#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)



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.



Suspected #Oseltamivir-induced #bradycardia in a #pediatric patient: A case report from King Abdullah Specialist Children’s Hospital, Riyadh, #Saudi Arabia (Clin Pract., abstract)

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

Clin Pract. 2018 Nov 28;8(4):1094. doi: 10.4081/cp.2018.1094. eCollection 2018 Oct 26.

Suspected Oseltamivir-induced bradycardia in a pediatric patient: A case report from King Abdullah Specialist Children’s Hospital, Riyadh, Saudi Arabia.

Arabi H1, Zaid AA1, Alreefi M2, Alahmed S2.

Author information: 1 King Abdullah Specialist Children’s Hospital, National Guard Health Affairs. 2 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.



In recent years, influenza infection in the pediatric population has been a widescale issue that physicians face during the winter season. Medications used to treat and prevent such infections include Oseltamivir, an anti-viral neuraminidase inhibitor developed for both influenzas A and B. The most commonly well-known and manifesting adverse effects are nausea, vomiting and gastrointestinal upset. There is paucity of reports on other potential serious side effects of Oseltamivir in the pediatric population. One of the rarely reported adverse reactions in adult population is sinus bradycardia. This case reports the development of sinus bradycardia in a pediatric patient after administration of Oseltamivir. The previously healthy five-year-old patient was started on Oseltamivir after a positive polymerase chain reaction for influenza. The patient developed sinus bradycardia but remained hemodynamically stable. This finding led to consultations and investigations to determine the cause of bradycardia. It is pivotal to increase the awareness of the potential link between Oseltamivir and bradycardia in pediatric and adult populations to avoid unnecessary clinical investigations and to enhance physician decisionmaking. A prospective cohort study on Oseltamivir is needed for better understanding of its adverse effects in the pediatric population.

KEYWORDS: Bradycardia; Influenza; Oseltamvir; Pediatrics

PMID: 30595829 PMCID: PMC6280064 DOI: 10.4081/cp.2018.1094

Keywords: Seasonal Influenza; Antivirals; Oseltamivir; Bradycardia; Drugs safety.


#Scope and extent of #healthcare-associated #MERS #coronavirus #transmission during two contemporaneous #outbreaks in #Riyadh, #Saudi Arabia, 2017 (Infect Control Hosp Epidemiol., abstract)

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

Infect Control Hosp Epidemiol. 2019 Jan;40(1):79-88. doi: 10.1017/ice.2018.290.

Scope and extent of healthcare-associated Middle East respiratory syndrome coronavirus transmission during two contemporaneous outbreaks in Riyadh, Saudi Arabia, 2017.

Alanazi KH1, Killerby ME2, Biggs HM2, Abedi GR2, Jokhdar H1, Alsharef AA1, Mohammed M1, Abdalla O1, Almari A1, Bereagesh S1, Tawfik S1, Alresheedi H1, Alhakeem RF1, Hakawi A1, Alfalah H3, Amer H3, Thornburg NJ2, Tamin A2, Trivedi S4, Tong S2, Lu X2, Queen K2, Li Y2, Sakthivel SK5, Tao Y2, Zhang J2, Paden CR2, Al-Abdely HM1, Assiri AM1, Gerber SI2, Watson JT2.

Author information: 1 Ministry of Health,Riyadh,Saudi Arabia. 2 Division of Viral Diseases,National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia,United States. 3 King Saud Medical City,Riyadh,Saudi Arabia. 4 IHRC,contractor to National Center for Immunization and Respiratory Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia,United States. 5 Batelle, contractor to National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA,USA.




To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.


Outbreak investigation.


Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.


Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.


In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.


We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.

PMID: 30595141 DOI: 10.1017/ice.2018.290

Keywords: MERS-CoV; Nosocomial Outbreaks; Saudi Arabia.


#Seroprevalence of #Zika virus among asymptomatic #pregnant mothers and their #newborns in the #Najran region of southwest #Saudi Arabia (Ann Saudi Med., abstract)

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

Ann Saudi Med. 2018 Nov-Dec;38(6):408-412. doi: 10.5144/0256-4947.2018.408.

