MERS-CoV Confirmation among 6,873 suspected persons and relevant Epidemiologic and Clinical Features, Saudi Arabia — 2014 to 2019
Background: Of the three lethal coronaviruses, in addition to the ongoing pandemic-causing SARS-CoV 2, Middle East Respiratory Syndrome Coronavirus (MERS-CoV) remains in circulation. Information on MERS-CoV has relied on small sample of patients. We updated the epidemiology, laboratory and clinical...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-11-01
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| Series: | EClinicalMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537021004727 |
| _version_ | 1818900605771448320 |
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| author | Shahul H. Ebrahim, MD, PhD Andrew D. Maher, MPH Udhayashankar Kanagasabai, MD, MPH Sarah H. Alfaraj, MD Nojom A. Alzahrani Saleh A. Alqahtani, MD Abdullah M. Assiri, MD Ziad A. Memish, MD |
| author_facet | Shahul H. Ebrahim, MD, PhD Andrew D. Maher, MPH Udhayashankar Kanagasabai, MD, MPH Sarah H. Alfaraj, MD Nojom A. Alzahrani Saleh A. Alqahtani, MD Abdullah M. Assiri, MD Ziad A. Memish, MD |
| author_sort | Shahul H. Ebrahim, MD, PhD |
| collection | DOAJ |
| description | Background: Of the three lethal coronaviruses, in addition to the ongoing pandemic-causing SARS-CoV 2, Middle East Respiratory Syndrome Coronavirus (MERS-CoV) remains in circulation. Information on MERS-CoV has relied on small sample of patients. We updated the epidemiology, laboratory and clinical characteristics, and survival patterns of MERS-CoV retrospectively with the largest sample of followed patients. Methods: We conducted a retrospective review of line-listed records of non-random, continuously admitted patients who were suspected (6,873) or confirmed with MERS-CoV (501) admitted to one of the four MERS-CoV referral hospitals in Saudi Arabia, 2014-2019. Findings: Of the 6,873 MERS-CoV suspected persons, the majority were male (56%) and Saudi nationals (83%) and 95% had no known history that increased their risk of exposure to MERS-CoV patients or vectors (95%). More confirmed cases reported history that increased their risk of MERS-CoV infection (41%). Among the suspected, MERS-CoV confirmation (7.4% overall) was independently associated with being male, known transmission link to MERS-CoV patients or vectors, fever, symptoms for 7 days, admission through intensive care unit, and diabetes. Among persons with confirmed MERS-CoV, single symptoms were reported by 20%, 3-symptom combinations (fever, cough and dyspnea) reported by 21% and 2-symptom combinations (fever, cough) reported by 16%. Of the two-thirds (62%) of MERS-CoV confirmed patients who presented with co-morbidity, 32% had 2-''comorbidities (diabetes, hypertension). More than half of the MERS-CoV patents showed abnormal chest X-ray, elevated aspartate aminotransferase, and creatinine kinase. About a quarter of MERS-CoV patients had positive cultures on blood, urine, or respiratory secretions. During an average hospital stay of 18 days (range 11 to 30), 64% developed complications involving liver, lungs, or kidneys. Ventilation requirement (29% of MERS-CoV cases) was independently associated with abnormal chest X-ray, viremia (Ct value <30), elevated creatinine, and prothrombin time. Death (21% overall) was independently associated with older age, dyspnea and abnormal chest X-ray on admission, and low hemoglobulin levels. Interpretations: With two-thirds of the symptomatic persons developing multiorgan complications MERS-CoV remains the coronavirus with the highest severity (29%) and case fatality rate (21%) among the three lethal coronaviruses. Metabolic abnormalities appear to be an independent risk factor for sustained MERS-CoV transmission. The poorly understood transmission dynamics and non-specific clinical and laboratory features call for high index of suspicion among respiratory disease experts to help early detection of outbreaks. We reiterate the need for case control studies on transmission. Funding: No special funding to declare. |
| first_indexed | 2024-12-19T20:06:31Z |
| format | Article |
| id | doaj.art-8c385be1801f47edabfd81582b4fe428 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-12-19T20:06:31Z |
