Epidemiology and evolution of Middle East respiratory syndrome coronavirus, 2012–2020

Abstract Background The ongoing transmission of the Middle East respiratory syndrome coronavirus (MERS-CoV) in the Middle East and its expansion to other regions are raising concerns of a potential pandemic. An in-depth analysis about both population and molecular epidemiology of this pathogen is needed. Methods MERS cases reported globally as of June 2020 were collected mainly from World Health Organization official reports, supplemented by other reliable sources. Determinants for case fatality and spatial diffusion of MERS were assessed with Logistic regressions and Cox proportional hazard models, respectively. Phylogenetic and phylogeographic analyses were performed to examine the evolution and migration history of MERS-CoV. Results A total of 2562 confirmed MERS cases with 150 case clusters were reported with a case fatality rate of 32.7% (95% CI: 30.9‒34.6%). Saudi Arabia accounted for 83.6% of the cases. Age of ≥ 65 years old, underlying conditions and ≥ 5 days delay in diagnosis were independent risk factors for death. However, a history of animal contact was associated with a higher risk (adjusted OR = 2.97, 95% CI: 1.10–7.98) among female cases < 65 years but with a lower risk (adjusted OR = 0.31, 95% CI: 0.18–0.51) among male cases ≥ 65 years old. Diffusion of the disease was fastest from its origin in Saudi Arabia to the east, and was primarily driven by the transportation network. The most recent sub-clade C5.1 (since 2013) was associated with non-synonymous mutations and a higher mortality rate. Phylogeographic analyses pointed to Riyadh of Saudi Arabia and Abu Dhabi of the United Arab Emirates as the hubs for both local and international spread of MERS-CoV. Conclusions MERS-CoV remains primarily locally transmitted in the Middle East, with opportunistic exportation to other continents and a potential of causing transmission clusters of human cases. Animal contact is associated with a higher risk of death, but the association differs by age and sex. Transportation network is the leading driver for the spatial diffusion of the disease. These findings how this pathogen spread are helpful for targeting public health surveillance and interventions to control endemics and to prevent a potential pandemic. Graphical abstract

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Middle East Respiratory Syndrome (MERS) Infection in Hematological and Oncological Patients: A Case Series from a Tertiary Care Center in Saudi Arabia

Blood ◽

10.1182/blood-2019-123253 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5871-5871 ◽

Cited By ~ 1

Author(s):

Ahmed Alaskar ◽

Mohammed Bosaeed ◽

Hina Rehan ◽

May Anne Mendoza ◽

Bader Alahmari ◽

...

Keyword(s):

Saudi Arabia ◽

Middle East ◽

Clinical Presentation ◽

Conflicts Of Interest ◽

Tertiary Care ◽

Case Series ◽

Case Fatality ◽

Middle East Respiratory Syndrome ◽

Future Research ◽

Fatality Rate

We present the largest to date of a case series of nine patients with hematological and oncological malignancies who were infected with Middle East Respiratory Syndrome Coronavirus (MERS-CoV). MERS-CoV is a novel beta-coronavirus with a high fatality rate in comorbid patients. The majority of MERS cases globally were reported from Saudi Arabia (1983 cases, including 745 related deaths with a case-fatality rate of 37.5%) according to the WHO update of February 2019. All were clinically stable before acquiring the virus. Most of the cases had an active disease as relapse or refractory with three cases being neutropenic. The clinical presentation and radiological features of the patients were variable and inconsistent (Table 1). Diagnosis was confirmed with RT-PCR assays targeting upstream of the E gene and the open-reading frame gene 1a which had to be done repeatedly and required an average of 3 (with max. of 7) samples for a test to be positive (Table 2). All the patients developed respiratory failure, were admitted to the critical care unit (ICU) and required mechanical ventilation. The length of hospital stay ranged from 15 - 48, with an average of 24 days. Unfortunately, all nine patients died within days after admission to the ICU. In addition, the time from diagnosis to death has an average of 9 days ranging from 2-24 days, respectively. In conclusion, MERS CoV infection in hematology/oncology patients has a very poor prognosis regardless of the status of the underlying disease. The clinical presentation is not distinctive and confirming the diagnosis requires numerous respiratory samples. Measures to prevent nosocomial outbreaks should include proper compliance with personal protection equipment by health-care workers when managing patients with suspected and confirmed MERS-CoV infection and prompt isolation of infected patients. Future research is required to enhance our understanding of the disease and to evaluate superior diagnostic and therapeutic options. Disclosures No relevant conflicts of interest to declare.

