokines, chemokines, and mediators of JAK-STAT pathway were positively regulated in leukemia, NAFLD, and T2D cases. Among the 161 genes that are positively regulated in the lungs of COVID-19 patients, 99–111 genes in leukemia (including various studied subtypes), 77 genes in NAFLD, and 48 genes in psoriasis were also positively regulated. Because of the high similarity in gene expression patterns, the patients of leukemia, NAFLD, T2D, psoriasis, and PAH may need additional preventive care against acquiring SARS-CoV-2 infections. Further, two genes CARBONIC ANHYDRASE 11 (CA11) and CLUSTERIN (CLU) were positively regulated in the lungs of patients infected with either SARS-CoV-2, or SARS-CoV or Middle East Respiratory Syndrome Coronavirus (MERS-CoV).

Middle East respiratory syndrome coronavirus infection profile in Qatar: An 8-year experience.

The Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012. The objective of the study was to describe the epidemiology, risk factors, clinical characteristics, and outcome of MERS-CoV in Qatar. A total of 28 cases of MERS-CoV were identified, corresponding to an incidence of 1.7 per 1,000,000 population. Most patients had a history of contact with camels 15, travel to Kingdom of Saudi Arabia 7 or known contact with individuals with confirmed MERS-CoV infection 7. Majority of patients had acute kidney injury (AKI) 17 and 9 needed renal replacement therapy. All patients were hospitalized, 14 required critical care support. Overall, total of 10 died. The immediate cause of death was multiorgan failure with acute respiratory syndrome (ARDS) 9. MERS-CoV is a rare infection in the State of Qatar. There was no hospital outbreaks or healthcare worker reported infection. The infection causes severe respiratory failure and acute renal failure. Patients with AKI and on ventilator support carry higher risk of mortality.

Risk Assessment for the Transmission of Middle East Respiratory Syndrome Coronavirus (MERS-Cov) on Aircraft: A Systematic Review.

AbstractMiddle East respiratory syndrome coronavirus (MERS-CoV) causes a potentially fatal respiratory disease. Although it is most common in the Arabian Peninsula, it has been exported to 17 countries outside the Middle East, mostly through air travel. The Risk Assessment Guidelines for Infectious Diseases transmitted on Aircraft (RAGIDA) advise authorities on measures to take when an infected individual travelled by air. The aim of this systematic review was to gather all available information on documented MERS-CoV cases that had travelled by air, to update RAGIDA. The databases used were PubMed, Embase, Scopus and Global Index Medicus; Google was searched for grey literature and hand searching was performed on the EU Early Warning and Response System and the WHO Disease Outbreak News. Forty-seven records were identified, describing 21 cases of MERS that had travelled on 31 flights. Contact tracing was performed for 17 cases. Most countries traced passengers sitting in the same row and the two rows in front and behind the case. Only one country decided to trace all passengers and crew. No cases of in-flight transmission were observed; thus, considering the resources it requires, a conservative approach may be appropriate when contact tracing passengers and crew where a case of MERS has travelled by air.

SARS-CoV-2: a new dimension to our understanding of coronaviruses.

Coronaviruses have marked their significant emergence since the twenty-first century with the outbreaks of three out of the seven existing human coronaviruses, including the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003, Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2019. These viruses have not only acquired large-scale transmission during their specified outbreak period, but cases of MERS-CoV still remain active, although there is only limited transmission. While, on the other hand, SARS-CoV-2 continues to remain a rising threat to global public health. The recent novel coronavirus, SARS-CoV-2, responsible for the ongoing coronavirus disease 2019 (COVID-19), emerged during December 2019 in Wuhan, China, and has repeatedly raised questions about its characteristic variability. Despite belonging to the same family, SARS-CoV-2 has proven to be quite difficult to control and contain in terms of transmissibility, leading to around 19.8 million reported cases and more than 730,000 deaths of individuals worldwide. Here, we discuss how SARS-CoV-2 differs from its two other related human coronaviruses in terms of genome composition, site of infection, and transmissibility, among several other notable aspects—all indicating to the possibility that it is these variations in addition to other unknowns that are contributing to this virus’ differing deadly pattern.

