#Diagnostic #delays in #MERS #coronavirus #patients and #health #systems (J Infect Public Health, abstract)

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

J Infect Public Health. 2019 Apr 18. pii: S1876-0341(19)30135-2. doi: 10.1016/j.jiph.2019.04.002. [Epub ahead of print]

Diagnostic delays in Middle East respiratory syndrome coronavirus patients and health systems.

Ahmed AE1.

Author information: 1 College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia. Electronic address: ahmeda5@vcu.edu.

 

Abstract

BACKGROUND:

Although Middle East respiratory syndrome coronavirus (MERS-CoV) diagnostic delays remain a major challenge in health systems, the source of delays has not been recognized in the literature. The aim of this study is to quantify patient and health-system delays and to identify their associated factors.

METHODS:

The study of 266 patients was based on public source data from the World Health Organization (WHO) (January 2, 2017-May 16, 2018). The diagnostic delays, patient delays, and health-system delays were calculated and modelled using a Poisson regression analysis.

RESULTS:

In 266 MERS-CoV patients reported during the study period, the median diagnostic delays, patient delays, and health-system delays were 5 days (interquartile [IQR] range: 3-8 days), 4 days (IQR range: 2-7 days), and 2 days (IQR range: 1-2 days), respectively. Both patient delay (r = 0.894, P = 0.001) and health-system delay (r = 0.163, P = 0.025) were positively correlated with diagnostic delay. Older age was associated with longer health-system delay (adjusted relative ratios (aRR), 1.011; 95% confidence intervals (CI), 1.004-1.017). Diagnostic delay (aRR, 1.137; 95% CI, 1.006-1.285) and health-system delays (aRR, 1.217; 95% CI, 1.003-1.476) were significantly longer in patients who died.

CONCLUSION:

Delays in MERS-CoV diagnosis exist and may be attributable to patient delay and health-system delay as both were significantly correlated with longer diagnosis delay. Early MERS-CoV diagnosis may require more sensitive risk assessment tools to reduce avoidable delays, specifically those related to patients and health system.

Copyright © 2019. Published by Elsevier Ltd.

KEYWORDS: Coronavirus; Diagnostic delay; Health-system delay; MERS-CoV; Patient delay; Saudi Arabia

PMID: 31006635 DOI: 10.1016/j.jiph.2019.04.002

Keywords: MERS-CoV; Diagnostic tests; Saudi Arabia.

——

Advertisements

#Epidemiological study of #MERS #coronavirus #infection in dromedary #camels in #Saudi Arabia, April-May 2015 (Rev Sci Tech., abstract)

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

Rev Sci Tech. 2018 Dec;37(3):985-997. doi: 10.20506/rst.37.3.2901.

Epidemiological study of Middle East respiratory syndrome coronavirus infection in dromedary camels in Saudi Arabia, April-May 2015.

Elfadil AA, Ahmed AG, Abdalla MO, Gumaa E, Osman OH, Younis AE, Al-Hafufi AN, Saif LJ, Zaki A, Al-Rumaihi A, Al-Harbi N, Kasem S, Al-Brahim RH, Al-Sahhaf A, Bayoumi FE, Qasim IA, Abu-Obeida A, Al-Dowairij A.

Abstract 

A cross-sectional study was conducted in five regions in Saudi Arabia to investigate the epidemiology of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in dromedary camels (Camelus dromedarius) during April and May2015. Serum and nasal swab samples were tested for MERS-CoV antibodies and ribonucleic acid (RNA) using a recombinant enzyme-linked immunosorbent assay (rELISA) and real-time reverse-transcription polymerase chain reaction (rRT-PCR), respectively. The overall MERS-CoV antibody seroprevalence was 80.5%, whereas the overall viral RNA prevalence was 2.4%. The associations of risk factors with each prevalence were quantified using univariate and multivariate analyses. The multivariate models identified region, age, grazing system, exposure to wild animals and dung removal as factors significantly associated with seroprevalence (p ??0.05). A higher seroprevalence was more likely to occur in camels from the Riyadh, Eastern, Northern and Makkah regions than those from the Jazan region; camels ??4 and 1-3 years of age (marginally significant) than calves < 1 year; and camels raised in zero grazing and semi-open grazing systems than those raised in an open grazing system. However, the presence of wild animals and daily dung removal were negatively associated with seroprevalence. On the other hand, region and sex were significantly associated with MERS-CoV RNA prevalence(p ??0.05). A higher viral RNA prevalence was more likely to occur in camels from the Riyadh region and Eastern region (marginally significant) than in those from the Makkah region, and in male camels than female camels. In conclusion, the risk factors identified in this study can be considered to be predictors of MERS-CoV infection in camels and should be taken into account when developing an efficient and cost-effective control strategy.