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Middle East Respiratory Syndrome

JURNAL BIOMEDIK (JBM) ◽

10.35790/jbm.8.1.2016.12331 ◽

2016 ◽

Vol 8 (1) ◽

Author(s):

Novie H. Rampengan

Keyword(s):

Saudi Arabia ◽

Middle East ◽

World Health Organization ◽

Antiviral Agents ◽

Supportive Therapy ◽

Middle East Respiratory Syndrome ◽

World Health ◽

Infected People ◽

Corona Virus ◽

Health Organization

Abstract: Middle East Respiratory Syndrome (MERS) is a respiratory disease caused by Corona virus (MERS-CoV). This virus was first reported in 2012 in Saudi Arabia. World Health Organization (WHO) reported that until June 2015 there were 26 countries infected by MERS-CoV with a total of 1,334 laboratory confirmed cases of MERS-CoV infection and 471 deaths. According to WHO as many as 75% of MERS-CoV cases are secondary cases, obtained from other infected people. In mid 2015 it is reported that MERS-CoV attacked South Korea with 172 confirmed cases of MERS-CoV and 27 deaths. There are no approved antiviral agents for the treatment of MERS-CoV infection or vaccine available for the prevention of MERS-CoV. MERS cases are treated with supportive therapy such as hydration, antipyretics, analgesics, respiratory support, and antibiotics in case of secondary infectionKeywords: Middle East Respiratory Syndrome, Corona virus, treatmentAbstrak: Middle East Respiratory Syndrome (MERS) merupakan penyakit saluran napas yang disebabkan oleh Corona virus (MERS-CoV). Virus ini pertama kali dilaporkan pada tahun 2012 di Arab Saudi. WHO melaporkan bahwa sampai Juni 2015 terdapat 26 negara terinfeksi MERS-CoV dengan total 1.334 kasus yang dikonfirmasi laboratorium terinfeksi MERS-CoV dan 471 kematian. Menurut WHO sebanyak 75% dari kasus MERS-CoV merupakan kasus sekunder, yaitu diperoleh dari orang lain yang terinfeksi. Pada pertengahan tahun 2015 dilaporkan MERS-CoV menyerang Korea Selatan dengan 172 kasus yang dikonfirmasi laboratorium terinfeksi MERS-CoV dan 27 kematian. Belum ada antivirus yang disetujui untuk pengobatan infeksi MERS-CoV atau vaksin yang tersedia untuk pencegahan MERS-CoV. Penanganan MERS-CoV dengan terapi suportif berupa hidrasi, antipiretik, analgetik, bantuan pernapasan, dan antibiotik bila terjadi infeksi sekunder.Kata kunci: Middle East Respiratory Syndrome, Corona virus, penanganan

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Exploring the risk of Middle East Respiratory Syndrome- coronavirus among expatriate healthcare workers. A comparative epidemiological study of Saudi Arabian and South Korean healthcare workers

10.21203/rs.2.19463/v1 ◽

2019 ◽

Author(s):

Mohammed Owais Qureshi ◽

Abrar Chughtai ◽

Holly Seale

Keyword(s):

