MERS-CoV Mortality by Region and Healthcare Provider, Kingdom of Saudi Arabia, 2012 -2015 Public

Abstract

Background: Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) has caused persistent outbreaks in the Kingdom of Saudi Arabia (KSA) since 2012. Of special concern has been the virus's transmission within healthcare facilities, affecting hospital patients, visitors, and healthcare workers. The objective of this study was to describe differences in the mortality rates of MERS patients among different regions and healthcare providers in KSA from 2012 to 2015 and to examine the relationship between patient mortality and predictors of interest using Generalized Estimating Equations accounting for clustering effect and correlation of outcome within hospital.

Methods: Data from the KSA Ministry of Health (MoH) were collected through the national MERS-CoV surveillance system. All confirmed, symptomatic MERS-CoV cases in KSA from September 2012 to December 2015 were included. We performed Chi-square tests for the association of outcome with all predictors, and we used cross-sectional multi-level analysis to generalize estimating equations (GEE). Cases were analyzed as observations within hospitals and hospitals were grouped into regions.

Results: A total of 1,283 cases of MERS-CoV infection were reported with an overall mortality rate of 43%. The probability of death for symptomatic MERS patients in Ministry of Health (MoH) hospitals (adjusted for age, gender, nationality, and infection source) was 39% in the Central division, 19% in the Eastern division, and 16% in the Western division. National Guard (NG) hospitals showed lower odds of death compared to MoH hospitals in the Central and Eastern divisions. Military hospitals showed higher odds of death compared to MoH hospitals only in the Western division.

Conclusion: Discrepancies were observed in the probability of death for MERS-CoV patients across different divisions and healthcare provider sectors in KSA. Patient age and source of infection are strong predictors of mortality in all regions. Inconsistent case reporting from some regions led to the inability to estimate probabilities and odds of mortality for those regions. Observed results reflect variability in standards of care across healthcare providers in KSA. Improving infection control protocols in hospitals could limit the transmission of MERS-CoV and improve the survival of patients.

Table of Contents

Acknowledgements..........................................................................................i

Chapter 1 - Introduction..................................................................................2

Chapter 2 - Literature Review...........................................................................5

Chapter 3 - Manuscript...................................................................................17

Abstract.........................................................................................................17

Introduction..................................................................................................18

Methods........................................................................................................18

Results..........................................................................................................21

Discussion.....................................................................................................31

Chapter 4 - Conclusion and Recommendations.................................................33

References.....................................................................................................34

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
Mot-clé	multilevel analysis KSA respiratory infection Middle Eastern Respiratory Syndrome surveillance Kingdom of Saudi Arabia public health mortality healthcare infectious disease MERS-CoV
Committee Chair / Thesis Advisor	McNabb, Scott JN, Emory University
Partnering Agencies	International governmental organization (e.g., Agency for International Development, etc.)

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