Middle East Respiratory Syndrome Infection Research Articles

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.

Efficacy and Safety of a Booster Vaccination with Two Inactivated SARS-CoV-2 Vaccines on Symptomatic COVID-19 Infection in Adults: Results of a Double-Blind, Randomized, Placebo-Controlled, Phase 3 Trial in Abu Dhabi.

The protective efficacy of COVID-19 vaccinations has declined over time such that booster doses are required. To evaluate the efficacy and adverse events of booster doses of two inactivated COVID-19 vaccines. This is a double-blind, randomized, placebo-controlled phase 3 trial aiming to evaluate the protective efficacy, safety, and immunogenicity of inactivated SARS-CoV-2 vaccine (Vero cells) after inoculation with booster doses of inactivated COVID-19 vaccine. Healthy volunteers were recruited in an earlier phase 3 trial of two doses of inactivated vaccine. The participants in Abu Dhabi maintained the blind state of the trial and received a booster dose of vaccine or placebo at least six months after the primary immunization. Adults aged 18 and older with no history of SARS-CoV, SARS-CoV-2, or Middle East respiratory syndrome infection (via onsite inquiry) were screened for eligibility. A total of 9370 volunteers were screened and randomly allocated, of which 61 voluntarily withdrew from the screening stage without booster inoculation; 9309 received the booster vaccination, with 3083 in the WIV04 group, 3150 in the HB02 group, and 3076 in the alum-only group. Further, 5μg and 4μg of inactivated SARS-CoV-2 virion was adsorbed into aluminum hydroxide in a 0.5 mL aqueous suspension for WIV04 and HB02 vaccines. The primary efficacy outcome was the prevention of PCR-confirmed symptomatic COVID-19 from 14 days after the booster vaccine in the per-protocol population. A safety analysis was performed in the intention-to-treat population. Symptomatic COVID-19 was identified in 36 participants in the WIV04 group (9.9 [95% CI, 7.2-13.8] per 1000 person-years), 28 in the HB02 group (7.6 [95% CI, 5.2-11.0] per 1000 person-years), and 193 in the alum-only group (55.2 [95% CI, 47.9-63.5] per 1000 person-years), resulting in a vaccine efficacy of 82.0% (95% CI, 74.2-87.8%) for WIV04 and 86.3% (95% CI, 79.6-91.1%) for HB02. One severe case of COVID-19 occurred in the alum-only group, and none occurred in the vaccine groups. Adverse reactions within seven days after vaccination occurred in 29.4% to 34.3% of participants in the three groups. Serious adverse events were rare and not related to vaccines (WIV04: 17 [0.5%]; HB02: 11 [0.4%]; alum only: 40 [1.3%]). This study evaluated the safety of the booster dose, which was well tolerated by participants. Booster doses given over six months after the completion of primary immunization can help to provide more-effective protection against COVID-19 in healthy people 18 years of age or older. At the same time, the anti-SARS-CoV-2 antibodies produced by the two groups of experimental vaccines exhibited extensive cross-neutralization against representative SARS-CoV-2 variants. This study is registered on ClinicalTrials.gov (NCT04510207).

Post-traumatic stress among COVID-19 survivors: A descriptive study of hospitalized first-wave survivors.

The coronavirus Severe Acute Respiratory Syndrome Coronavirus Type 1 induces a severe respiratory disease, coronavirus disease 2019 (COVID-19). After Severe Acute Respiratory Syndrome Coronavirus Type 1 and Middle East Respiratory Syndrome infection, increased post-traumatic stress disorder (PTSD) rates were described. This single-centred, prospective study aimed to evaluate the rates of PTSD in patients who were hospitalized for COVID-19. Inclusion criteria were COVID-19 patients hospitalized in the intensive care unit (ICU) or in a standard unit with at least 2 L/min oxygen. Six months post-hospitalization, subjects were assessed for PTSD using a validated screening tool, the Post-Traumatic Stress Checklist-5 (PCL-5). A total of 40 patients were included. No demographic differences between the ICU and non-ICU groups were found. The mean PCL-5 score for the population was 8.85±10. The mean PCL-5 score was 6.7±8 in the ICU group and 10.5±11 in the non-ICU group (P=0.27). We screened one patient with a positive PCL-5 score and one with a possible PCL-5 cluster score. Nine patients had a PCL-5 score of up to 15. Seven patients reported no symptoms. Seven patients accepted a psychological follow-up: one for PTSD, three for possible PTSD and three for other psychological problems. The PCL-5 tool can be used by lung physicians during consultations to identify patients for whom follow-up mental health assessment and treatment for PTSD are warranted. Lung physicians should be aware of the risk of PTSD in patients hospitalized for COVID-19 and ensure appropriate screening and follow-up care.

