#Spatiotemporal #Clustering of Middle East Respiratory Syndrome #Coronavirus (#MERS-CoV) Incidence in #Saudi Arabia, 2012-2019 (Int J Environ Res Public Health, abstract)

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

Int J Environ Res Public Health. 2019 Jul 15;16(14). pii: E2520. doi: 10.3390/ijerph16142520.

Spatiotemporal Clustering of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Incidence in Saudi Arabia, 2012-2019.

Al-Ahmadi K1, Alahmadi S2, Al-Zahrani A3.

Author information: 1 King Abdulaziz City for Science and Technology, P.O. Box 6086, Riyadh 11442, Saudi Arabia. 2 King Abdulaziz City for Science and Technology, P.O. Box 6086, Riyadh 11442, Saudi Arabia. salahmdi@kacst.edu.sa. 3 King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia.

 

Abstract

Middle East respiratory syndrome coronavirus (MERS-CoV) is a great public health concern globally. Although 83% of the globally confirmed cases have emerged in Saudi Arabia, the spatiotemporal clustering of MERS-CoV incidence has not been investigated. This study analysed the spatiotemporal patterns and clusters of laboratory-confirmed MERS-CoV cases reported in Saudi Arabia between June 2012 and March 2019. Temporal, seasonal, spatial and spatiotemporal cluster analyses were performed using Kulldorff’s spatial scan statistics to determine the time period and geographical areas with the highest MERS-CoV infection risk. A strongly significant temporal cluster for MERS-CoV infection risk was identified between April 5 and May 24, 2014. Most MERS-CoV infections occurred during the spring season (41.88%), with April and May showing significant seasonal clusters. Wadi Addawasir showed a high-risk spatial cluster for MERS-CoV infection. The most likely high-risk MERS-CoV annual spatiotemporal clusters were identified for a group of cities (n = 10) in Riyadh province between 2014 and 2016. A monthly spatiotemporal cluster included Jeddah, Makkah and Taif cities, with the most likely high-risk MERS-CoV infection cluster occurring between April and May 2014. Significant spatiotemporal clusters of MERS-CoV incidence were identified in Saudi Arabia. The findings are relevant to control the spread of the disease. This study provides preliminary risk assessments for the further investigation of the environmental risk factors associated with MERS-CoV clusters.

KEYWORDS: GIS; Middle East respiratory syndrome; Saudi Arabia; coronavirus; epidemiology; outbreak; spatiotemporal cluster

PMID: 31311073 DOI: 10.3390/ijerph16142520

Keywords: MERS-CoV; Saudi Arabia.

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#Epidemiology of #respiratory viruses in #Saudi Arabia: toward a complete picture (Arch Virol., abstract)

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

Arch Virol. 2019 May 28. doi: 10.1007/s00705-019-04300-2. [Epub ahead of print]

Epidemiology of respiratory viruses in Saudi Arabia: toward a complete picture.

Farrag MA1, Hamed ME1, Amer HM2, Almajhdi FN3.

Author information: 1 Department of Botany and Microbiology, College of Science, King Saud University, P.O. Box 2455QA6, Riyadh, 11451, Saudi Arabia. 2 Department of Virology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt. 3 Department of Botany and Microbiology, College of Science, King Saud University, P.O. Box 2455QA6, Riyadh, 11451, Saudi Arabia. majhdi@ksu.edu.sa.

 

Abstract

Acute lower respiratory tract infection is a major health problem that affects more than 15% of the total population of Saudi Arabia each year. Epidemiological studies conducted over the last three decades have indicated that viruses are responsible for the majority of these infections. The epidemiology of respiratory viruses in Saudi Arabia is proposed to be affected mainly by the presence and mobility of large numbers of foreign workers and the gathering of millions of Muslims in Mecca during the Hajj and Umrah seasons. Knowledge concerning the epidemiology, circulation pattern, and evolutionary kinetics of respiratory viruses in Saudi Arabia are scant, with the available literature being inconsistent. This review summarizes the available data on the epidemiology and evolution of respiratory viruses. The demographic features associated with Middle East respiratory syndrome-related coronavirus infections are specifically analyzed for a better understanding of the epidemiology of this virus. The data support the view that continuous entry and exit of pilgrims and foreign workers with different ethnicities and socioeconomic backgrounds in Saudi Arabia is the most likely vehicle for global dissemination of respiratory viruses and for the emergence of new viruses (or virus variants) capable of greater dissemination.

PMID:  31139937 DOI: 10.1007/s00705-019-04300-2

Keywords: Infectious Diseases; MERS-CoV; Saudi Arabia.

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#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.

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#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.

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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.

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#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.

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#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.

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