Patterns of Human Respiratory Viruses and Lack of MERS-Coronavirus in Patients with Acute Upper Respiratory Tract Infections in Southwestern Province of Saudi Arabia

Abstract

We undertook enhanced surveillance of those presenting with respiratory symptoms at five healthcare centers by testing all symptomatic outpatients between November 2013 and January 2014 (winter time). Nasal swabs were collected from 182 patients and screened for MERS-CoV as well as other respiratory viruses using RT-PCR and multiplex microarray. A total of 75 (41.2%) of these patients had positive viral infection. MERS-CoV was not detected in any of the samples. Human rhinovirus (hRV) was the most detected pathogen (40.9%) followed by non-MERS-CoV human coronaviruses (19.3%), influenza (Flu) viruses (15.9%), and human respiratory syncytial virus (hRSV) (13.6%). Viruses differed markedly depending on age in which hRV, Flu A, and hCoV-OC43 were more prevalent in adults and RSV, hCoV-HKU1, and hCoV-NL63 were mostly restricted to children under the age of 15. Moreover, coinfection was not uncommon in this study, in which 17.3% of the infected patients had dual infections due to several combinations of viruses. Dual infections decreased with age and completely disappeared in people older than 45 years. Our study confirms that MERS-CoV is not common in the southwestern region of Saudi Arabia and shows high diversity and prevalence of other common respiratory viruses. This study also highlights the importance and contribution of enhanced surveillance systems for better infection control.

Influenza is more common than Middle East Respiratory Syndrome Coronavirus (MERS-CoV) among hospitalized adult Saudi patients

“…The findings are also consistent with other studies among travelers and pilgrims where influenza far exceeded MERS [36][37][38][39][40]. Similarly, in a small study in Saudi Arabia, influenza viruses were detected in 16% of 182 patients [29]. Similarly, among a small study of 52 suspected MERS cases in the United States of America, Influenza was the most commonly (35%) identified respiratory agent [41] and another study found influenza A and B in 11% of 296 investigated patients [26].…”

“…In the South Korea outbreak, 184 (1%) had MERS among 16,752 suspected cases [28]. In a small study from Saudi Arabia, MERS-CoV was not detected in 182 cases tested November 2013 and January 2014 (winter time) [29]. Thus, the overall positivity of MERS-CoV among a large cohort remains low.…”

MERS‐CoV, influenza and other respiratory viruses among symptomatic pilgrims during 2014 Hajj season

“…Remaining NP samples were used for complementary DNA (cDNA) synthesis and microarray testing as described previously . Nucleic acid was extracted from all samples and used to synthesize cDNA using SuperScript III First‐Strand Synthesis SuperMix Kit (Life Technologies, Carlsbad, CA).…”

“…Nucleic acid was extracted from all samples and used to synthesize cDNA using SuperScript III First‐Strand Synthesis SuperMix Kit (Life Technologies, Carlsbad, CA). All samples were then tested for hCoVs (HKU1, OC43, NL63, and 229E), influenza viruses (flu A, flu B, and flu A/H1N1), hRV (A and B), human parainfluenza viruses (hPIV) (1, 2, 3, and 4), human metapneumovirus (hMPV) (A and B), enterovirus (EV) (A, B, C, and D), human adenoviruses (hAdv) (A, B, C, and E), and human respiratory syncytial virus (hRSV) (A and B) using Infiniti RVP Plus Assay on Infiniti Plus Analyzer (AutoGenomics Inc., Carlsbad, CA) according to manufacturer's instructions and as previously described . Samples were considered positive when the ratio between the virus and background signals was above the calculated threshold.…”

The Human Coronaviruses

“…To date, six human coronaviruses have been discovered, i.e., the human coronaviruses OC43 and 229E, NL63 and HKU1, and the SARS and MERS coronaviruses. Except for the latter two, all human coronaviruses have been noted to occur worldwide and are mostly associated with a seasonality that follows the typical flu-like symptom season [23][24][25][26][27][28][29][30][31]. As the nomenclature of coronaviruses is far from being logical, these viruses are described in the next section in more detail according to their systematic order.…”