#MERS #Coronavirus, #Saudi Arabia, 2017–2018 (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 11—November 2019 / Research Letter

Middle East Respiratory Syndrome Coronavirus, Saudi Arabia, 2017–2018

Ahmed Hakawi, Erica Billig Rose  , Holly M. Biggs, Xiaoyan Lu, Mutaz Mohammed, Osman Abdalla, Glen R. Abedi, Ali A. Alsharef, Aref Ali Alamri, Samar Ahmad Bereagesh, Kamel M. Al Dosari, Saad Abdullah Ashehri, Waad Ghassan Fakhouri, Saleh Zaid Alzaid, Stephen Lindstrom, Susan I. Gerber, Abdullah Asiri, Hani Jokhdar, and John T. Watson

Author affiliations: Ministry of Health, Riyadh, Saudi Arabia (A. Hakawi, M. Mohammed, O. Abdalla, A.A. Alsharef, A.A. Alamri, S.A. Bereagesh, K.M. Al Dosari, S.A. Ashehri, W.G. Fakhouri, S.Z. Alzaid, A. Asiri, H. Jokhdar); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (E.B. Rose, H.M. Biggs, X. Lu, G.R. Abedi, S. Lindstrom, S.I. Gerber, J.T. Watson)



We characterized exposures and demographics of Middle East respiratory syndrome coronavirus cases reported to the Saudi Arabia Ministry of Health during July 1–October 31, 2017, and June 1–September 16, 2018. Molecular characterization of available specimens showed that lineage 5 predominated among circulating viruses during these periods.

Keywords: MERS-CoV; Saudi Arabia.



#Transmissibility of #MERS-CoV #Infection in Closed Setting, #Riyadh, #Saudi Arabia, 2015 (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 10—October 2019 / Synopsis

Transmissibility of MERS-CoV Infection in Closed Setting, Riyadh, Saudi Arabia, 2015

Maria D. Van Kerkhove1  , Sadoof Aswad, Abdullah Assiri, Ranawaka A.P.M Perera, Malik Peiris, Hassan E. El Bushra, and Abdulaziz A. BinSaeed

Author affiliations: Institut Pasteur, Paris, France (M.D. Van Kerkhove); Ministry of Health, Riyadh, Saudi Arabia (S. Aswad, A. Assiri, H.E. El Bushra, A.A. BinSaeed); Jubail General Hospital, Riyadh (S. Aswad); The University of Hong Kong, Hong Kong, China (R.A.P.M. Perera, M. Peiris); HKU-Pasteur Research Pole, Hong Kong (M. Peiris)



To investigate a cluster of Middle East respiratory syndrome (MERS) cases in a women-only dormitory in Riyadh, Saudi Arabia, in October 2015, we collected epidemiologic information, nasopharyngeal/oropharyngeal swab samples, and blood samples from 828 residents during November 2015 and December 2015–January 2016. We found confirmed infection for 19 (8 by reverse transcription PCR and 11 by serologic testing). Infection attack rates varied (2.7%–32.3%) by dormitory building. No deaths occurred. Independent risk factors for infection were direct contact with a confirmed case-patient and sharing a room with a confirmed case-patient; a protective factor was having an air conditioner in the bedroom. For 9 women from whom a second serum sample was collected, antibodies remained detectable at titers >1:20 by pseudoparticle neutralization tests (n = 8) and 90% plaque-reduction neutralization tests (n = 2). In closed high-contact settings, MERS coronavirus was highly infectious and pathogenicity was relatively low.

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


#Community-acquired #UTIs in #children: #Resistance patterns of #uropathogens in a tertiary care center in #Saudi Arabia (Int J Pediatr Adolesc Med., abstract)

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

Int J Pediatr Adolesc Med. 2019 Jun;6(2):51-54. doi: 10.1016/j.ijpam.2019.02.010. Epub 2019 Mar 8.

Community-acquired urinary tract infections in children: Resistance patterns of uropathogens in a tertiary care center in Saudi Arabia.

Hameed T1,2,3, Al Nafeesah A4, Chishti S1,3, Al Shaalan M1,2,3, Al Fakeeh K1,2,3.

Author information: 1 Department of Pediatrics, King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City – Central Region, Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia. 2 King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. 3 King Abdullah International Medical Research Center, Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia. 4 Unaizah College of Medicine and Medical Sciences, Al-Qassim University, Unaizah, Saudi Arabia.




The aim of the present study was to investigate the bacterial pathogens and their resistance patterns in children presenting with their first admission for a urinary tract infection (UTI) in a large tertiary care center in Riyadh, Saudi Arabia.


A retrospective chart review was conducted of pediatric patients 0-14 years of age who were admitted for their first community-acquired UTI in a large tertiary care center in Riyadh, Saudi Arabia. The review covered a 6-year period (2006-2012).


Data were obtained from 202 children, of which 162 (80.2%) were female. The most frequently isolated uropathogens were Escherichia coli (75.7%), followed by Klebsiella pneumoniae (9.4%), Pseudomonas aeruginosa (5.9%) and Enterococcus species (3.5%). Sixteen (7.9%) isolates were ESBLs. Among all uropathogens, 68% were resistant to ampicillin, 54% resistant to co-trimoxazole, and 30% resistant/intermediate sensitivity to amoxicillin/clavulinic acid. Overall, there was a low resistance rate to cefotaxime (4.4%).