Saudi Arabia ◽

Middle East ◽

Infectious Diseases ◽

South Korea ◽

Healthcare Workers ◽

Saudi Arabian ◽

Middle East Respiratory Syndrome ◽

World Health ◽

Healthcare Sector ◽

Healthcare Associated

Abstract Background In comparison to South Korea, which was able to contain the outbreak of Middle East respiratory syndrome corona virus (MERS-CoV) in 2015, new cases are still emerging in the Kingdom of Saudi Arabia. The Saudi Arabian healthcare sector, which is dependent on the expatriate workforce to cater to its growing local healthcare demands, has been reporting multiple healthcare-associated MERS-CoV outbreaks since 2012. In this paper, we compare the epidemiology of MERS-CoV among healthcare workers (HCWs) in Saudi Arabia and South Korea and to ascertain the risks of MERS-CoV among expatriate HCWs. Methods Data were collected from publicly available resources such as World Health Organization and health department websites. A line list of all reported cases of MERS-CoV among HCWs in Saudi Arabia and South Korea was prepared and analysed. Results Among the total infected HCWs in Saudi Arabia, 84.6% (n=192/227) were expatriates. The mean age of infected HCWs in both settings was similar (Saudi Arabia 38 years, South Korea 39 years). Female HCWs were more likely to be infected, while male HCWs were more likely to die. In Saudi Arabia, 36.5% (n= 68/186) of HCWs with MERS-CoV were asymptomatic, compared to 7% (n=2/28) HCWs in South Korea. Most of the expatriate HCWs in Saudi Arabia were asymptomatic (78%, n=53/68) to MERS-CoV. Unlike South Korea, in Saudi Arabia, a diversity of HCWs other than doctors, and nurses were also infected with MERS-CoV. Conclusions A high proportion of expatriate HCWs were infected with MERS-CoV in Saudi Arabia which highlights the need for adequate training and education in this group about emerging infectious diseases and the appropriate strategies to prevent acquisition. Also, we did not find any policy statements restricting the contact of HCWs, vulnerable to MERS-CoV like pregnant HCW, HCWs over the age 60, HCWs with underlying comorbidity etc, from getting in proximity with a suspected or potential MERS-CoV infected patient. Policy development in this regard should be a priority, to contain healthcare-associated transmission of emerging and remerging infectious diseases like MERS-CoV. Further studies should be conducted to determine social, cultural and other factors contributing to high infection rate among expatriate HCWs.

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Prevalence of comorbidities in cases of Middle East respiratory syndrome coronavirus: a retrospective study

Epidemiology and Infection ◽

10.1017/s0950268818002923 ◽

2018 ◽

Vol 147 ◽

Cited By ~ 26

Author(s):

F.Y. Alqahtani ◽

F.S. Aleanizy ◽

R. Ali El Hadi Mohamed ◽

M. S. Alanazi ◽

N. Mohamed ◽

...

Keyword(s):

Saudi Arabia ◽

Middle East ◽

Clinical Presentation ◽

Clinical Manifestations ◽

Case Fatality ◽

Middle East Respiratory Syndrome ◽

Shortness Of Breath ◽

Life Threatening ◽

Stage Renal Disease ◽

End Stage

AbstractThe Middle East respiratory syndrome coronavirus (MERS-CoV) is a life-threatening respiratory disease with a high case fatality rate; however, its risk factors remain unclear. We aimed to explore the influence of demographic factors, clinical manifestations and underlying comorbidities on mortality in MERS-CoV patients. Retrospective chart reviews were performed to identify all laboratory-confirmed cases of MERS-COV infection in Saudi Arabia that were reported to the Ministry of Health of Saudi Arabia between 23 April 2014 and 7 June 2016. Statistical analyses were conducted to assess the effect of sex, age, clinical presentation and comorbidities on mortality from MERS-CoV. A total of 281 confirmed MERS-CoV cases were identified: 167 (59.4%) patients were male and 55 (20%) died. Mortality predominantly occurred among Saudi nationals and older patients and was significantly associated with respiratory failure and shortness of breath. Of the 281 confirmed cases, 160 (56.9%) involved comorbidities, wherein diabetes mellitus, hypertension, ischemic heart disease, congestive heart failure, end-stage renal disease and chronic kidney disease were significantly associated with mortality from MERS-CoV and two or three comorbidities significantly affected the fatality rates from MERS-CoV. The findings of this study show that old age and the existence of underlying comorbidities significantly increase mortality from MERS-CoV.