Middle East Respiratory Syndrome Coronavirus, Saudi Arabia, 2017 Outbreak: Super-Spreading Event and Control Measures

Background: The hallmark of Middle East respiratory syndrome coronavirus (MERS-CoV) disease is the ability to cause major healthcare-associated outbreaks with superspreading events leading to massive transmission and excessive morbidity and mortality. This abstract provides overview of MERS-CoV multi-healthcare facilities outbreak in Riyadh in June 2017, with focus on cluster reported and the control measures taken at King Saud Medical City. The outbreak began with a patient who presented with acute renal failure requiring hemodialysis and became a MERS-CoV superspreader, igniting the cluster of cases in several hospitals in King Saud Medical City. Methods: For epidemiologic investigation, a case was defined as any patient with laboratory-confirmed MERS-CoV infection with connection to the affected healthcare facilities. Contact tracing and testing were performed according to the Ministry of Health (MOH) guidelines. MERS-CoV testing was recommended for HCWs who had unprotected close contact with a confirmed case. Considering the superspreading phenomena, contact tracing was included all persons attended the same area with the positive case either as a patient, an HCW, or a patient’s visitor or companion. Laboratory confirmation was conducted using real-time RT-PCR. Genome sequencing and phylogenetic analysis were performed for available MERS-CoV rRT-PCR–positive samples by the CDC. The infection control measures applied included decreasing patient load through downsizing emergency department acceptance, maintaining low elective services, limiting inpatient admissions, and encouraging discharge. Early detection and quarantining of any suspected cases took place through extensive contact tracing, properly triaging all patients upon admission, consistent monitoring of inpatients and HCWs for any emerging acute respiratory illness, allocation of more single rooms inside the facility and staff dormitory, and extending the services of virology laboratory to get timely results. Further measures consisted of extensive education on infection control practices, monitoring healthcare worker adherence, reassuring the public by maintaining transparency of published reports, and launching a hotline to respond to HCW concerns. Moreover, travel restrictions applied to any person with a history of exposure to a confirmed MERS-CoV case during the 2-week monitoring period. Results: Overall, 44 cases of MERS-CoV infection were reported from 3 simultaneous clusters during the 2017 Riyadh outbreak, including 11 fatal cases. Among all of the cases, 29 cases were reported at King Saud Medical City. The outbreak at KSMC required 30 days to be controlled. Conclusions: High vigilance for early detection is a key control measure. To be more sensitive, point-of-care MERS-CoV testing is required because clinical suspicion is challenging in patients presenting with acute renal failure.Funding: NoneDisclosures: None

Epidemiology of paediatric Middle East respiratory syndrome coronavirus and implications for the control of coronavirus virus disease 2019.

AimTo compare the clinical features of Middle East respiratory syndrome coronavirus (MERS‐CoV) infection between paediatric and adult cases.MethodsUsing multiple public data sources, we created an enhanced open‐source surveillance dataset of all MERS‐CoV cases between 20 September 2012 and 31 December 2018 in Saudi Arabia including available risk factor data.ResultsOf the 1791 cases of MERS‐CoV identified, 30 cases (1.7%) were aged under 18 years and 1725 cases (96.3%) were aged 18 years and over. Three paediatric cases were fatal, aged 0, 2 and 15 years. The odds of asymptomatic MERS‐CoV infection among cases under 18 years (n = 10/23; 44%) was significantly higher (odds ratio (OR) = 4.98; 95% confidence interval (CI): 2.15–11.51; P = 0.001) compared to adults (n = 199/1487; 13%). The odds of hospitalisation were significantly lower (OR = 0.17; 95% CI: 0.08–0.39; P < 0.001) among cases under 18 years (n = 12/24; 50%) compared to adults (n = 1231/1443; 85%). Children were more likely to have a known source of exposure compared to adults (OR = 2.68; 95% CI: 1.29–5.56; P = 0.008).ConclusionsClinically severe illness is less common in children, although death can occur, and the proportion of paediatric cases (1.7%) is similar to that reported for COVID‐19. Age‐specific differences in the clinical presentation of MERS‐CoV cases could have implications for transmission for other betacoronaviruses including severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Children may be at risk within the household with an infected adult. More studies are required on the role of children in transmission of betacoronaviruses.