E. coli is the predominant uropathogen causing UTIs in children, yet there is a high rate of multidrug-resistant organisms. For children admitted for a community-acquired UTI, a third-generation cephalosporin remains an appropriate empiric antibiotic. Our study and the work of others emphasize the importance of choosing empiric antibiotics for pediatric UTIs based on local resistance patterns.

PMID: 31388546 PMCID: PMC6676371 DOI: 10.1016/j.ijpam.2019.02.010

Keywords: Antibiotics; Drugs Resistance; UTI; Pediatrics; Saudi Arabia.


Characteristics and #outcome of #viral #pneumonia caused by #influenza and #MERS #coronavirus #infections: A 4-year experience from a tertiary care center (Ann Thorac Med., abstract)

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

Ann Thorac Med. 2019 Jul-Sep;14(3):179-185. doi: 10.4103/atm.ATM_179_18.

Characteristics and outcome of viral pneumonia caused by influenza and Middle East respiratory syndrome-coronavirus infections: A 4-year experience from a tertiary care center.

Al-Baadani AM1, Elzein FE1, Alhemyadi SA1, Khan OA1, Albenmousa AH1, Idrees MM1.

Author information: 1 Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.




After the emergence of new influenza viruses, the morbidity and mortality of viral pneumonia have received a great attention.


The objective of this study is to describe the epidemiologic, clinical and laboratory changes, and outcomes of viral pneumonia caused by influenza and the Middle East respiratory syndrome-coronavirus (MERS-CoV) infections.


In a retrospective cohort study, the medical records of all patients diagnosed with viral pneumonia at Prince Sultan Military Medical City, Riyadh, Saudi Arabia, during the period from January 2012 to December 2015 were screened. Cases who were > 18 years old and were confirmed by a respiratory viral panel to have viral pneumonia either MERS-CoV or influenza viruses were included in the analysis. Sociodemographic, clinical, laboratory, and outcome data were extracted from patients’ medical files. The data were analyzed descriptively and inferentially to identify the predictors of poor outcome.


A total of 448 patients with confirmed viral pneumonia were included, of those, 216 (48.2%) were caused by influenza A (non H1N1)/influenza B, 150 (33.5%) by H1N1, and 82 (18.3%) by MERS-CoV. The majority of patients presented with fever (82%), shortness of breath (64%), and flu-like symptoms (54.9%), particularly in MERS-CoV infected cases (92%). The peak incidence of viral pneumonia was in early spring and autumn. The mortality rate was 13.8%, and it was significantly higher among MERS-CoV cases. The predictors of death were age > 65 years, male gender, and associated comorbidities particularly diabetes mellitus, hypertension, and chronic kidney diseases. The number of comorbid illnesses was directly related to the increase in mortality in this group of patients.


Viral pneumonia caused by influenza and MERS-CoV carries a high mortality rate, particularly among MERS-CoV infected cases. Old age, male gender, and comorbid illnesses are predictors of poor outcome. Routine testing for newly emergent viruses is warranted for adults who have been hospitalized with pneumonia.

KEYWORDS: H1N1; Middle East respiratory syndrome-coronavirus; Viral pneumonia; influenza

PMID: 31333767 PMCID: PMC6611200 DOI: 10.4103/atm.ATM_179_18

Keywords: Influenza A; H1N1pdm09; MERS-CoV; Pneumonia; Saudi Arabia.


#Risk #Factors for #Fatal #MERS #Coronavirus #Infections in #Saudi Arabia: Analysis of the #WHO Line #List, 2013-2018 (Am J Public Health, abstract)

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

Am J Public Health. 2019 Jul 18:e1-e6. doi: 10.2105/AJPH.2019.305186. [Epub ahead of print]

Risk Factors for Fatal Middle East Respiratory Syndrome Coronavirus Infections in Saudi Arabia: Analysis of the WHO Line List, 2013-2018.

Rahman A1, Sarkar A1.

Author information: 1 Both authors are with the Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St John’s, Newfoundland and Labrador, Canada.




To explore complex associations among demographic factors, risk factors, health care, and fatality rates of Middle East respiratory syndrome coronavirus (MERS-CoV) in the Kingdom of Saudi Arabia.


We based this study on analysis of a publicly accessible line listing of 1256 MERS-CoV cases (2013 to October 2018) available on the World Health Organization’s Web site. For analyses of demographic factors (e.g., age, gender), access to health care, promptness of laboratory services, risk factors (comorbidity, exposure to camels and persons with MERS-CoV), occupation (health care), and outcome (fatality), we used descriptive statistics, risk ratio (RR), and the Pearson χ2 test.


Presence of comorbidity (RR = 3; 95% confidence interval [CI] = 2.2, 3.9), being male (RR = 1.6; 95% CI = 1.2, 2.1), exposure to dromedary camels (RR = 1.6; 95% CI = 1.3, 2.3), and consumption of camel milk (RR = 1.5; 95% CI = 0.9, 1.7) can significantly increase risk for fatality. Health care workers have significantly lower fatality (P < .001) than the rest of the persons with MERS-CoV.


Policies that promote health awareness for the high-risk population and their prompt seeking of health care should be considered. Publicly accessible line lists of infectious diseases such as MERS-CoV can be valuable sources for epidemiological analysis.

(Am J Public Health. Published online ahead of print July 18, 2019: e1-e6. doi:10.2105/AJPH.2019.305186).

PMID: 31318592 DOI: 10.2105/AJPH.2019.305186

Keywords: MERS-CoV; Saudi Arabia.


#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.



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.


#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.



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.