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. 2017 Jan 12;7(1):e011865.
doi: 10.1136/bmjopen-2016-011865.

Case characteristics among Middle East respiratory syndrome coronavirus outbreak and non-outbreak cases in Saudi Arabia from 2012 to 2015

F S Alhamlan  1   2 , M S Majumder  3   4 , J S Brownstein  4 , J Hawkins  4 , H M Al-Abdely  5 , A Alzahrani  5 , D A Obaid  1 , M N Al-Ahdal  1   2   6 , A BinSaeed  5
Affiliations

Case characteristics among Middle East respiratory syndrome coronavirus outbreak and non-outbreak cases in Saudi Arabia from 2012 to 2015

F S Alhamlan et al. BMJ Open. .

Erratum in

Abstract

Objectives: As of 1 November 2015, the Saudi Ministry of Health had reported 1273 cases of Middle East respiratory syndrome (MERS); among these cases, which included 9 outbreaks at several hospitals, 717 (56%) patients recovered, 14 (1%) remain hospitalised and 543 (43%) died. This study aimed to determine the epidemiological, demographic and clinical characteristics that distinguished cases of MERS contracted during outbreaks from those contracted sporadically (ie, non-outbreak) between 2012 and 2015 in Saudi Arabia.

Design: Data from the Saudi Ministry of Health of confirmed outbreak and non-outbreak cases of MERS coronavirus (CoV) infections from September 2012 through October 2015 were abstracted and analysed. Univariate and descriptive statistical analyses were conducted, and the time between disease onset and confirmation, onset and notification and onset and death were examined.

Results: A total of 1250 patients (aged 0-109 years; mean, 50.825 years) were reported infected with MERS-CoV. Approximately two-thirds of all MERS cases were diagnosed in men for outbreak and non-outbreak cases. Healthcare workers comprised 22% of all MERS cases for outbreak and non-outbreak cases. Nosocomial infections comprised one-third of all Saudi MERS cases; however, nosocomial infections occurred more frequently in outbreak than non-outbreak cases (p<0.001). Patients contracting MERS during an outbreak were significantly more likely to die of MERS (p<0.001).

Conclusions: To date, nosocomial infections have fuelled MERS outbreaks. Given that the Kingdom of Saudi Arabia is a worldwide religious travel destination, localised outbreaks may have massive global implications and effective outbreak preventive measures are needed.

Keywords: INFECTIOUS DISEASES.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Incidence of Middle East respiratory syndrome coronavirus infections (1250 confirmed cases) across the Kingdom of Saudi Arabia.
Figure 2
Figure 2
Epidemiological curve showing the number of cases of MERS-CoV infection and various patient characteristics in the Kingdom of Saudi Arabia by month and year of confirmation. HCW, healthcare worker.
Figure 3
Figure 3
Histogram of the time from disease onset to MERS-CoV confirmation for outbreak and non-outbreak cases. Average time from onset to confirmation was 6.6 days for outbreak cases and 11.9 days for non-outbreak cases.
Figure 4
Figure 4
Histogram of time from disease onset to notification for outbreak and non-outbreak cases. Average time from onset to notification was 5.3 days for outbreak cases and 9.2 days for non-outbreak cases.
Figure 5
Figure 5
Histogram of time from onset to death for outbreak and non-outbreak in those cases ending in death. Average time from onset to death among patients who died was 15.6 days for outbreak cases and 19.5 days for non-outbreak cases.
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