#COVID19: preparing for #superspreader potential among #Umrah #pilgrims to #Saudi Arabia (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

COVID-19: preparing for superspreader potential among Umrah pilgrims to Saudi Arabia

Shahul H Ebrahim, Ziad A Memish

Published: February 27, 2020 / DOI: https://doi.org/10.1016/S0140-6736(20)30466-9

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The ongoing coronavirus disease 2019 (COVID-19) outbreak is a Public Health Emergency of International Concern (PHEIC), and the emergence of new epicentres of spread, such as South Korea and Iran, besides Wuhan, China, should draw attention to potential superspreader events.1 Of concern is the continuous Umrah pilgrimage to Saudi Arabia by Muslim pilgrims from more than 180 countries. In addition to the non-pilgrim air traffic (39 million people in 2018), Saudi Arabia received 7·5 million Umrah visa holders in 2019 (appendix).

(…)

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We declare no competing interests.

Keywords: SARS-CoV-2; COVID-19; Saudi Arabia.

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#Seroprevalence of #MERS-CoV in Healthy #Adults in Western #Saudi Arabia, 2011-2016 (J Infect Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Infect Public Health, 2020 Jan 28 [Online ahead of print]

Seroprevalence of MERS-CoV in Healthy Adults in Western Saudi Arabia, 2011-2016

Afnan A Degnah 1, Sawsan S Al-Amri 2, Ahmed M Hassan 3, Abdulrahman S Almasoud 4, Manar Mousa 5, Sarah A Almahboub 2, Rowa Y Alhabbab 6, Ahmed A Mirza 6, Salwa I Hindawi 7, Naif Khalaf Alharbi 8, Esam I Azhar 9, Anwar M Hashem 10

Affiliations: 1 Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia. 2 Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia. 3 Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia. 4 Department of Infectious Disease Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. 5 Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. 6 Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia. 7 Department of Hematology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. 8 Department of Infectious Disease Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. 9 Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia. Electronic address: eazhar@kau.edu.sa. 10 Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. Electronic address: amhashem@kau.edu.sa.

PMID: 32005618 DOI: 10.1016/j.jiph.2020.01.001

 

Abstract

Background:

The Middle East respiratory syndrome coronavirus (MERS-CoV) is a newly recognized zoonotic coronavirus. Current evidence confirms the role of dromedaries in primary human infections but does not explain the sporadic community cases. However, asymptomatic or subclinical cases could represent a possible source of infection in the community.

Methods: 

Archived human sera (7461) collected between 2011 and 2016 from healthy adult blood donors from 50 different nationalities in the western part of Saudi Arabia were obtained for MERS-CoV seroprevalence investigation. Samples were tested for MERS-CoV S1-specific antibodies (Abs) by ELISA and confirmed by testing for neutralizing Abs (nAbs) using both pseudotyped and live virus neutralization assays.

Results:

Out of 7461 samples, 174 sera from individuals with 18 different nationalities were ELISA positive (2.3%, 95% CI 2.0-2.7). Presence of nAbs was confirmed in 17 samples (0.23%, 95% CI 0.1-0.4) of which one sample exhibited positivity in both neutralization assays. Confirmed seropositivity was identified in young (15-44 years) men and women from Saudi Arabia, Egypt, Yemen, Pakistan, Palestine, Sudan, and India without significant preference.

Conclusions:

An increasing trend of MERS-CoV seroprevalence was observed in the general population in western Saudi Arabia, suggesting that asymptomatic or mild infections might exist and act as an unrecognized source of infection. Seropositivity of individuals from different nationalities underscores the potential MERS exportation outside of the Arabian Peninsula. Thus, enhanced and continuous surveillance is highly warranted.

Keywords: Blood donors; MERS-CoV; Saudi Arabia; Seroprevalence.

Copyright © 2020. Published by Elsevier Ltd.

Keywords: MERS-CoV; Serology; Seroprevalence; Saudi Arabia.

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#Molecular characterisation of an #avian #influenza (#H5N8) #outbreak in backyard #flocks in Al Ahsa, Eastern #Saudi Arabia, 2017-2018 (Vet Res Open., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Vet Rec Open. 2019 Dec 1;6(1):e000362. doi: 10.1136/vetreco-2019-000362. eCollection 2019.

Molecular characterisation of an avian influenza (H5N8) outbreak in backyard flocks in Al Ahsa, Eastern Saudi Arabia, 2017-2018.

Hemida MG1,2, Chu D3, Abdelaziz A4, Alnaeem A5, Chan SMS3, Peiris M3.

