Case characteristics among Middle East respiratory syndrome coronavirus outbreak and non-outbreak cases in Saudi Arabia from 2012 to 2015

Abstract

ObjectivesAs of 1 November 2015, the Saudi Ministry of Health had reported 1273 cases of Middle East respiratory syndrome (MERS); among these cases, which included 9 outbreaks at several hospitals, 717 (56%) patients recovered, 14 (1%) remain hospitalised and 543 (43%) died. This study aimed to determine the epidemiological, demographic and clinical characteristics that distinguished cases of MERS contracted during outbreaks from those contracted sporadically (ie, non-outbreak) between 2012 and 2015 in Saudi Arabia.DesignData from the Saudi Ministry of Health of confirmed outbreak and non-outbreak cases of MERS coronavirus (CoV) infections from September 2012 through October 2015 were abstracted and analysed. Univariate and descriptive statistical analyses were conducted, and the time between disease onset and confirmation, onset and notification and onset and death were examined.ResultsA total of 1250 patients (aged 0–109 years; mean, 50.825 years) were reported infected with MERS-CoV. Approximately two-thirds of all MERS cases were diagnosed in men for outbreak and non-outbreak cases. Healthcare workers comprised 22% of all MERS cases for outbreak and non-outbreak cases. Nosocomial infections comprised one-third of all Saudi MERS cases; however, nosocomial infections occurred more frequently in outbreak than non-outbreak cases (p<0.001). Patients contracting MERS during an outbreak were significantly more likely to die of MERS (p<0.001).ConclusionsTo date, nosocomial infections have fuelled MERS outbreaks. Given that the Kingdom of Saudi Arabia is a worldwide religious travel destination, localised outbreaks may have massive global implications and effective outbreak preventive measures are needed.

Diagnostic delays in 537 symptomatic cases of Middle East respiratory syndrome coronavirus infection in Saudi Arabia

“…The results of the present study are consistent with those of a Saudi Arabian study using Saudi Ministry of Health public data on MERS cases reported between September 2012 and September 2015, in which it was estimated that the mean time from symptom onset to confirmation was 6.60 days and the mean time from symptom onset to notification was 5.30 days (Alhamlan et al, 2017). The median time from symptom onset to confirmation was not reported in that study.…”

Focus on Middle East respiratory syndrome coronavirus (MERS-CoV)

“…The retrospective fatality rate varies between outbreaks, ranging from 36.5 to 60% [33,35,37,38,42]. The mortality rate of 20.4% observed for the Korean outbreak is probably the most reliable epidemiologically due to the comprehensive investigations carried out [34].…”

“…The first cases of infection with MERS-CoV were reported in 2012 [1]. Hospital-acquired MERS-CoV infections have been described worldwide and represented a third of all cases reported in Saudi Arabia in the early stages of the epidemic [1,32,33]. Clustered hospital-acquired infections were frequently observed during the first outbreaks and probably contributed to spreading the disease from the primary site of virus infection to the whole Arabian peninsula, the most striking example of hospital-acquired outbreak being the Korean outbreak in 2015 [34].…”

“…Clustered hospital-acquired infections were frequently observed during the first outbreaks and probably contributed to spreading the disease from the primary site of virus infection to the whole Arabian peninsula, the most striking example of hospital-acquired outbreak being the Korean outbreak in 2015 [34]. Care providers are often affected and represent 15-22% of cases [33][34][35][36][37][38][39].…”

Individual and network characteristic associated with hospital-acquired Middle East Respiratory Syndrome coronavirus

“…Strong links between healthcare facilities and the spread of the MERS disease have been found in KSA, where the majority of patients were in contact with other patients at healthcare facilities [15][16][17][18]. Unfortunately, this phenomenon is widespread and well-known as nosocomial infections (hospital-acquired infections) which occur frequently with surgical-site infections (SSIs), pneumonia and gastrointestinal infections among the top hospitalacquired infections (HAIs) [19,20].…”