#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.


#Epidemiology and predictors of #survival of #MERS-CoV #infections in #Riyadh region, 2014-2015 (J Infect Public Health, abstract)

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

J Infect Public Health. 2018 Oct 16. pii: S1876-0341(18)30148-5. doi: 10.1016/j.jiph.2018.09.008. [Epub ahead of print]

Epidemiology and predictors of survival of MERS-CoV infections in Riyadh region, 2014-2015.

Al-Jasser FS1, Nouh RM2, Youssef RM3.

Author information: 1 Prevention and Control of Infection Administration, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia; Department of Family & Community Medicine, College of Medicine and King Khaled Hospital, King Saud University, Riyadh, Saudi Arabia. Electronic address: dr.f.j@hotmail.com. 2 Field Epidemiology Training Program (FETP), Department of Public Health, Ministry of Health, Riyadh, Saudi Arabia. 3 Department of Family & Community Medicine, College of Medicine and King Khaled Hospital, King Saud University, Riyadh, Saudi Arabia; Prince Sattam Chair for Epidemiology and Public Health Research, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.




MERS-CoV emerged as a zoonotic disease in Saudi Arabia with 1437 cases as of July 2016. This study aimed at describing the epidemiology of MERS-CoV infection, clinical aspects of the disease and the determinants of survival.


The medical records of Prince Mohamed Bin Abdulaziz Hospital were reviewed between April 2014 and December 2015 to identify admission and discharge with MERS-CoV. Patient’s characteristics, epidemiologic and clinical data and laboratory results were extracted and described. Logistic regression analyses were used to model the determinants of the survival of these patients. Significance of the results were judged at the 5% level.


249 confirmed cases were admitted mostly in August (20.48%) and September (14.86%) of the year 2015. A third (39.36%) reported contact with an index case, developed the disease after 6.2days and continued to shed the virus for 13.17days on average. The case fatality rate was 20.08%. Independent predictors of being discharged alive among confirmed cases were younger age (ORA=0.953), breathing ambient air (ORA=8.981), not being transferred to the ICU (ORA=24.240) and not receiving renal replacement therapy (ORA=8.342). These variables explain 63.9% of the variability of patients’ status at discharge.


MERS-CoV spread from human-to-human as community acquired and nosocomial infection. The study identified high risk patients in need for special medical attention in order to improve patients’ outcome.

Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

KEYWORDS: Determinants of survival; Epidemiology; MERS-CoV; Saudi Arabia

PMID: 30340964 DOI: 10.1016/j.jiph.2018.09.008

Keywords: MERS-CoV; Saudi Arabia.


Defeating re-emerging #Alkhurma hemorrhagic fever virus #outbreak in #Saudi Arabia and worldwide (PLoS Negl Trop Dis., summary)

[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Summary, edited.]


Defeating re-emerging Alkhurma hemorrhagic fever virus outbreak in Saudi Arabia and worldwide

Ernest Tambo , Ashraf G. El-Dessouky

Published: September 27, 2018 / DOI: https://doi.org/10.1371/journal.pntd.0006707

Citation: Tambo E, El-Dessouky AG (2018) Defeating re-emerging Alkhurma hemorrhagic fever virus outbreak in Saudi Arabia and worldwide. PLoS Negl Trop Dis 12(9): e0006707. https://doi.org/10.1371/journal.pntd.0006707

Editor: Richard Odame Phillips, Kwame Nkrumah University of Science and Technology, GHANA

Published: September 27, 2018

Copyright: © 2018 Tambo, El-Dessouky. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.


Sporadic incidence and prevalence of Alkhurma hemorrhagic fever virus (AHFV) (family Flaviviridae; genus Flavivirus) in Saudi Arabia (KSA) is profiled periodically. The virus, which is related to tick-borne encephalitis (TBE) complex and is genetically closely related to Kyasanur Forest disease virus (KFDV), was primarily identified in KSA in November and December 1995 based on isolation from the blood of 6 male butchers aged 24 to 39 years old and residents in the Jeddah province, of whom 4 recovered completely [1,2]. Since then, new outbreaks with sporadic incidences have been reported in KSA, and subsequent cases of AHF have been documented among tourists in Egypt and Djibouti, extending to India, Europe, and beyond, suggesting that AHFV infections’ geographic distribution is underreported [3,4,5].