Author information: 1 Department of Microbiology and Parasitology, College of Veterinary Medicine, King Faisal University, Al-Hufuf, Saudi Arabia. 2 Department of Virology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr el-Sheikh, Egypt. 3 School of Public Health, The University of Hong Kong, Hong Kong. 4 Veterinary Education Hospital, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt. 5 College of Veterinary Medicine, King Faisal University, Al-Hasa, Saudi Arabia.

 

Abstract

BACKGROUND:

Avian influenza viruses are still causing major concern not only to the poultry industry but also to human health across the globe. The live poultry markets and the small-scale local breeding of various species of birds in backyards are still playing important roles in the sustainability of most virulent influenza viruses, especially H5N8.

METHODS:

The authors investigated an outbreak of highly pathogenic avian influenza H5N8 in backyard flocks in Al Ahsa, Eastern Saudi Arabia that occurred in 2017-2018.

RESULTS:

A range of poultry including chickens, ostriches, ducks, pigeons and turkeys were clinically affected. Phylogenetic analysis suggested that this was a common source outbreak caused by a virus closely related to H5N8 viruses causing outbreaks elsewhere in Saudi Arabia in early 2018.

CONCLUSIONS:

Small backyard flocks are still contributing to the epidemiology and transmission of H5N8.

© British Veterinary Association 2019. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.

KEYWORDS: H5N8; Saudi Arabia; backyards; eastern region; highly pathogenic avian influenza; influenza; outbreak; phylogenetic analysis

PMID: 31897300 PMCID: PMC6924712 DOI: 10.1136/vetreco-2019-000362

Keywords: Avian Influenza; H5N8; Poultry; Saudi Arabia.

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#Enzootic #patterns of #MERS #coronavirus in imported #African and local #Arabian dromedary #camels: a prospective genomic study (Lancet Planet Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Lancet Planet Health. 2019 Dec 11. pii: S2542-5196(19)30243-8. doi: 10.1016/S2542-5196(19)30243-8. [Epub ahead of print]

Enzootic patterns of Middle East respiratory syndrome coronavirus in imported African and local Arabian dromedary camels: a prospective genomic study.

El-Kafrawy SA1, Corman VM2, Tolah AM3, Al Masaudi SB4, Hassan AM5, Müller MA6, Bleicker T7, Harakeh SM1, Alzahrani AA8, Alsaaidi GA8, Alagili AN9, Hashem AM10, Zumla A11, Drosten C12, Azhar EI13.

Author information: 1 Special Infectious Agent Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia. 2 Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Berlin Institute of Health, Institute of Virology, Berlin, Germany; German Centre for Infection Research, associated partner Charité, Berlin, Germany. 3 Special Infectious Agent Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Biological Science, Division of Microbiology, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia. 4 Department of Biological Science, Division of Microbiology, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia. 5 Special Infectious Agent Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia. 6 Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Berlin Institute of Health, Institute of Virology, Berlin, Germany; German Centre for Infection Research, associated partner Charité, Berlin, Germany; Martsinovsky Institute of Medical Parasitology, Tropical and Vector Borne Diseases, Sechenov University, Moscow, Russia. 7 Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Berlin Institute of Health, Institute of Virology, Berlin, Germany. 8 Directorate of Agriculture, Ministry of Environment Water and Agriculture, Makkah Region, Saudi Arabia. 9 Mammals Research Chair, Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia. 10 Special Infectious Agent Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. 11 Department of Infection, Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, UK; NIHR Biomedical Research Centre, University College London Hospitals, London, UK. 12 Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Berlin Institute of Health, Institute of Virology, Berlin, Germany; German Centre for Infection Research, associated partner Charité, Berlin, Germany. Electronic address: christian.drosten@charite.de. 13 Special Infectious Agent Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia. Electronic address: eazhar@kau.edu.sa.

 

Abstract

BACKGROUND:

The Middle East respiratory syndrome coronavirus (MERS-CoV) is a lethal zoonotic pathogen endemic to the Arabian Peninsula. Dromedary camels are a likely source of infection and the virus probably originated in Africa. We studied the genetic diversity, geographical structure, infection prevalence, and age-associated prevalence among camels at the largest entry port of camels from Africa into the Arabian Peninsula.

