Since the first diagnosis of Middle East respiratory syndrome (MERS) caused by the MERS coronavirus (MERS-CoV) in the Kingdom of Saudi Arabia in 2012, sporadic cases and clusters have occurred throughout the country (1). During June-August, 2015, a large MERS outbreak occurred at King Abulaziz Medical City, a 1,200-bed tertiary-care hospital that includes a 150-bed emergency department that registers 250,000 visits per year.In late June 2015, approximately 3 months after the last previously recognized MERS case in the hospital, a man aged 67 years with multiple comorbidities (diabetes, hypertension, congestive heart failure, and a history of coronary artery bypass graft surgery) and a 10-day history of fever and cough was evaluated in the emergency department ( Figure). The patient had no identified exposure to camels. A nasopharyngeal swab from the patient tested positive for MERS-CoV by reverse transcription-polymerase chain reaction (RT-PCR) (2). The patient was admitted and died in the hospital after 31 days. Although this patient's hospitalization overlapped with the onset of subsequent hospital-associated MERS cases, no direct links between this first case and any of the subsequent cases were identified.Approximately 3 weeks after the first patient's admission, a second patient, a man aged 56 years, with multiple comorbidities (diabetes with hypothyroidism, coronary artery disease, and hypertension with a history of coronary artery bypass surgery) and a history of camel exposure was evaluated in the emergency department for fever, cough, and shortness of breath. His nasopharyngeal specimen tested positive for MERS-CoV by RT-PCR. Three additional cases of MERS were epidemiologically linked to this patient's illness during his first week of hospitalization, including infections in two health care workers from the emergency department. An outbreak investigation was conducted by the hospital's infection control program to identify risk factors for infection and to develop and implement control measures. A suspected MERS case was defined as the occurrence of respiratory symptoms in a person with or without documented exposure to a patient with confirmed or probable MERS infection, but without confirmation by laboratory test results. A probable case was the occurrence of respiratory symptoms in a person with history of exposure to a patient with confirmed or probable MERS infection, but with inconclusive laboratory results (such as positive results by PCR on only one of the two genomic targets). A confirmed case was a suspected or probable case that was subsequently confirmed by a positive RT-PCR test for MERS-CoV. Contacts of persons with confirmed and probable cases were screened and persons with suspected cases were tested.A total of 130 MERS cases were detected at King Abulaziz Medical City during late June-late August. Among these cases, 81 (62%) were confirmed and 49 (38%) were probable, including 43 (33%) cases in health care workers; 20 of these 43 cases (47%) occurred in emergency department health care...

Objective To assess SARS-COV-2 seroprevalence in Oman and longitudinal changes in antibody levels over time within the first 11 months of the COVID-19 pandemic. Methods This nationwide cross-sectional study was conducted as a four-cycle serosurvey using a multistage stratified sampling method from July–November 2020. A questionnaire was used and included demographics, history of acute respiratory infection and list of symptoms, COVID-19 contact, previous diagnosis or admission, travel history, and risk factors. Results In total, 17,457 participants were surveyed. Thirty percent were female, and 66.3% Omani. There was significant increase in seroprevalence throughout the study cycles, starting from [5.5 (4.8–6.2)] for the first cycle and ending with [22 (19.6–24.6)] for the forth cycle. There was no difference in seroprevalence between genders, but significant differences between age groups. There was a transition of seroprevalence from being higher in non-Omanis in cycle one, [9.1 (7.6–10.9)] to Omanis [3.2 (2.6–3.9)] to being higher in Omanis [24.3 (21.0–27.9)] to non-Omanis [16.8 (14.9–18.9)] in cycle four. There was remarkable variation in seroprevalence of COVID-19 according to governorate. Close contacts of people with COVID-19 had a 96% higher risk of having the disease, (adjusted odds ratio [AOR]=1.96, 95% confidence interval [CI] 1.64–2.34); laborers have 58% higher risk of infection compared to office workers (AOR=1.58, 95% CI; 1.04–2.35). Conclusion The study showed a wide variation of SARS-CoV-2 dissemination between governorates in Oman, with higher seroprevalence estimates in migrants in the first two cycles. Prevalence estimates remain low and are insufficient to provide herd immunity.