Seroprevalence of Zika virus among asymptomatic pregnant mothers and their newborns in the Najran region of southwest Saudi Arabia.

Alayed MS, Qureshi MA, Ahmed S, Alqahtani AS, Al-Qahtani AM, Alshaybari K, Alshahrani M, Asaad AM.




Zika virus (ZIKV) is a teratogenic flavivirus that can cause microcephaly. Its main vector, Aedes aegypti, has been previ.ously identified in Saudi Arabia, but no ZIKV infection has yet been reported. Nevertheless, the country is at risk from ZIKV because it receives many travelers throughout the year, including pilgrims from ZIKV-endemic countries.


Screen asymptomatic pregnant mothers and their newborns attending a major hospital in the Najran region for subclinical or past infections with ZIKV, using ELISA and RT-PCR.




Najran Maternity and Children Hospital (NMCH).


All pregnant women admitted to NMCH in labor between November 2016 and July 2017 were included in the study. Clinical and demographic data were collected by pre-validated physician-administered questionnaires. Paired umbilical and maternal serum samples were collected and frozen at -60°C, using ELISA to measure anti-ZIKA IgG and IgM antibodies and RT-PCR to further investigate positive samples.


Maternal and newborn serum anti-ZIKV IgM and IgG and ZIKV RT-PCR.


410 mother-newborn pairs.


The median gestational age was 38.5 weeks (range 33-42). Most (n=342, 83.41%) of the women were from Najran city. All of the newborns had normal growth parameters with no congenital malformations. None of the mothers had symptoms suggestive of ZIKV infection; 3 (0.7%) exhibited a low-grade fever (38°C), but did not test positive for anti-ZIKV antibodies. Thirty-five (8.53%) of mothers had travelled inside Saudi Arabia, but none outside the country. Twenty-four (5.85%) mothers tested positive for anti-ZIKV IgM and 52 (12.68%) tested positive for anti-ZIKV IgG, but all infant samples were negative. All seropositive ZIKV IgM were also ZIKV IgG positive, but RT-PCR test.ing of all seropositive samples was negative.


Although previous (resolved) ZIKV infection and cross-reactivity of the ELISA method with other flaviviruses cannot be ex.cluded, the study found no confirmed cases of acute ZIKV infection. However, given the presence of the vector in Saudi Arabia, the presence of presumptive positive serology and the ongoing risk of ZIKV entry via a regular influx of travelers from endemic areas, we propose that continuous surveillance be conducted for ZIKV as well for other flaviviruses. Larger-scale nationwide studies are strongly recommended to gain a broader view of the potential threat from ZIKV in the country.


Small sample size, unavailability of plaque reduction neutralization tests to confirm serology results, and RT-PCR was only conducted on ELISA-positive serum samples, due to resource constraints.


PMID: 30531174 DOI: 10.5144/0256-4947.2018.408

Keywords: Saudi Arabia; Zika Virus; Zika Congenital Infection; Seroprevalence; Pregnancy.


Middle East respiratory syndrome #coronavirus (#MERS-CoV): #Impact on #Saudi Arabia, 2015 (Saudi J Biol Sci., abstract)

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

Saudi J Biol Sci. 2018 Nov;25(7):1402-1405. doi: 10.1016/j.sjbs.2016.09.020. Epub 2016 Oct 1.

Middle East respiratory syndrome coronavirus (MERS-CoV): Impact on Saudi Arabia, 2015.

Faridi U1.

Author information: 1 Department of Biochemistry, Tabuk University, Tabuk, Saudi Arabia.