Paradox of COVID-19 in pregnancy: are pregnant women more protected against or at elevated risk of severe COVID-19?

Many underlying medical conditions have been linked to worse COVID-19 prognosis. Based on reports on SARS-CoV-1 and Middle East respiratory syndrome infections, pregnancy has been considered a predisposing factor to severe COVID-19, with pregnant women being a high-risk group for several physiological reasons. Specifically, pregnant women undergo physiological adaptations that predispose them to severe respiratory viral diseases, including SARS-CoV-2. However, a significant amount of evidence suggests that the clinical outcome of COVID-19 among pregnant women is not different from the general population. In view of this, this report discusses the physiological conditions in pregnant women that adversely affect their immunity, cardiovascular homeostasis, and their endothelial and coagulopathic functions, thereby making them more prone to severe viral infections. We also discuss how these physiological adaptations appear to paradoxically offer protection against severe COVID-19 among pregnant women.

Middle East Respiratory Syndrome (MERS) Virus-Pathophysiological Axis and the Current Treatment Strategies.

Middle East respiratory syndrome (MERS) is a lethal respiratory disease with its first case reported back in 2012 (Jeddah, Saudi Arabia). It is a novel, single-stranded, positive-sense RNA beta coronavirus (MERS-CoV) that was isolated from a patient who died from a severe respiratory illness. Later, it was found that this patient was infected with MERS. MERS is endemic to countries in the Middle East regions, such as Saudi Arabia, Jordan, Qatar, Oman, Kuwait and the United Arab Emirates. It has been reported that the MERS virus originated from bats and dromedary camels, the natural hosts of MERS-CoV. The transmission of the virus to humans has been thought to be either direct or indirect. Few camel-to-human transmissions were reported earlier. However, the mode of transmission of how the virus affects humans remains unanswered. Moreover, outbreaks in either family-based or hospital-based settings were observed with high mortality rates, especially in individuals who did not receive proper management or those with underlying comorbidities, such as diabetes and renal failure. Since then, there have been numerous reports hypothesising complications in fatal cases of MERS. Over the years, various diagnostic methods, treatment strategies and preventive measures have been strategised in containing the MERS infection. Evidence from multiple sources implicated that no treatment options and vaccines have been developed in specific, for the direct management of MERS-CoV infection. Nevertheless, there are supportive measures outlined in response to symptom-related management. Health authorities should stress more on infection and prevention control measures, to ensure that MERS remains as a low-level threat to public health.