Demographic, clinical, and outcomes of confirmed cases of Middle East Respiratory Syndrome coronavirus (MERS-CoV) in Najran, Kingdom of Saudi Arabia (KSA); A retrospective record based study

IntroductionMERS is caused by a viral infection, which was first identified in KSA, 2012. MERS-CoV infection consequences with either hospitalization or death. MethodsAll positive MERS-CoV cases that diagnosed in and reported to a referral hospital in Najran, KSA from March/2014 to December/2018 were revised retrospectively. We identified patients from infection control department and medical records. Demographic, clinical, and outcome data were collected. ResultsOf the 54 positive MERS-CoV cases, 3 cases were excluded because no available data. Therefore, the final number of the included cases in the study was 51 cases (94.4). Most of the patients were Saudi 36 (70.6%), and majority of cases were reported in the winter 18 (35.3) season. Fever 47 (92.2%), cough 44 (86.3%), and shortness of breath 37 (72.5%) were reported as most common symptoms. Most patients had diabetes mellitus and hypertension. Overall mortality rate was 37.3%, and interestingly the mortality rate dropped sharply over 5 years. In logistic regression analysis, Season and Chronic Kidney disease patients were the only two variables statistically significantly associated with death. The odds of death the patients infected by MERS-CoV during Autumn and Winter season were 4.09 times higher than those patients who infected during Spring and Summer season (OR = 4.09, CI 1.18-14.15, P < 0.026). Compared with MERS-CoV patients who had Non-Chronic kidney diseases, the odds of death the MERS-CoV patients who had chronic kidney diseases were 18.08 times higher (OR = 18.08, CI -2.01-162.99, P < 0.01). ConclusionThe case fatality rate of MERS-CoV infection was high. Further studies with large sample sizes are needed to explore the reasons behind the decrease in the mortality rate over the time period.

Spatial association between primary Middle East respiratory syndrome coronavirus infection and exposure to dromedary camels in Saudi Arabia.

Middle East respiratory syndrome coronavirus (MERS‐CoV) is an emerging zoonotic disease. Exposure to dromedary camels (Camelus dromedaries) has been consistently considered the main source of primary human infection. Although Saudi Arabia reports the highest rate of human MERS‐CoV infection and has one of the largest populations of dromedary camels worldwide, their spatial association has not yet been investigated. Thus, this study aimed to examine the correlation between the spatial distribution of primary MERS‐CoV cases with or without a history of camel exposure reported between 2012 and 2019 and dromedary camels at the provincial level in Saudi Arabia. In most provinces, a high proportion of older men develop infections after exposure to camels. Primary human infections during spring and winter were highest in provinces characterized by seasonal breeding and calving, increased camel mobilization and camel–human interactions. A strong and significant association was found between the total number of dromedary camels and the numbers of primary camel‐exposed and non‐exposed MERS‐CoV cases. Furthermore, spatial correlations between MERS‐CoV cases and camel sex, age and dairy status were significant. Via a cluster analysis, we identified Riyadh, Makkah and Eastern provinces as having the most primary MERS‐CoV cases and the highest number of camels. Transmission of MERS‐CoV from camels to humans occurs in most primary cases, but there is still a high proportion of primary infections with an ambiguous link to camels. The results from this study include significant correlations between primary MERS‐CoV cases and camel populations in all provinces, regardless of camel exposure history. This supports the hypothesis of the role of an asymptomatic human carrier or, less likely, an unknown animal host that has direct contact with both infected camels and humans. In this study, we performed a preliminary risk assessment of prioritization measures to control the transmission of infection from camels to humans.

A realistic two-strain model for MERS-CoV infection uncovers the high risk for epidemic propagation.