The study demonstrated salient evidence that proper institution of IPC measures during management of an outbreak of MERS could remarkably change the course of the outbreak.

Background: Seasonal influenza infections are a major cause of morbidity and mortality worldwide. Healthcare workers (HCWs) are an important target group for vaccination against influenza due to their increased risk of infection and their potential to transmit the infection to their patients, families and communities. The aim of this study was to assess the potential hesitancy and its associated factors towards influenza vaccination amongst HCWs in the South Al Batinah governorate in Oman. Methods: A cross-sectional survey of 390 HCWs with direct or indirect patient contact was conducted in May and June 2019 using a self-administered questionnaire. Associations between HCW characteristics and vaccination status were examined using bivariate and multivariate analyses to identify the likelihood of vaccination against seasonal influenza among HCWs. Results: Overall, 60% of HCWs were vaccinated in the 2018/2019 season; vaccine uptake among nurses was 52% and uptake was higher among women. Self-protection and protection of the community were the most cited reasons for vaccine acceptance, with side effects being the main reason for hesitancy. Vaccinated respondents had a higher mean knowledge score (7.18; standard deviation SD: 2.14) than unvaccinated respondents (6.30; SD: 2.2). Odds of vaccination were highest among respondents who believed influenza vaccine should be mandatory for HCWs (Odds ratio (OR): 2.04 [1.30–3.18]), those working in the general medicine, emergency medicine, or intensive care units (OR: 1.92 [1.20–3.10]), nurses and doctors (OR: 1.75 [1.09–2.79]) and those who believe that HCWs should receive an influenza vaccine (OR: 1.35 [1.07–2.77]). Conclusions: The study provides valuable insights into the enablers and barriers of influenza vaccination practices among HCWs and may inform interventions to increase acceptance of vaccination.

Background:The problems associated with exposure to excessive heat are a key health concern throughout the world, and are likely to become increasingly important as Earth’s climate warms. Heat exposure is particularly problematic when large groups of people gather, but there is relatively little literature on the subject. Islam requires all adherents who are able to undertake a pilgrimage to Mecca (Saudi Arabia), known as the Hajj. This can result in huge numbers of pilgrims travelling to Mecca in the summer months, during which the temperatures can be very high, and to undertake physically demanding activities.Objective:The aim of this study was to identify the perception level of heat-related health issues and the coping behaviors adopted by pilgrims in the face of excessive heat exposure.Methods:A cross-sectional study was conducted in Mecca, Saudi Arabia among male Arab pilgrims performing Hajj of the Islamic calendar year 1436 (Summer 2015). Sample was divided into two strata: domestic pilgrims and international Arabs. A total of 14 camps were selected randomly, seven from each stratum. A total of 412 participants completed the questionnaire.Results:Mean age was 43.48 (SD = 13.42) years. Majority of pilgrims had never performed Hajj before (68.2%). Almost 89.5% among pilgrims more than 40 years of age had more water intake compared to only 76.5% for people under 40 years. Only 7.3% of educated people used to go out at noon time, and almost two-fold of pilgrims with lower educational level did so (15.4%). Approximately 51.8% among those who were aware of Mecca’s weather used cotton clothes, compared to 36.0% among pilgrims unaware of Mecca’s weather.Conclusion:This study reveals the extent of pilgrims’ understanding of, and abilities to cope with, excessive heat and also suggests coping strategies and options for improved understanding of heat-related health issues world-wide.Al Mayahi ZK, Ali Kabbash I. Perceptions of, and practices for coping with, heat exposure among male Arab pilgrims to the Hajj, 1436. Prehosp Disaster Med. 2019;34(2):161–174