English

With a continuous increase in Covid-19 cases, patients infected with SARS-CoV-2 have shown a wide variety of symptoms including fever, shortness of breath, cough, myalgia, dizziness, headache, impaired consciousness, abdominal pain and diarrhoea. Lab studies have shown higher leukocyte counts and neutrophil-lymphocyte ratio (NLR), decreased lymphocytes, increased prothrombin time and a partial thromboplastin time, increased serum lactate dehydrogenase, ferritin and various other markers, indicating multiple organ system dysfunction including respiratory system, immune system, nervous system and gastrointestinal tract. Apart from these, heart and kidneys are also found to be affected in some patients. Patients presenting with previous history of diseases such as cardiovascular diseases, kidney diseases, pregnant females, neonates, immunosuppressed patients, and aged people have shown poor prognosis of disease. Various studies suggest possible reasons of multiple organ dysfunctions including wide distribution of angiotensin-converting enzyme 2 (ACE-2) receptors, cytokine storm and hypercoagulability of blood. We have listed the various organ systems affected by the virus and possible explanations as to why and how these organ systems are affected. SARS-CoV-2 outbreak has caused a global pandemic, with more than 33,400,000 confirmed cases of Covid-19, including more than 1,000,000 deaths, reported to World Health Organization (WHO) globally till 30 September 2020. 1 with a basic reproductive number estimated to be 2.2 (1.4 - 3.9) the virus spread is very fast affecting many individuals across the globe. 2 One of the major causes of efficient spread of SARS-CoV-2 in humans is the angiotensin-converting enzyme 2 receptors, used by the virus to enter the cells. 3 Hence, wide distribution of angiotensin-converting enzyme 2 receptors in body including lungs, kidney, bladder, gastrointestinal tract, heart, central nervous system and peripheral nervous system4 and even placenta5 is one of the reasons the virus is found to affect these organs. Two closely related viruses causing Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS) were also found to affect multiple organ systems. SARS‐CoV-1 was found in the respiratory pathway (trachea, bronchus, lung), gastrointestinal tract (stomach, small intestines), glands (sweat gland, liver, pancreas, parathyroid, pituitary, adrenal gland), renal system (convoluted renal tubules) and brain tissue (cerebrum) in the autopsy samples of patients who died because of severe acute respiratory syndrome. 6 Respiratory, circulatory, gastrointestinal, haematological, renal and hepatological symptoms were also found to be affected in patients with Middle East respiratory syndrome infection. 7 Though the virus is found to affect multiple organ systems, the underlying mechanisms are not clearly understood.

Urogenital System Damaging Manifestations of 3 Human Infected Coronaviruses.

At present, there are no comparative studies on the damage of the 3 coronaviruses infections to the urinary system. Therefore, we reviewed the correlations and differences between invading mechanisms and resultant urogenital system damage by the 3 kinds of coronaviruses in an effort to help doctors in the prevention and treatment of these damages, which will be of significance in improving prognosis and quality of life after rehabilitation. We searched PubMed® for English language articles published since 2003 with the key words "Coronavirus disease 2019 (COVID-19)," "severe acute respiratory syndrome-2 (SARS-CoV-2)," "severe acute respiratory syndrome (SARS)-CoV" and "Middle East respiratory syndrome (MERS)-CoV "with "semen" and "kidney." We also used relevant data from websites including the World Health Organization and Centers for Disease Control and Prevention. Recent studies have revealed that both SARS-CoV and SARS-CoV-2 invade target cells through a membrane-bound angiotensin-converting enzyme 2, an important component of the renin-angiotensin system, which maintains human homeostasis, whereas MERS utilizes host cells' receptor dipeptidyl peptidase 4 for entry. While pneumonia is the most prominent symptom in patients infected by coronaviruses due to the transmission through respiratory droplets, the urogenital system can also suffer from infection with coronaviruses, resulting in renal failure, testicular atrophy etc. The impairments of the genitourinary system would be different with the 3 coronavirus infections but they still have a strong correlation. The pathogenesis and clinical symptoms of SARS-CoV, MERS-CoV and SARS-CoV-2 coronaviruses in the genitourinary system are comparable. All 3 coronaviruses have been found to affect kidney and testicular function. Therefore, both urologists and nephrologists should pay attention to the damage caused by coronavirus infection to the genitourinary system, especially monitoring renal and semen function.

Non-steroidal anti-inflammatory drugs in management of COVID-19; A systematic review on current evidence.