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) causes severe acute respiratory illness with a case fatality rate (CFR) of 35,5%. The highest number of MERS-CoV cases are from Saudi-Arabia, the major worldwide hotspot for this disease. In the absence of neither effective treatment nor a ready-to-use vaccine and with yet an incomplete understanding of its epidemiological cycle, prevention and containment measures can be derived from mathematical models of disease epidemiology. We constructed 2-strain models to predict past outbreaks in the interval 2012–2016 and derive key epidemiological information for Macca, Madina and Riyadh. We approached variability in infection through three different disease incidence functions capturing social behavior in response to an epidemic (e.g. Bilinear, BL; Non-monotone, NM; and Saturated, SAT models). The best model combination successfully anticipated the total number of MERS-CoV clinical cases for the 2015–2016 season and accurately predicted both the number of cases at the peak of seasonal incidence and the overall shape of the epidemic cycle. The evolution in the basic reproduction number (R0) warns that MERS-CoV may easily take an epidemic form. The best model correctly captures this feature, indicating a high epidemic risk (1≤R0≤2,5) in Riyadh and Macca and confirming the alleged co-circulation of more than one strain. Accurate predictions of the future MERS-CoV peak week, as well as the number of cases at the peak are now possible. These results indicate public health agencies should be aware that measures for strict containment are urgently needed before new epidemics take off in the region.

Common Co-morbidities Are Challenging in the Diagnosis of Middle East Respiratory Syndrome (MERS-CoV) in Saudi Arabia.

Middle East respiratory syndrome coronavirus (MERS-CoV) is a relatively recent human disease reported initially in Saudi Arabia in September, 2012. Morbidities investigation includes a process of excluding other possible options until certain suspected cases are confirmed. In this study, we formulated a model under the authorization of the Saudi Ministry of Health to accurately identify cases among admitted suspected cases depending on specific signs and symptoms. Real-time polymerase chain reaction was used for confirmation of the positive cases. The results showed that the number of patients with combined symptoms of fever/sore throat and fever/cough/SOB was significantly higher in confirmed cases than in non-confirmed cases (p<0.05). Besides, the number of confirmed MERS-CoV cases was significantly higher among cases included in the study than excluded cases. It was also clearly demonstrated that fever combined with other symptoms represents 60% of the confirmed cases, which is significantly higher than for cases with other combined symptoms (p<0.0001). To the best of our knowledge, there are no appropriate diagnostic models that can differentiate human MERS-CoV infection among other respiratory infections. Therefore, we recommend the adoption of this newly established model of MERS-CoV to short- list corona suspected cases in Saudi Arabia.

Effect of Information Disclosure Policy on Control of Infectious Disease: MERS-CoV Outbreak in South Korea.

This study examined the effect of disclosing a list of hospitals with Middle East respiratory syndrome coronavirus (MERS-CoV) patients on the number of laboratory-confirmed MERS-CoV cases in South Korea. MERS-CoV data from 20 May 2015 to 5 July 2015 were from the Korean Ministry of Health & Welfare website and analyzed using segmented linear autoregressive error models for interrupted time series. This study showed that the number of laboratory-confirmed cases was increased by 9.632 on 5 June (p < 0.001). However, this number was significantly decreased following disclosure of a list of hospitals with MERS-CoV cases (Estimate = −0.699; p < 0.001). Disclosing the list of hospitals exposed to MERS-CoV was critical to the prevention of further infection. It reduced the number of confirmed MERS-CoV cases. Thus, providing accurate and timely information is a key to critical care response.

Infection prevention and control for the MERS-COV, 2019: a teaching case-study student's guide

The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a viral respiratory disease caused by a novel coronavirus that was first identified in the Kingdom of Saudi Arabia (KSA) in 2012. On the 12th of February 2019, the Ministry of Health (MOH) represented by the Control and Command Center (CCC) reported an increase in MERS-CoV cases in Wadi Al-Dawasir Province, KSA, which in conjunction with the camel mating season. The CCC confirmed that the epidemiological surveillance field teams at the Ministry of Environment, Water and Agriculture (MEWA) have detected a number of positive samples of MERS-CoV in camels. This case study aims to develop the capacity of trainees in the processes of public health infection control and prevention, based on a MERS-CoV outbreak investigation in Wadi Aldawasir - KSA. This case study is designed for the training of basic level field epidemiology trainees or any other health care workers working in public health-related fields. It can be administered in 3-4 hours. Used as adjunct training material, the case study provides the trainees with competencies in investigating an outbreak in preparation for the actual real-life experience of such outbreaks.