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.
The Middle East Respiratory Syndrome (MERS) has been identified in 2012 and since then outbreaks have been reported in various localities in the Middle East and in other parts of the world. To help predict the possible dynamics of MERS, as well as ways to contain it, this paper develops a mathematical model for the disease. It has a compartmental structure similar to SARS models and is in the form of a coupled system of nonlinear ordinary differential equations (ODEs). The model predictions are fitted to data from the outbreaks in Riyadh (Saudi Arabia) during 2013-2016. The results reveal that MERS will eventually be contained in the city. However, the containment time and the severity of the outbreaks depend crucially on the contact coefficients and the isolation rate constant. When randomness is added to the model coefficients, the simulations show that the model is sensitive to the scaled contact rate among people and to the isolation rate. The model is analyzed using stability theory for ODEs and indicates that when using only isolation, the endemic steady state is locally stable and attracting. Numerical simulations with parameters estimated from the city of Riyadh illustrate the analytical results and the model behavior, which may have important implications for the disease containment in the city. Indeed, the model highlights the importance of isolation of infected individuals and may be used to assess other control measures. The model is general and may be used to analyze outbreaks in other parts of the Middle East and other areas.
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