Keywords: Flavivirus; Alkhurma hemorrhagic fever; Saudi Arabia.


#Hajj, #Umrah, and the neglected #tropical #diseases (PLoS Negl Trop Dis., introduction)

[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]


Hajj, Umrah, and the neglected tropical diseases

Mashal M. Almutairi , Waleed Saleh Alsalem, Mazen Hassanain, Peter J. Hotez

Published: August 16, 2018 / DOI: https://doi.org/10.1371/journal.pntd.0006539

Citation: Almutairi MM, Alsalem WS, Hassanain M, Hotez PJ (2018) Hajj, Umrah, and the neglected tropical diseases. PLoS Negl Trop Dis 12(8): e0006539. https://doi.org/10.1371/journal.pntd.0006539

Editor: Samuel V. Scarpino, Northeastern University, UNITED STATES

Published: August 16, 2018

Copyright: © 2018 Almutairi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The authors received no specific funding for this work.

Competing interests: PJH is investigator and patent holder on several vaccines in development, including vaccines for diseases discussed in the article.



Together, the Hajj and Umrah rank among the leading global venues that host annual mass human migrations. The Hajj is an annual pilgrimage to the Islamic holy city of Makkah in Saudi Arabia (Fig 1). It is considered a religious obligation for all adult Muslims worldwide who have the physical and financial ability and draws an estimated 2–3 million people annually [1]. Umrah is an Islamic pilgrimage to Makkah, which occurs at times other than the period of the Hajj—the period of Ramadan (fasting month) is considered the peak period [2]. In 2018, the Hajj is scheduled to take place in August, while Ramadan will occur between May and June [2].

Through the Hajj and Umrah, it is estimated that visitors to Saudi Arabia arrive from almost every country, based on a ratio of “one pilgrim per 1,000 Muslims from that country” [2]. Currently, the largest countries in terms of Muslim populations are Asian nations located in tropical disease–endemic areas, led by Indonesia, Pakistan, India, and Bangladesh, followed by Nigeria and Egypt in Africa, where neglected tropical diseases (NTDs) are also widespread (Table 1) [3]. Together, these nations account for almost 700,000 Hajj pilgrims, and according to the Global Burden of Disease Study, they account for some of the largest numbers of people living with NTDs [4].

The largest numbers of Hajj immigrants are from South and Southeast Asian tropical countries where globally the largest numbers of cases of dengue, lymphatic filariasis (LF), soil-transmitted helminth infections, leprosy, and kala-azar are also endemic [4]. Similarly, Nigeria is the most highly endemic country in Africa for the major NTDs, especially schistosomiasis, soil-transmitted helminth infections, LF, onchocerciasis, and rabies. Each of these diseases has the potential of being either introduced or reintroduced in the Middle East and North Africa (MENA) region due to Hajj and Umrah activities.

Previously reported major Hajj-associated infectious diseases included respiratory tract infections like seasonal influenza, meningococcal disease, lower respiratory infections due to pneumococcus, and tuberculosis; water-borne and blood-borne infections including hepatitis A, B, and C were discussed elsewhere [5, 6]. In this report, we focus on the major NTDs that have either been introduced into the Middle East through Hajj and Umrah pilgrimages from tropical disease–endemic countries of Asia and Africa or where importation from Saudi Arabia to other parts of the world are possible. In some cases, these diseases have now become endemic in Saudi Arabia and elsewhere in the MENA region. Our report emphasizes the recent scientific literature published within the last five years.


Keywords: Mass Gathering Events; The Hajj; Middle East Region; Saudi Arabia; Infectious Diseases; Emerging Diseases.