KEYWORDS: Camel; Dromedary camel; Epidemiology; MERS-CoV; Middle East respiratory syndrome coronavirus; Prevalence; Risk factor; Saudi Arabia

PMID: 30964454 DOI: 10.20506/rst.37.3.2901

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

——

Noninvasive #ventilation in critically ill patients with the #MERS (Influenza Other Respir Viruses, abstract)

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

Influenza Other Respir Viruses. 2019 Mar 18. doi: 10.1111/irv.12635. [Epub ahead of print]

Noninvasive ventilation in critically ill patients with the Middle East respiratory syndrome.

Alraddadi BM1,2, Qushmaq I1, Al-Hameed FM3, Mandourah Y4, Almekhlafi GA4, Jose J5, Al-Omari A6, Kharaba A7, Almotairi A8, Al Khatib K9, Shalhoub S10,11, Abdulmomen A12, Mady A13,14, Solaiman O15, Al-Aithan AM16, Al-Raddadi R17, Ragab A18, Balkhy HH19, Al Harthy A14, Sadat M20, Tlajyeh H20, Merson L21, Hayden FG22, Fowler RA23, Arabi YM20; Saudi Critical Care Trials Group.

Author information: 1 Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia. 2 Department of Medicine, University of Jeddah, Jeddah, Saudi Arabia. 3 Department of Intensive Care, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia. 4 Prince Sultan Military Medical City, Military Medical Services, Ministry of Defense, Riyadh, Saudi Arabia. 5 Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. 6 Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. 7 Department of Critical Care, Ohoud Hospitals, King Fahad Hospital, Al-Madinah Al-Monawarah, Saudi Arabia. 8 Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia. 9 Intensive Care Department, Al-Noor Specialist Hospital, Makkah, Saudi Arabia. 10 Department of Medicine, Division of Infectious Diseases, University of Western Ontario, London, Canada. 11 Department of Medicine, Division of Infectious Diseases, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. 12 King Saud University, Riyadh, Saudi Arabia. 13 Department of Anesthesiology, Intensive Care, Tanta University Hospitals, Tanta, Egypt. 14 Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia. 15 King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. 16 Intensive Care Department, King Abdulaziz Hospital, Al Ahsa, Saudi Arabia. 17 Department of Family and Community Medicine, King Abdulaziz University Hospital, Ministry of Health, Jeddah, Saudi Arabia. 18 Intensive Care Department, King Fahd Hospital, Jeddah, Saudi Arabia. 19 Infection Prevention and Control Department, King Abdullah International Medical Research Center, College of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. 20 Intensive Care Department, King Abdullah International Medical Research Center, College of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. 21 Infectious Diseases Data Observatory, Churchill Hospital, Oxford University, International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), Headington, UK. 22 Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), Charlottesville, Virginia. 23 Department of Critical Care Medicine and Department of Medicine, Sunnybrook Hospital, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.

 

Abstract

BACKGROUND:

Noninvasive ventilation (NIV) has been used in patients with the Middle East respiratory syndrome (MERS) with acute hypoxemic respiratory failure, but the effectiveness of this approach has not been studied.

METHODS:

Patients with MERS from 14 Saudi Arabian centers were included in this analysis. Patients who were initially managed with NIV were compared to patients who were managed only with invasive mechanical ventilation (invasive MV).

RESULTS:

Of 302 MERS critically ill patients, NIV was used initially in 105 (35%) patients, whereas 197 (65%) patients were only managed with invasive MV. Patients who were managed with NIV initially had lower baseline SOFA score and less extensive infiltrates on chest radiograph compared with patients managed with invasive MV. The vast majority (92.4%) of patients who were managed initially with NIV required intubation and invasive mechanical ventilation, and were more likely to require inhaled nitric oxide compared to those who were managed initially with invasive MV. ICU and hospital length of stay were similar between NIV patients and invasive MV patients. The use of NIV was not independently associated with 90-day mortality (propensity score-adjusted odds ratio 0.61, 95% CI [0.23, 1.60] P = 0.27).

CONCLUSIONS:

In patients with MERS and acute hypoxemic respiratory failure, NIV failure was very high. The use of NIV was not associated with improved outcomes.

© 2019 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

KEYWORDS: Middle East respiratory syndrome; Saudi Arabia; acute respiratory distress syndrome; coronavirus; noninvasive ventilation; pneumonia; severe acute respiratory infection

PMID: 30884185 DOI: 10.1111/irv.12635

Keywords: MERS-CoV; Saudi Arabia; Intensive Care.