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Atypical presentation of Middle East respiratory syndrome coronavirus in a Lebanese patient returning from Saudi Arabia

The Journal of Infection in Developing Countries ◽

10.3855/jidc.9979 ◽

2018 ◽

Vol 12 (09) ◽

pp. 808-811 ◽

Cited By ~ 1

Author(s):

Saeed El Zein ◽

Jinane Khraibani ◽

Nada Zahreddine ◽

Rami Mahfouz ◽

Nada Ghosn ◽

...

Keyword(s):

Saudi Arabia ◽

Middle East ◽

Medical Center ◽

Middle East Respiratory Syndrome ◽

World Health ◽

American University ◽

American University Of Beirut ◽

Persistent Symptoms ◽

First Case ◽

Health Organization

Around 2090 confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) from 27 countries have been reported to the World Health Organization (WHO) between September 2012 and October 2017, the majority of whom occurring in countries in the Arabian Peninsula, mainly in Saudi Arabia. MERS- CoV can have atypical and misleading presentations resulting in delays in diagnosis and is associated with a high mortality rate especially in elderly patients with multiple comorbidities. Herein, we present the first case of confirmed MERS-CoV infection diagnosed at the American University of Beirut Medical Center (AUBMC) - Lebanon in June 2017 presenting without any respiratory symptoms. This is the second confirmed case of MERS-CoV infection in Lebanon since 2014. The first case presented with a febrile respiratory infection with persistent symptoms despite antibiotic treatment.

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The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Outbreak at King Abdul-Aziz Medical City-Riyadh from Emergency Medical Services Perspective

Prehospital and Disaster Medicine ◽

10.1017/s1049023x20000709 ◽

2020 ◽

Vol 35 (4) ◽

pp. 457-461

Author(s):

Abdullah Alabdali ◽

Kharsan Almakhalas ◽

Faisal Alhusain ◽

Saad Albaiz ◽

Khalid Almutairi ◽

...

Keyword(s):

Saudi Arabia ◽

Middle East ◽

Emergency Medical Services ◽

Lessons Learned ◽

Middle East Respiratory Syndrome ◽

World Health ◽

Medical Services ◽

Emergency Medical ◽

Medical City ◽

Health Organization

AbstractMiddle East Respiratory Syndrome Coronavirus (MERS-CoV) is a form of an infectious respiratory disease, discovered in November 2012 in Saudi Arabia. According to the World Health Organization (WHO; Geneva, Switzerland) reports, a total of 2,519 laboratory-confirmed cases and 866 MERS-CoV-related deaths were recorded as of March 5, 2016.1 The majority of reported cases originated from Saudi Arabia (2,121 cases). Also, MERS-CoV is believed to be of zoonotic origin and has been linked to camels in the Arabian area.1,2 In this report, the authors discuss the lessons learned from the MERS-CoV outbreak at King Abdul-Aziz Medical City-Riyadh (KAMC-R) from August through September 2015 from the Emergency Medical Services (EMS) perspective. The discussion includes the changes in policies and paramedic’s practice, the training and education in infection control procedures, and the process of transportation of these cases. The authors hope to share their experience in this unique situation and highlight the preparedness and response efforts that took place by the division of EMS during the outbreak.

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Middle East respiratory syndrome coronavirus infection in camelids

Veterinary Pathology ◽

10.1177/03009858211069120 ◽

2022 ◽

pp. 030098582110691

Author(s):

Nigeer Te ◽

Malgorzata Ciurkiewicz ◽

Judith M. A. van den Brand ◽

Jordi Rodon ◽

Ann-Kathrin Haverkamp ◽

...