METHODS:

In this prospective genomic study, we took nasal samples from camels imported from Sudan and Djibouti into the Port of Jeddah in Jeddah, Saudi Arabia, over an almost 2-year period and local Arabian camels over 2 months in the year after surveillance of the port. We determined the prevalence of MERS-CoV infection, age-associated patterns of infection, and undertook phylogeographical and migration analyses to determine intercountry virus transmission after local lineage establishment. We compared all virological characteristics between the local and imported cohorts. We compared major gene deletions between African and Arabian strains of the virus. Reproductive numbers were inferred with Bayesian birth death skyline analyses.

FINDINGS:

Between Aug 10, 2016, and May 3, 2018, we collected samples from 1196 imported camels, of which 868 originated from Sudan and 328 from Djibouti, and between May 1, and June 25, 2018, we collected samples from 472 local camels, of which 189 were from Riyadh and 283 were from Jeddah, Saudi Arabia. Virus prevalence was higher in local camels than in imported camels (224 [47·5%] of 472 vs 157 [13·1%] of 1196; p<0·0001). Infection prevalence peaked among camels older than 1 year and aged up to 2 years in both groups, with 255 (66·9%) of 381 positive cases in this age group. Although the overall geographical distribution of the virus corresponded with the phylogenetic tree topology, some virus exchange was observed between countries corresponding with trade routes in the region. East and west African strains of the virus appear to be geographically separated, with an origin of west African strains in east Africa. African strains of the virus were not re-sampled in Saudi Arabia despite sampling approximately 1 year after importation from Africa. All local Arabian samples contained strains of the virus that belong to a novel recombinant clade (NRC) first detected in 2014 in Saudi Arabia. Reproduction number estimates informed by the sequences suggest sustained endemicity of NRC, with a mean Re of 1·16.

INTERPRETATION:

Despite frequent imports of MERS-CoV with camels from Africa, African lineages of MERS-CoV do not establish themselves in Saudi Arabia. Arabian strains of the virus should be tested for changes in virulence and transmissibility.

FUNDING:

German Ministry of Research and Education, EU Horizon 2020, and Emerging Diseases Clinical Trials Partnership.

Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

PMID: 31843456 DOI: 10.1016/S2542-5196(19)30243-8

Keywords: MERS-CoV; Camels; Africa Region; Saudi Arabia; Recombination.

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#Genetic #diversity of #MERS-CoV spike protein gene in #Saudi Arabia (J Infect Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Infect Public Health. 2019 Dec 9. pii: S1876-0341(19)30345-4. doi: 10.1016/j.jiph.2019.11.007. [Epub ahead of print]

Genetic diversity of MERS-CoV spike protein gene in Saudi Arabia.

Sohrab SS1, Azhar EI2.

Author information: 1 Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia. Electronic address: ssohrab@kau.edu.sa. 2 Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia.

 

Abstract

BACKGROUND:

Middle East respiratory syndrome coronavirus (MERS-CoV) was primarily detected in 2012 and still causing disease in human and camel. Camel and bats have been identified as a potential source of virus for disease spread to human. Although, significant information related to MERS-CoV disease, spread, infection, epidemiology, clinical features have been published, A little information is available on the sequence diversity of Spike protein gene. The Spike protein gene plays a significant role in virus attachment to host cells. Recently, the information about recombinant MERS-CoV has been published. So, this work was designed to identify the emergence of any another recombinant virus in Jeddah, Saudi Arabia.

METHODS:

In this study samples were collected from both human and camels and the Spike protein gene was amplified and sequenced. The nucleotide and amino acid sequences of MERS-CoV Spike protein gene were used to analyze the recombination, genetic diversity and phylogenetic relationship with selected sequences from Saudi Arabia.

RESULTS:

The nucleotide sequence identity ranged from 65.7% to 99.8% among all the samples collected from human and camels from various locations in the Kingdom. The lowest similarity (65.7%) was observed in samples from Madinah and Dammam. The phylogenetic relationship formed different clusters with multiple isolates from various locations. The sample collected from human in Jeddah hospital formed a closed cluster with human samples collected from Buraydah, while camel sample formed a closed cluster with Hufuf isolates. The phylogenetic tree by using Aminoacid sequences formed closed cluster with Dammam, Makkah and Duba isolates. The amino acid sequences variations were observed in 28/35 samples and two unique amino acid sequences variations were observed in all samples analyzed while total 19 nucleotides sequences variations were observed in the Spike protein gene. The minor recombination events were identified in eight different sequences at various hotspots in both human and camel samples using recombination detection programme.

CONCLUSION:

The generated information from this study is very valuable and it will be used to design and develop therapeutic compounds and vaccine to control the MERS-CoV disease spread in not only in the Kingdom but also globally.

Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.

KEYWORDS: Camel; Genetic diversity; Human; MERS-CoV; Saudi Arabia

PMID: 31831395 DOI: 10.1016/j.jiph.2019.11.007

Keywords: MERS-CoV; Human; Camels; Recombination; Saudi Arabia.

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#Diabetes Mellitus, #Hypertension, and Death among 32 Patients with #MERS-CoV #Infection, #Saudi Arabia (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 26, Number 1—January 2020 / Research Letter

Diabetes Mellitus, Hypertension, and Death among 32 Patients with MERS-CoV Infection, Saudi Arabia

Khalid H. Alanazi, Glen R. Abedi  , Claire M. Midgley, Abdulrahim Alkhamis, Taghreed Alsaqer, Abdullah Almoaddi, Abdullah Algwizani, Sameeh S. Ghazal, Abdullah M. Assiri, Hani Jokhdar, Susan I. Gerber, Hail Alabdely, and John T. Watson

Author affiliations: Ministry of Health, Riyadh, Saudi Arabia (K.H. Alanazi, A. Alkhamis, T. Alsaqer, A. Almoaddi, A. Algwizani, S.S. Ghazal, A.M. Assiri, H. Jokhdar, H. Alabdely); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (G.R. Abedi, C.M. Midgley, S.I. Gerber, J.T. Watson)

 

Abstract

Diabetes mellitus and hypertension are recognized risk factors for severe clinical outcomes, including death, associated with Middle East respiratory syndrome coronavirus infection. Among 32 virus-infected patients in Saudi Arabia, severity of illness and frequency of death corresponded closely with presence of multiple and more severe underlying conditions.

Keywords: MERS-CoV; Diabetes; Saudi Arabia.

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#Climate factors and incidence of Middle East respiratory syndrome #coronavirus [#MERS-CoV] (J Infect Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Infect Public Health. 2019 Dec 5. pii: S1876-0341(19)30351-X. doi: 10.1016/j.jiph.2019.11.011. [Epub ahead of print]

Climate factors and incidence of Middle East respiratory syndrome coronavirus.

Altamimi A1, Ahmed AE2.

Author information: 1 Tropical Diseases Center, National Health Laboratory, Saudi Center for Disease Prevention and Control (Saudi CDC), Riyadh, Saudi Arabia. 2 Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Department of Preventive Medicine & Biostatistics/Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA. Electronic address: anwar.ahmed.ctr@usuhs.edu.

 

Abstract

BACKGROUND:

Our understanding of climate factors and their links to the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) outbreaks is incomplete. This study aimed to estimate the monthly incidence of MERS-CoV cases and to investigate their correlation to climate factors.

METHODS:

The study used aggregated monthly MERS-CoV cases that reported to the Saudi Center for Disease Prevention and Control from the Riyadh Region between November 1, 2012 and December 31, 2018. Data on the meteorological situation throughout the study period was calculated based on Google reports on the Riyadh Region (24.7136°N, 46.6753°E). The Poisson regression was used to estimate the incidence rate ratio (IRR) and its 95% confidence intervals (CI) for each climate factor.

RESULTS:

A total of 712 MERS-CoV cases were included in the analysis (mean age 54.2±9.9 years), and more than half (404) (56.1%) MERS-CoV cases were diagnosed during a five-month period from April to August. The highest peak timing positioned in August 2015, followed by April 2014, June 2017, March 2015, and June 2016. High temperatures (IRR=1.054, 95% CI: 1.043-1.065) and a high ultraviolet index (IRR=1.401, 95% CI: 1.331-1.475) were correlated with a higher incidence of MERS-CoV cases. However, low relative humidity (IRR=0.956, 95% CI: 0.948-0.964) and low wind speed (IRR=0.945, 95% CI: 0.912-0.979) were correlated with a lower incidence of MERS-CoV cases.

CONCLUSION:

The novel coronavirus, MERS-CoV, is influenced by climate conditions with increasing incidence between April and August. High temperature, high ultraviolet index, low wind speed, and low relative humidity are contributors to increased MERS-CoV cases. The climate factors must be evaluated in hospitals and community settings and integrated into guidelines to serve as source of control measures to prevent and eliminate the risk of infection.

Copyright © 2019. Published by Elsevier Ltd.

KEYWORDS: MERS-CoV; Meteorological factors; Weather conditions

PMID: 31813836 DOI: 10.1016/j.jiph.2019.11.011

Keywords: MERS-CoV; Saudi Arabia.

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