——

#Clinical #predictors of #mortality of Middle East Respiratory Syndrome (#MERS) #infection: A cohort study (Travel Med Infect Dis., abstract)

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

Travel Med Infect Dis. 2019 Mar 11. pii: S1477-8939(18)30382-X. doi: 10.1016/j.tmaid.2019.03.004. [Epub ahead of print]

Clinical predictors of mortality of Middle East Respiratory Syndrome (MERS) infection: A cohort study.

Alfaraj SH1, Al-Tawfiq JA2, Assiri AY3, Alzahrani NA4, Alanazi AA4, Memish ZA5.

Author information: 1 Corona Center, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia; Infectious Diseases Division, Department of Pediatrics, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia; University of British Columbia, Vancouver, BC, Canada. 2 Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA. 3 Critical Care Department, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Saudi Arabia. 4 Corona Center, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia. 5 College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Infectious Diseases Division, Department of Medicine, Department of Research, Prince Mohamed Bin Abdulaziz Hospital (?PMAH?), Ministry of Health, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: zmemish@yahoo.com.

 

Abstract

BACKGROUND:

Since the emergence of the Middle East Respiratory Syndrome (MERS) in 2012, the virus had caused a high case fatality rate. The clinical presentation of MERS varied from asymptomatic to severe bilateral pneumonia, depending on the case definition and surveillance strategies. There are few studies examining the mortality predictors in this disease. In this study, we examined clinical predictors of mortality of Middle East Respiratory Syndrome (MERS) infection.

METHODS:

This is a retrospective analysis of symptomatic admitted patients to a large tertiary MERS-CoV center in Saudi Arabia over the period from April 2014 to March 2018. Clinical and laboratory data were collected and analysis was done using a binary regression model.

RESULTS:

A total of 314 symptomatic MERS patients were included in the analysis, with a mean age of 48 (±17.3) years. Of these cases, 78 (24.8%) died. The following parameters were associated with increased mortality, age, WBC, neutrophil count, serum albumin level, use of a continuous renal replacement therapy (CRRT) and corticosteroid use. The odd ratio for mortality was highest for CRRT and corticosteroid use (4.95 and 3.85, respectively). The use of interferon-ribavirin was not associated with mortality in this cohort.

CONCLUSION:

Several factors contributed to increased mortality in this cohort of MERS-CoV patients. Of these factors, the use of corticosteroid and CRRT were the most significant. Further studies are needed to evaluate whether these factors were a mark of severe disease or actual contributors to higher mortality.

Copyright © 2019. Published by Elsevier Ltd.

PMID: 30872071 DOI: 10.1016/j.tmaid.2019.03.004

Keywords: MERS-CoV; Saudi Arabia.

——

#MERS #Coronavirus #Infection #Dynamics and #Antibody Responses among Clinically Diverse #Patients, #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 25, Number 4—April 2019 / Research

Middle East Respiratory Syndrome Coronavirus Infection Dynamics and Antibody Responses among Clinically Diverse Patients, Saudi Arabia

Hail M. Al-Abdely1, Claire M. Midgley1  , Abdulrahim M. Alkhamis, Glen R. Abedi, Xiaoyan Lu, Alison M. Binder, Khalid H. Alanazi, Azaibi Tamin, Weam M. Banjar, Sandra Lester, Osman Abdalla, Rebecca M. Dahl, Mutaz Mohammed, Suvang Trivedi, Homoud S. Algarni, Senthilkumar K. Sakthivel, Abdullah Algwizani, Fahad Bafaqeeh, Abdullah Alzahrani, Ali Abraheem Alsharef, Raafat F. Alhakeem, Hani A. Aziz Jokhdar, Sameeh S. Ghazal, Natalie J. Thornburg, Dean D. Erdman, Abdullah M. Assiri, John T. Watson  , and Susan I. Gerber

Author affiliations: Ministry of Health, Riyadh, Saudi Arabia (H.M. Al-Abdely, A.M. Alkhamis, K.H. Alanazi, W.M. Banjar, O. Abdalla, M. Mohammed, H.S. Algarni, A. Alzahrani, A.A. Alsharef, R.F. Alhakeem, H.A.A. Jokhdar, A.M. Assiri); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.M. Midgley, G.R. Abedi, X. Lu, A.M. Binder, A. Tamin, S. Lester, R.M. Dahl, S.K. Sakthivel, N.J. Thornburg, D.D. Erdman, J.T. Watson, S.I. Gerber); Princess Nourah Bint Abdulrahman University, Riyadh (W.M. Banjar); Prince Mohammed Bin Abdulaziz Hospital, Riyadh (A. Algwizani, F. Bafaqeeh, S.S. Ghazal)

 

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.

