Distribution and Determinants of MERS-CoV, Kingdom of Saudi Arabia, 2012- 2014 Open Access

Abstract

Introduction: MERS-CoV is a novel virus that predominately affects the Kingdom of Saudi Arabia (KSA). Little is known about its mode of transmission, so it is important to analyze reported data collected from infected patients to understand the distribution and determinants of morbidity and mortality.

Methods: Secondary, de-identified reported MERS-CoV data from the MoH in KSA were stratified by year, age, gender, nationality, and region. We analyzed these data with SAS and performed Chi-square and Fisher exact tests when appropriate.

Results: A total of 693 confirmed MERS-CoV cases were reported to the KSA MoH between June 2012 and 31 December 2014. The average age of MERS-CoV cases was 49.3 years and 35.8% were between 40 - 59 years. MERS-CoV cases were mostly male (64%) and Saudi (65%). Over 90% of MERS-CoV cases were reported from 4 regions. Of 693 cases, 13.1% were asymptomatic or had mild symptoms; 42% had severe symptoms but survived; and 45% had severe symptoms and died. The average age of patients who died was 59.3 years, and 79% were ≥ 60 years old. Those who died were mostly male (70%) and Saudi (78%). The number of MERS-CoV cases and deaths significantly increased in KSA across the study period, while the case fatality rate (CFR) decreased. Overall, 80% of cases were reported in 2014, and the number of cases increased each month, peaking in April.

Discussion: MERS-CoV is a global public health threat that must be addressed. The significant increase in 2014 case reports might be due to a real increase, the broadening of the case definition, or to hospital-associated outbreaks. The CFR was very high, but there might be bias due to the greater attention paid to severe cases than asymptomatic/mild ones. To properly identify MERS-CoV cases, we recommend the following: training for healthcare workers, public health surveillance evaluation and strengthening (including adopting e-Surveillance), standardization of reporting, and conducting studies involving both human subjects and camels. Improvements in compliance to current infection control protocols are also needed. To control this disease, attention must also be paid to cultural beliefs and denial.

Table of Contents

Abstract .............................................................................................................................. i

Acknowledgements ............................................................................................................ ii

List of Figures .................................................................................................................... iii

List of Tables ..................................................................................................................... iv

Chapter I: Introduction.......................................................................................................1

Chapter II: Review of the Literature...........................................................................…….. 5

Chapter III: Manuscript ......................................................................................................13

Abstract ............................................................................................................................. 13

Introduction ....................................................................................................................... 11

Methods ............................................................................................................................. 17

Results ............................................................................................................................... 19

Discussion .......................................................................................................................... 21

Chapter IV: Conclusion and Recommendations................................................................. 25

References ......................................................................................................................... 36

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Medicine and Surgery Health Sciences, Nursing
Keyword	KSA MERS coronavirus viruses Saudi Arabia Coronavirus Kingdom of Saudi Arabia Middle East respiratory syndrome coronavirus MERS CoV Respiratory infections MERS MERS Patient
Committee Chair / Thesis Advisor	McNabb, Scott JN, Emory University

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