Temporal dynamics of Middle East respiratory syndrome coronavirus in the Arabian Peninsula, 2012–2017

Abstract

Middle East respiratory syndrome coronavirus (MERS-CoV) remains a notable disease and poses a significant threat to global public health. The Arabian Peninsula is considered a major global epicentre for the disease and the virus has crossed regional and continental boundaries since 2012. In this study, we focused on exploring the temporal dynamics of MERS-CoV in human populations in the Arabian Peninsula between 2012 and 2017, using publicly available data on case counts and combining two analytical methods. Disease progression was assessed by quantifying the time-dependent reproductive number (TD-Rs), while case series temporal pattern was modelled using the AutoRegressive Integrated Moving Average (ARIMA). We accounted for geographical variability between three major affected regions in Saudi Arabia including Eastern Province, Riyadh and Makkah. In Saudi Arabia, the epidemic size was large with TD-Rs >1, indicating significant spread until 2017. In both Makkah and Riyadh regions, the epidemic progression reached its peak in April 2014 (TD-Rs > 7), during the highest incidence period of MERS-CoV cases. In Eastern Province, one unique super-spreading event (TD-R > 10) was identified in May 2013, which comprised of the most notable cases of human-to-human transmission. Best-fitting ARIMA model inferred statistically significant biannual seasonality in Riyadh region, a region characterised by heavy seasonal camel-related activities. However, no statistical evidence of seasonality was identified in Eastern Province and Makkah. Instead, both areas were marked by an endemic pattern of cases with sporadic outbreaks. Our study suggested new insights into the epidemiology of the virus, including inferences about epidemic progression and evidence for seasonality. Despite the inherent limitations of the available data, our conclusions provide further guidance to currently implement risk-based surveillance in high-risk populations and, subsequently, improve related interventions strategies against the epidemic at country and regional levels.

Climate factors and incidence of Middle East respiratory syndrome coronavirus

“…To date, limited studies investigate climate parameters as factors that could promote the MERS virus activity and transmission. Although MERS-CoV cases were reported throughout the year in Saudi Arabia, a seasonality pattern appears to be higher during certain months of the year [8]. Similar seasonality may exist in the Riyadh Region as well.…”

Coronavirus seasonality, respiratory infections and weather

“…SARS-CoV was inactivated at 65 °C for 10 min [ 55 ] and by ultraviolet light (UVC) for 10 min [ 55 ]. MERS-CoV is also not very seasonal [ 56 ], is not strongly influenced by weather and transmission is more influenced by other measures [ 57 – 59 ], including camel-related events [ 60 ]. A case-crossover analysis of the impact of weather on primary cases of MERS in Saudi Arabia found more cases when conditions were relatively cold and dry [ 61 ].…”

MERS-CoV: epidemiology, molecular dynamics, therapeutics, and future challenges

“…The epidemic progression in Makkah and Riyadh regions had been the highest in April 2014 and Eastern Province, in May 2013. A statistically significant biannual seasonality has been observed in Riyadh related to the large camel based seasonal-activities [28].…”

“…Another study, evaluating time, season, space and spatiotemporal variation of MERS-CoV by Kulldorff 's spatial scan statistics has also identified that the 41.88% of infections occur during the spring season (with seasonal clusters being significant in April and May [28,29]. The first cases of MERS-CoV were reported from The United Arab Emirates, Qatar, Jordan, Oman and Kuwait however it spread to Riyadh and Eastern Provinces resulted in 80% cases of the region [30][31][32].…”

“…The report on the first culture of a new coronavirus by Dr. Ali Mohamed Zaki in 2012 [24,26] from the KSA and the subsequent case in the United Kingdom [27] has triggered a flurry of research on MERS-CoV prevalence especially, the KSA. Three areas of Saudi Arabia, including Eastern Province, Riyadh and Makkah have been found affected severely based on a study involving timerelated variation of MERS-CoV from 2012 to 2017 in the Arabian Peninsula [28]. Time-dependent reproductive number (TD-Rs) explored from the data on case counts considering a statistical Auto-Regressive Integrated Moving Average (ARIMA).…”