| publishDate | 2021-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-8c385be1801f47edabfd81582b4fe4282022-12-21T20:07:28ZengElsevierEClinicalMedicine2589-53702021-11-0141101191MERS-CoV Confirmation among 6,873 suspected persons and relevant Epidemiologic and Clinical Features, Saudi Arabia — 2014 to 2019Shahul H. Ebrahim, MD, PhD0Andrew D. Maher, MPH1Udhayashankar Kanagasabai, MD, MPH2Sarah H. Alfaraj, MD3Nojom A. Alzahrani4Saleh A. Alqahtani, MD5Abdullah M. Assiri, MD6Ziad A. Memish, MD7Adjunct Professor, University of Sciences, Technique and Technology, BamakoInstitute for Global Health Sciences, University of California San Francisco, USAJohn F. Kennedy Medical Center, Monrovia, LiberiaCorona Center, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi ArabiaCorona Center, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi ArabiaDepartment of Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia & Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USAInfection Prevention and Control, Preventive Health, Ministry of Health, Riyadh, Kingdom of Saudi ArabiaResearch & Innovation Center, King Saud Medical City, Ministry of Health and College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Corresponding author.Background: Of the three lethal coronaviruses, in addition to the ongoing pandemic-causing SARS-CoV 2, Middle East Respiratory Syndrome Coronavirus (MERS-CoV) remains in circulation. Information on MERS-CoV has relied on small sample of patients. We updated the epidemiology, laboratory and clinical characteristics, and survival patterns of MERS-CoV retrospectively with the largest sample of followed patients. Methods: We conducted a retrospective review of line-listed records of non-random, continuously admitted patients who were suspected (6,873) or confirmed with MERS-CoV (501) admitted to one of the four MERS-CoV referral hospitals in Saudi Arabia, 2014-2019. Findings: Of the 6,873 MERS-CoV suspected persons, the majority were male (56%) and Saudi nationals (83%) and 95% had no known history that increased their risk of exposure to MERS-CoV patients or vectors (95%). More confirmed cases reported history that increased their risk of MERS-CoV infection (41%). Among the suspected, MERS-CoV confirmation (7.4% overall) was independently associated with being male, known transmission link to MERS-CoV patients or vectors, fever, symptoms for 7 days, admission through intensive care unit, and diabetes. Among persons with confirmed MERS-CoV, single symptoms were reported by 20%, 3-symptom combinations (fever, cough and dyspnea) reported by 21% and 2-symptom combinations (fever, cough) reported by 16%. Of the two-thirds (62%) of MERS-CoV confirmed patients who presented with co-morbidity, 32% had 2-''comorbidities (diabetes, hypertension). More than half of the MERS-CoV patents showed abnormal chest X-ray, elevated aspartate aminotransferase, and creatinine kinase. About a quarter of MERS-CoV patients had positive cultures on blood, urine, or respiratory secretions. During an average hospital stay of 18 days (range 11 to 30), 64% developed complications involving liver, lungs, or kidneys. Ventilation requirement (29% of MERS-CoV cases) was independently associated with abnormal chest X-ray, viremia (Ct value <30), elevated creatinine, and prothrombin time. Death (21% overall) was independently associated with older age, dyspnea and abnormal chest X-ray on admission, and low hemoglobulin levels. Interpretations: With two-thirds of the symptomatic persons developing multiorgan complications MERS-CoV remains the coronavirus with the highest severity (29%) and case fatality rate (21%) among the three lethal coronaviruses. Metabolic abnormalities appear to be an independent risk factor for sustained MERS-CoV transmission. The poorly understood transmission dynamics and non-specific clinical and laboratory features call for high index of suspicion among respiratory disease experts to help early detection of outbreaks. We reiterate the need for case control studies on transmission. Funding: No special funding to declare.http://www.sciencedirect.com/science/article/pii/S2589537021004727MERS-CoVSaudi ArabiaEpidemiology |
| spellingShingle | Shahul H. Ebrahim, MD, PhD Andrew D. Maher, MPH Udhayashankar Kanagasabai, MD, MPH Sarah H. Alfaraj, MD Nojom A. Alzahrani Saleh A. Alqahtani, MD Abdullah M. Assiri, MD Ziad A. Memish, MD MERS-CoV Confirmation among 6,873 suspected persons and relevant Epidemiologic and Clinical Features, Saudi Arabia — 2014 to 2019 EClinicalMedicine MERS-CoV Saudi Arabia Epidemiology |
| title | MERS-CoV Confirmation among 6,873 suspected persons and relevant Epidemiologic and Clinical Features, Saudi Arabia — 2014 to 2019 |
| title_full | MERS-CoV Confirmation among 6,873 suspected persons and relevant Epidemiologic and Clinical Features, Saudi Arabia — 2014 to 2019 |
| title_fullStr | MERS-CoV Confirmation among 6,873 suspected persons and relevant Epidemiologic and Clinical Features, Saudi Arabia — 2014 to 2019 |
| title_full_unstemmed | MERS-CoV Confirmation among 6,873 suspected persons and relevant Epidemiologic and Clinical Features, Saudi Arabia — 2014 to 2019 |
| title_short | MERS-CoV Confirmation among 6,873 suspected persons and relevant Epidemiologic and Clinical Features, Saudi Arabia — 2014 to 2019 |
| title_sort | mers cov confirmation among 6 873 suspected persons and relevant epidemiologic and clinical features saudi arabia 2014 to 2019 |
| topic | MERS-CoV Saudi Arabia Epidemiology |
| url | http://www.sciencedirect.com/science/article/pii/S2589537021004727 |
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