Sindrome Respiratoria del Medio Oriente - 2014

The New England journal of medicine, 2015

A marked increase in the number of cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection occurred in Jeddah, Saudi Arabia, in early 2014. We evaluated patients with MERS-CoV infection in Jeddah to explore reasons for this increase and to assess the epidemiologic and clinical features of this disease. We identified all cases of laboratory-confirmed MERS-CoV infection in Jeddah that were reported to the Saudi Arabian Ministry of Health from January 1 through May 16, 2014. We conducted telephone interviews with symptomatic patients who were not health care personnel, and we reviewed hospital records. We identified patients who were reported as being asymptomatic and interviewed them regarding a history of symptoms in the month before testing. Descriptive analyses were performed. Of 255 patients with laboratory-confirmed MERS-CoV infection, 93 died (case fatality rate, 36.5%). The median age of all patients was 45 years (interquartile range, 30 to 59), and 174 patie...

Journal of the Egyptian Society of Parasitology, 2017

In recent years, several outbreaks of the Middle East Respiratory Syndrome Corona Virus (MERS-CoV) were reported to the WHO by Saudi Arabia (2014, 2015, and 2017) and the Republic of Korea (2015). These large outbreaks indicate that MERS-CoV, if not adequately controlled, can cause severe outbreaks and negative socioeconomic consequences. The disease was identified and reported in 27 countries around the world, particularly in the Middle East, Africa, Asia, Europe, and North America. The total number of laboratory-confirmed MERS-CoV cases reported to the WHO between 2012 and 21 July 2017 was 2040, of which 1672 (82%) were reported by the Kingdom of Saudi Arabia. Since the 5 th December 2016, about 190 cases were confirmed in Saudi Arabia, out of which 63 were reported in one outbreak and four different clusters in the Riyadh region. This review discusses the background of the disease along with its epidemiology, risk factors, clinical features, diagnosis, treatment, vaccination, prevention and control. The review also concludes with some future perspectives.

Clinical Infectious Diseases, 2014

The Middle East respiratory syndrome (MERS) is a new killer respiratory disease caused by the MERS coronavirus (CoV) first reported from the Kingdom of Saudi Arabia (KSA) in September 2012, after identification of a novel betacoronavirus from a Saudi Arabian patient who died from a severe respiratory illness . Retrospective study of stored samples later showed that, earlier in April 2012, a cluster of severe respiratory illness occurred in a public health hospital in Zarqa, Jordan, where eight healthcare workers (HCWs) were among the 11 people affected, with two deaths attributed to MERS-CoV . The appearance of any new fatal infectious disease, and uncertainty about its origin and mode of transmission, invariably threatens global health security and its detection in western countries rapidly focuses political and scientific attention. Unfortunately, at the same time, it evokes unnecessary and unwarranted fierce scientific competition and discourse, as was illustrated by the HIV, severe acute respiratory syndrome (SARS) and avian influenza epidemics . Disappointingly, the events surrounding the MERS-CoV have been no different . MERS-CoV was first isolated, sequenced and patented by Erasmus Medical Centre (EMC) researchers in Rotterdam, the Netherlands, and initially it was named after their centre as HCoV-EMC [2]. Subsequently, international consensus led to renaming it as MERS-CoV [9]. Since the first KSA case report in September 2012, the KSA Ministry of Health (MoH) has recommended mandatory testing for MERS-CoV in all cases of respiratory illness requiring intensive care admission. 6 months after MERS-CoV was discovered, at the end of March 2013, there were only 17 MERS-CoV cases reported globally, nine of which were from KSA [10], four of these from one family case cluster . This small number of MERS-CoV cases would not have attracted much global attention had it not been for the high mortality rate in persons who contracted the disease, all of whom had medical comorbidities [9]. Frenzied media reports followed the detection of MERS cases in the UK [12], France , Germany [15] and Italy , and focussed international attention. The media scaremongering and hype led to exaggerated claims of the potential threat of MERS-CoV to global health security. A flurry of scientific, political and media activity ensued, with global attention focussed on the pandemic potential of MERS-CoV. This had become particularly urgent and important in light of an estimated 2 million pilgrims from over 182 countries expected to visit Makkah and Madinah, KSA, to perform the

American Journal of Transplantation, 2014

Since mid-March 2014, the frequency with which cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported has increased, with the majority of recent cases reported from Saudi Arabia and United Arab Emirates (UAE). In addition, the frequency with which travel-associated MERS cases have been reported and the number of countries that have reported them to the World Health Organization (WHO) have also increased. The first case of MERS in the United States, identified in a traveler recently returned from Saudi Arabia, was reported to CDC by the Indiana State Department of Health on May 1, 2014, and confirmed by CDC on May 2. A second imported case of MERS in the United States, identified in a traveler from Saudi Arabia having no connection with the first case, was reported to CDC by the Florida Department of Health on May 11, 2014. The purpose of this report is to alert clinicians, health officials, and others to increase awareness of the need to consider MERS-CoV infection in persons who have recently traveled from countries in or near the Arabian Peninsula.* This report summarizes recent epidemiologic information, provides preliminary descriptions of the cases reported from Indiana and Florida, and updates CDC guidance about patient evaluation, home care and isolation, specimen collection, and travel as of May 13, 2014. MERS-CoV was first reported to cause human infection in September 2012. Since mid-March 2014, the frequency with which cases have been reported has increased. † As of May 12, 2014, 536 laboratory-confirmed § cases of MERS-CoV infection have been reported by WHO (Figure 1). This includes 145 deaths. All reported cases have been directly or indirectly linked through travel or residence to seven countries: Saudi Arabia, UAE, Qatar, Oman, Jordan, Kuwait, and Yemen (Figure 2). Public health investigations are ongoing to determine the reason for the increase in cases. The median age of persons with laboratory-confirmed MERS-CoV infection is 49 years (range = <1-94 years);