Keywords: MERS-CoV; Saudi Arabia.

——

#Atypical #influenza A #H1N1pdm09 strains caused an influenza virus #outbreak in #Saudi Arabia during the 2009-2011 #pandemic season (J Infect Public Health, abstract)

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

J Infect Public Health. 2019 Feb 21. pii: S1876-0341(19)30069-3. doi: 10.1016/j.jiph.2019.01.067. [Epub ahead of print]

Atypical influenza A(H1N1)pdm09 strains caused an influenza virus outbreak in Saudi Arabia during the 2009-2011 pandemic season.

Khan A1, AlBalwi MA2, AlAbdulkareem I3, AlMasoud A1, AlAsiri A1, AlHarbi W1, AlSehile F4, El-Saed A5, Balkhy HH6.

Author information: 1 Department of Medical Genomics Research, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. 2 Department of Medical Genomics Research, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. Electronic address: balwim@ngha.med.sa. 3 Intramural health sciences research, Princess Nourah Bint Abdulrahman university, Riyadh, Saudi Arabia. 4 King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. 5 Department of Infection Prevention & Control Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. 6 King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Infection Prevention & Control Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.

 

Abstract

BACKGROUND:

The triple assortment influenza A(H1N1) virus emerged in spring 2009 and disseminated worldwide, including Saudi Arabia. This study was carried out to characterize Saudi influenza isolates in relation to the global strains and to evaluate the potential role of mutated residues in transmission, adaptation, and the pathogenicity of the virus.

METHODS:

Nasopharyngeal samples (n = 6492) collected between September 2009 to March 2011 from patients with influenza-like illness were screened by PCR for influenza A(H1N1). Phylogenetic and Molecular evolutionary analysis were carried out to place the Saudi strains in relation to the global strains followed by Mutation analysis of surface and internal proteins.

RESULTS:

Concatenated whole-genome phylogenetic analysis along with hemagglutinin (HA) signature changes, that is, Aspartic Acid (D) at position 187, P83S, S203T, and R223Q confirmed that the Saudi strains belong to the antigenic category of A/California/07/2009. However, phylogenetic analysis revealed unusual strains of A(H1N1) circulating in Saudi Arabia, not belonging to any of known clades, appearing in five distinct groups well supported by group-specific mutations and novel mutation complexes. These cases had characteristic inter- and intragroup substitution patterns while few of their closest matches showed up as sporadic cases the world over. Specific mutation patterns were detected within the functional domains of internal proteins PB2, PB1, PA, NP, NS1, and M2 having a putative role in viral fitness and virulence. Bayesian coalescent MCMC analysis revealed that Saudi strains belonged to cluster 2 of A(H1N1)pdm09 and spread a month later as compared to other strains of this cluster.

CONCLUSION:

Influenza outbreak in Saudi Arabia during 2009-2011 was caused by atypical strains of influenza A(H1N1)pdm09, probably introduced in this community on multiple occasions. To understand the antigenic significance of these novel point mutations and mutation complexes require functional studies, which will be crucial for risk assessment of emergent strains and defining infection control measures.

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

KEYWORDS: Influenza A(H1N1) virus; Phylogenetic; Saudi Arabia

PMID: 30799182 DOI: 10.1016/j.jiph.2019.01.067

Keywords: Seasonal Influenza; H1N1pdm09; Saudi Arabia.

——

#Genetic Characterization of #MERS #Coronavirus, South #Korea, 2018 (Emerg Infect Dis., abstract)

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

Volume 25, Number 5—May 2019 / Dispatch

Genetic Characterization of Middle East Respiratory Syndrome Coronavirus, South Korea, 2018

Yoon-Seok Chung, Jeong Min Kim, Heui Man Kim, Kye Ryeong Park, Anna Lee, Nam-Joo Lee, Mi-Seon Kim, Jun Sub Kim, Chi-Kyeong Kim, Jae In Lee, and Chun Kang

Author affiliations: Korea Centers for Disease Control and Prevention, Cheongju, South Korea (Y.-S. Chung, J.M. Kim, H.M. Kim, K.R. Park, A. Lee, N.-J. Lee, M.-S. Kim, J.S. Kim, C.-K. Kim, C. Kang); Seoul Institute of Public Health and Environment, Seoul, South Korea (J.I. Lee)

 

Abstract

We evaluated genetic variation in Middle East respiratory syndrome coronavirus (MERS-CoV) imported to South Korea in 2018 using specimens from a patient and isolates from infected Caco-2 cells. The MERS-CoV strain in this study was genetically similar to a strain isolated in Riyadh, Saudi Arabia, in 2017.

Keywords: MERS-CoV; Saudi Arabia; South Korea.

——