Keyword(s):

Middle East ◽

Respiratory Tract ◽

Antiviral Treatment ◽

Case Fatality ◽

Reservoir Host ◽

Middle East Respiratory Syndrome ◽

World Health ◽

Upper Respiratory Tract ◽

Intermediate Hosts ◽

Dromedary Camels

Middle East respiratory syndrome coronavirus (MERS-CoV) is the cause of a severe respiratory disease with a high case fatality rate in humans. Since its emergence in mid-2012, 2578 laboratory-confirmed cases in 27 countries have been reported by the World Health Organization, leading to 888 known deaths due to the disease and related complications. Dromedary camels are considered the major reservoir host for this virus leading to zoonotic infection in humans. Dromedary camels, llamas, and alpacas are susceptible to MERS-CoV, developing a mild-to-moderate upper respiratory tract infection characterized by epithelial hyperplasia as well as infiltration of neutrophils, lymphocytes, and some macrophages within epithelium, lamina propria, in association with abundant viral antigen. The very mild lesions in the lower respiratory tract of these camelids correlate with absence of overt illness following MERS-CoV infection. Unfortunately, there is no approved antiviral treatment or vaccine for MERS-CoV infection in humans. Thus, there is an urgent need to develop intervention strategies in camelids, such as vaccination, to minimize virus spillover to humans. Therefore, the development of camelid models of MERS-CoV infection is key not only to assess vaccine prototypes but also to understand the biologic mechanisms by which the infection can be naturally controlled in these reservoir species. This review summarizes information on virus-induced pathological changes, pathogenesis, viral epidemiology, and control strategies in camelids, as the intermediate hosts and primary source of MERS-CoV infection in humans.

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Limited Genetic Diversity Detected in Middle East Respiratory Syndrome-Related Coronavirus Variants Circulating in Dromedary Camels in Jordan

Viruses ◽

10.3390/v13040592 ◽

2021 ◽

Vol 13 (4) ◽

pp. 592

Author(s):

Stephanie N. Seifert ◽

Jonathan E. Schulz ◽

Stacy Ricklefs ◽

Michael Letko ◽

Elangeni Yabba ◽

...

Keyword(s):

Genetic Diversity ◽

Middle East ◽

United Arab Emirates ◽

Sequence Data ◽

Case Fatality ◽

High Sensitivity ◽

Middle East Respiratory Syndrome ◽

Full Genome Sequence ◽

Genome Sequences ◽

Dromedary Camels

Middle East respiratory syndrome-related coronavirus (MERS-CoV) is a persistent zoonotic pathogen with frequent spillover from dromedary camels to humans in the Arabian Peninsula, resulting in limited outbreaks of MERS with a high case-fatality rate. Full genome sequence data from camel-derived MERS-CoV variants show diverse lineages circulating in domestic camels with frequent recombination. More than 90% of the available full MERS-CoV genome sequences derived from camels are from just two countries, the Kingdom of Saudi Arabia (KSA) and United Arab Emirates (UAE). In this study, we employ a novel method to amplify and sequence the partial MERS-CoV genome with high sensitivity from nasal swabs of infected camels. We recovered more than 99% of the MERS-CoV genome from field-collected samples with greater than 500 TCID50 equivalent per nasal swab from camel herds sampled in Jordan in May 2016. Our subsequent analyses of 14 camel-derived MERS-CoV genomes show a striking lack of genetic diversity circulating in Jordan camels relative to MERS-CoV genome sequences derived from large camel markets in KSA and UAE. The low genetic diversity detected in Jordan camels during our study is consistent with a lack of endemic circulation in these camel herds and reflective of data from MERS outbreaks in humans dominated by nosocomial transmission following a single introduction as reported during the 2015 MERS outbreak in South Korea. Our data suggest transmission of MERS-CoV among two camel herds in Jordan in 2016 following a single introduction event.

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