PLoS Currents, 2014

the Kingdom of Saudi Arabia (KSA) had a large outbreak of MERS-CoV, renewing fears of a major outbreak during the Hajj this October. Using KSA Ministry of Health data, the MERS-CoV Scenario and Modeling Working Group forecast incidence under three scenarios. In the expected incidence scenario, we estimate 6.2 (95% Prediction Interval [PI]: 1-17) pilgrims will develop MERS-CoV symptoms during the Hajj, and 4.0 (95% PI: 0-12) foreign pilgrims will be infected but return home before developing symptoms. In the most pessimistic scenario, 47.6 (95% PI: 32-66) cases will develop symptoms during the Hajj, and 29.0 (95% PI: 17-43) will be infected but return home asymptomatic. Large numbers of MERS-CoV cases are unlikely to occur during the 2014 Hajj even under pessimistic assumptions, but careful monitoring is still needed to detect possible mass infection events and minimize introductions into other countries.

Eastern Mediterranean Health Journal

Background: The prevalence of Middle East respiratory syndrome coronavirus (MERS-CoV) infection during the period of coronavirus disease 2019 (COVID-19) remains uncertain. Aims: This study aimed to provide an update on the epidemiology of MERS-CoV in Saudi Arabia from January 2019 to October 2020. Methods: Data on all laboratory-confirmed cases of MERS-CoV infection in Saudi Arabia from January 2019 to 20 October 2020 were retrieved from the Health Electronic Surveillance Network of the Ministry of Health of Saudi Arabia. Data collected were: demographic characteristics of cases, clinical course of the infection, related mortality and association with exposure to confirmed cases or camels. Results: In total, 299 cases of MERS-CoV infection were reported in the study period. The mean age of cases was 52.4 years. Most of the cases were males (78.9%) and had comorbidities (72.7%), and 11.9% of cases were health care providers. Of the 299 cases, 83 (27.7%) died. Older age and having com...

Emerging Infectious Diseases, 2016

Middle East respiratory syndrome (MERS) coronavirus (MERS-CoV) is a novel respiratory pathogen first reported in 2012. During September 2014-January 2015, an outbreak of 38 cases of MERS was reported from 4 healthcare facilities in Taif, Saudi Arabia; 21 of the 38 case-patients died. Clinical and public health records showed that 13 patients were healthcare personnel (HCP). Fifteen patients, including 4 HCP, were associated with 1 dialysis unit. Three additional HCP in this dialysis unit had serologic evidence of MERS-CoV infection. Viral RNA was amplified from acute-phase serum specimens of 15 patients, and full spike gene-coding sequencing was obtained from 10 patients who formed a discrete cluster; sequences from specimens of 9 patients were closely related. Similar gene sequences among patients unlinked by time or location suggest unrecognized viral transmission. Circulation persisted in multiple healthcare settings over an extended period, underscoring the importance of strengthening MERS-CoV surveillance and infection-control practices. M iddle East respiratory syndrome (MERS) coronavirus (MERS-CoV) is a novel betacoronavirus associated with a broad spectrum of respiratory illness; infection results in death in ≈35%-40% of cases (1). Since the virus was first identified 2012, more than 85% of cases have occurred in Saudi Arabia (1). Although risk factors for transmission have not been well described, camels (Camelus dromedarius) are suspected reservoirs, as suggested by case investigations (2,3), serologic studies (4,5), and isolation of live infectious MERS-CoV (2,3,6). Limited humanto-human transmission has been documented in households (7) and healthcare facilities (8-10), but no sustained community transmission has been documented (1). In Jeddah in 2014, secondary transmission (i.e., from infected to noninfected persons) accounted for 97% of assessed cases (9). Although detection of MERS-CoV RNA from persons with mild symptoms, typically in healthcare personnel (HCP), is well-documented (11), the potential role that mild cases play in transmission is not well defined (12). In healthcare facilities, extensive transmission of MERS-CoV in dialysis units has been documented (8,9); in those events, strengthening infection-control precautions preceded decreased numbers of reported cases. Currently, the surveillance case definition for MERS in Saudi Arabia requires the presence of symptoms (13), and testing is reserved primarily for symptomatic patients, often with severe illness.

Emerging Infectious Diseases, 2019

Emerging themes in epidemiology, 2014

In May 2014, Middle East respiratory syndrome coronavirus (MERS-CoV) infection, with closely related viral genomes, was diagnosed in two Dutch residents, returning from a pilgrimage to Medina and Mecca, Kingdom of Saudi Arabia (KSA). These patients travelled with a group of 29 other Dutch travellers. We conducted an epidemiological assessment of the travel group to identify likely source(s) of infection and presence of potential risk factors. All travellers, including the two cases, completed a questionnaire focussing on potential human, animal and food exposures to MERS-CoV. The questionnaire was modified from the WHO MERS-CoV questionnaire, taking into account the specific route and activities of the travel group. Twelve non-cases drank unpasteurized camel milk and had contact with camels. Most travellers, including one of the two patients (Case 1), visited local markets, where six of them consumed fruits. Two travellers, including Case 1, were exposed to coughing patients when vi...

EClinicalMedicine, 2021

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%, 3symptom 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.