Middle East respiratory syndrome is the acute respiratory syndrome caused by betacoronavirus MERS-CoV. The first case of this disease was reported from Saudi Arabia in 2012. This virus is lethal and is a close relative of a severe acute respiratory syndrome (SARS), which is responsible for more than 3000 deaths in 2002-2003. According to Ministry of Health, Saudi Arabia. The number of new cases is 457 in 2015. Riyadh has the highest number of reports in comparison to the other cities. According to this report, males are more susceptible than female, especially after the age of 40. Because of the awareness and early diagnosis the incidence is falling gradually. The pre-existence of another disease like cancer or diabetic etc. boosts the infection. MERS is a zoonotic disease and human to human transmission is low. The MERS-CoV is a RNA virus with protein envelope. On the outer surface, virus has spike like glycoprotein which is responsible for the attachment and entrance inside host cells. There is no specific treatment for the MERS-CoV till now, but drugs are in pipeline which bind with the spike glycoprotein and inhibit its entrance host cells. MERS-CoV and SAR-CoV are from the same genus, so it was thought that the drugs which inhibit the growth of SARS-CoV can also inhibit the growth of MERS-CoV but those drugs are not completely inhibiting virus activity. Until we don’t have proper structure and the treatment of MERS-CoV, We should take precautions, especially the health care workers, Camel owners and Pilgrims during Hajj and Umrah, because they are at a higher risk of getting infected.

KEYWORDS: Betacoronavirus; MERS-CoV; SARS; Saudi Arabia

PMID: 30505188 PMCID: PMC6252006  DOI: 10.1016/j.sjbs.2016.09.020

Keywords: Coronavirus; Betacoronavirus; MERS-CoV; SARS; Saudi Arabia; Human; Camels.


#Prevalence of #comorbidities in cases of #MERS #coronavirus: a retrospective study (Epidemiol Infect., abstract)

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

Epidemiol Infect. 2018 Nov 5:1-5. doi: 10.1017/S0950268818002923. [Epub ahead of print]

Prevalence of comorbidities in cases of Middle East respiratory syndrome coronavirus: a retrospective study.

Alqahtani FY1, Aleanizy FS1, Ali El Hadi Mohamed R2, Alanazi MS3, Mohamed N4, Alrasheed MM5, Abanmy N5, Alhawassi T5.

Author information: 1 Department of Pharmaceutics,College of Pharmacy, King Saud University,22452 Riyadh 11495,Saudi Arabia. 2 College of Science, Princess Nourah Bint Abdulrahman University,Riyadh 12484,Saudi Arabia. 3 Emergency medicine consultant,Emergency Department,Prince Mohamed Bin Abdulaziz Hospital,Ministry of Health,Riyadh 12455,Saudi Arabia. 4 College of Medicine, Princess Nourah bint Abdulrahman University,Riyadh 12484,Saudi Arabia. 5 Department of Clinical Pharmacy,College of Pharmacy, King Saud University,22452 Riyadh 11495,Saudi Arabia.



The Middle East respiratory syndrome coronavirus (MERS-CoV) is a life-threatening respiratory disease with a high case fatality rate; however, its risk factors remain unclear. We aimed to explore the influence of demographic factors, clinical manifestations and underlying comorbidities on mortality in MERS-CoV patients. Retrospective chart reviews were performed to identify all laboratory-confirmed cases of MERS-COV infection in Saudi Arabia that were reported to the Ministry of Health of Saudi Arabia between 23 April 2014 and 7 June 2016. Statistical analyses were conducted to assess the effect of sex, age, clinical presentation and comorbidities on mortality from MERS-CoV. A total of 281 confirmed MERS-CoV cases were identified: 167 (59.4%) patients were male and 55 (20%) died. Mortality predominantly occurred among Saudi nationals and older patients and was significantly associated with respiratory failure and shortness of breath. Of the 281 confirmed cases, 160 (56.9%) involved comorbidities, wherein diabetes mellitus, hypertension, ischemic heart disease, congestive heart failure, end-stage renal disease and chronic kidney disease were significantly associated with mortality from MERS-CoV and two or three comorbidities significantly affected the fatality rates from MERS-CoV. The findings of this study show that old age and the existence of underlying comorbidities significantly increase mortality from MERS-CoV.

KEYWORDS: Comorbidities; middle east respiratory syndrome coronavirus; mortality

PMID: 30394248 DOI: 10.1017/S0950268818002923

Keywords: MERS-CoV.


High #Prevalence of #MERS-CoV #Infection in #Camel #Workers in #Saudi Arabia (mBio, abstract)

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

MBio. 2018 Oct 30;9(5). pii: e01985-18. doi: 10.1128/mBio.01985-18.

High Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia.

Alshukairi AN#1, Zheng J#2, Zhao J#3, Nehdi A4, Baharoon SA5, Layqah L4, Bokhari A6, Al Johani SM7, Samman N4, Boudjelal M4, Ten Eyck P8, Al-Mozaini MA9, Zhao J#3,10, Perlman S#11,3, Alagaili AN#12.

Author information: 1 Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudia Arabia. 2 Department of Microbiology and Immunology, University of Iowa, Iowa City, Iowa, USA. 3 State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China. 4 Department of Medical Research Core Facility and Platforms, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia. 5 Department of Critical Care, King Saud Bin Abdulaziz for Health Sciences University, Riyadh, Kingdom of Saudi Arabia. 6 Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia. 7 College of Science and Health Professions, King Saud Bin Abdulaziz for Health Sciences University, Riyadh, Kingdom of Saudi Arabia. 8 Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa, USA. 9 Department of Infection and Immunology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia. 10 Guangzhou Eighth People’s Hospital of Guangzhou Medical University, Guangzhou, China. 11 Department of Microbiology and Immunology, University of Iowa, Iowa City, Iowa, USA stanley-perlman@uiowa.edu aalagaili@ksu.edu.sa. 12 KSU Mammals Research Chair, Zoology Department, King Saud University, Riyadh, Kingdom of Saudi Arabia stanley-perlman@uiowa.edu aalagaili@ksu.edu.sa. # Contributed equally



Middle East respiratory syndrome (MERS), a highly lethal respiratory disease caused by a novel coronavirus (MERS-CoV), is an emerging disease with high potential for epidemic spread. It has been listed by the WHO and the Coalition for Epidemic Preparedness Innovations (CEPI) as an important target for vaccine development. While initially the majority of MERS cases were hospital acquired, continued emergence of MERS is attributed to community acquisition, with camels likely being the direct or indirect source. However, the majority of patients do not describe camel exposure, making the route of transmission unclear. Here, using sensitive immunological assays and a cohort of camel workers (CWs) with well-documented camel exposure, we show that approximately 50% of camel workers (CWs) in the Kingdom of Saudi Arabia (KSA) and 0% of controls were previously infected. We obtained blood samples from 30 camel herders, truck drivers, and handlers with well-documented camel exposure and from healthy donors, and measured MERS-CoV-specific enzyme-linked immunosorbent assay (ELISA), immunofluorescence assay (IFA), and neutralizing antibody titers, as well as T cell responses. Totals of 16/30 CWs and 0/30 healthy control donors were seropositive by MERS-CoV-specific ELISA and/or neutralizing antibody titer, and an additional four CWs were seronegative but contained virus-specific T cells in their blood. Although virus transmission from CWs has not been formally demonstrated, a possible explanation for repeated MERS outbreaks is that CWs develop mild disease and then transmit the virus to uninfected individuals. Infection of some of these individuals, such as those with comorbidities, results in severe disease and in the episodic appearance of patients with MERS.



The Middle East respiratory syndrome (MERS) is a coronavirus (CoV)-mediated respiratory disease. Virus transmission occurs within health care settings, but cases also appear sporadically in the community. Camels are believed to be the source for community-acquired cases, but most patients do not have camel exposure. Here, we assessed whether camel workers (CWs) with high rates of exposure to camel nasal and oral secretions had evidence of MERS-CoV infection. The results indicate that a high percentage of CWs were positive for virus-specific immune responses but had no history of significant respiratory disease. Thus, a possible explanation for repeated MERS outbreaks is that CWs develop mild or subclinical disease. These CWs then transmit the virus to uninfected individuals, some of whom are highly susceptible, develop severe disease, and are detected as primary MERS cases in the community.

KEYWORDS: Middle East respiratory syndrome; T cells; antibody; camel workers; coronavirus; human Middle East respiratory syndrome; virus-specific T cell response; virus-specific antibody response

PMID: 30377284 DOI: 10.1128/mBio.01985-18

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