BackgroundSince there is still no definitive conclusion regarding which non‐steroidal anti‐inflammatory drugs (NSAIDs) are most effective and safe in viral respiratory infections, we decided to evaluate the efficacy and safety of various NSAIDs in viral respiratory infections so that we can reach a conclusion on which NSAID is best choice for coronavirus disease 2019 (COVID‐19).MethodsA search was performed in Medline (via PubMed), Embase and CENTRAL databases until 23 March 2020. Clinical trials on application of NSAIDs in viral respiratory infections were included.ResultsSix clinical trials were included. No clinical trial has been performed on COVID‐19, Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome infections. Studies show that ibuprofen and naproxen not only have positive effects in controlling cold symptoms, but also do not cause serious side effects in rhinovirus infections. In addition, it was found that clarithromycin, naproxen and oseltamivir combination leads to decrease in mortality rate and duration of hospitalisation in patients with pneumonia caused by influenza.ConclusionAlthough based on existing evidence, NSAIDs have been effective in treating respiratory infections caused by influenza and rhinovirus, since there is no clinical trial on COVID‐19 and case‐reports and clinical experiences are indicative of elongation of treatment duration and exacerbation of the clinical course of patients with COVID‐19, it is recommended to use substitutes such as acetaminophen for controlling fever and inflammation and be cautious about using NSAIDs in management of COVID‐19 patients until there are enough evidence. Naproxen may be a good choice for future clinical trials.

Middle East respiratory syndrome–related knowledge, preventive behaviours and risk perception among nursing students during outbreak

Aims and objectivesThe aim of this study was to survey nursing students’ Middle East respiratory syndrome–related knowledge, preventive behaviours and risk perception to examine the correlations among the variables during a Middle East respiratory syndrome outbreak.BackgroundMiddle East respiratory syndrome is a new viral respiratory illness. Nursing students who engage in clinical practice at hospitals may have been exposed to Middle East respiratory syndrome infection during the Middle East respiratory syndrome outbreak.DesignThis study was a descriptive cross‐sectional survey.MethodsParticipants (n = 249) were nursing students in their third or fourth year of the programme who were engaged in clinical practice for eight hours per day at the tertiary hospitals with Middle East respiratory syndrome patients. Knowledge, preventive behaviours and risk perception related to Middle East respiratory syndrome were measured using scales developed through a preliminary survey and validity testing.ResultsThe subjects’ knowledge level of Middle East respiratory syndrome was 84·4%; their practice of preventive behaviours was rated at 44·5%; and their risk perception rating was 2·4 out of 5. Middle East respiratory syndrome–related risk perception was significantly different according to gender and Middle East respiratory syndrome education. Middle East respiratory syndrome–related knowledge was significantly correlated with preventive behaviours and risk perception.ConclusionConsidering the low scores for items regarding knowledge and preventive behaviours, it is necessary to develop effective and systematic publicity and education programmes for nursing students. Enhancing Middle East respiratory syndrome–related knowledge by considering cooperation between hospitals and universities will sharpen nursing students’ risk perception of the disease and effectively increase their preventive behaviours.Relevance to clinical practiceSimilar to other emerging infectious diseases, Middle East respiratory syndrome outbreaks may occur in other countries. The results of this study can be used to develop and apply efficient and feasible Middle East respiratory syndrome education programmes for nursing students during Middle East respiratory syndrome outbreaks.

Middle East Respiratory Syndrome Infection Control and Prevention Guideline for Healthcare Facilities.

Middle East Respiratory Syndrome (MERS) is an acute viral respiratory illness with high mortality caused by a new strain of betacoronavirus (MERS-CoV). Since the report of the first patient in Saudi Arabia in 2012, large-scale outbreaks through hospital-acquired infection and inter-hospital transmission have been reported. Most of the patients reported in South Korea were also infected in hospital settings. Therefore, to eliminate the spread of MERS-CoV, infection prevention and control measures should be implemented with rigor. The present guideline has been drafted on the basis of the experiences of infection control in the South Korean hospitals involved in the recent MERS outbreak and on domestic and international infection prevention and control guidelines. To ensure efficient MERS-CoV infection prevention and control, care should be taken to provide comprehensive infection control measures including contact control, hand hygiene, personal protective equipment, disinfection, and environmental cleaning.