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Al-Tawfiq JA, Azhar EI, Memish ZA, Zumla A. Middle East Respiratory Syndrome Coronavirus. Semin Respir Crit Care Med 2021; 42:828-838. [PMID: 34918324 DOI: 10.1055/s-0041-1733804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The past two decades have witnessed the emergence of three zoonotic coronaviruses which have jumped species to cause lethal disease in humans: severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1), Middle East respiratory syndrome coronavirus (MERS-CoV), and SARS-CoV-2. MERS-CoV emerged in Saudi Arabia in 2012 and the origins of MERS-CoV are not fully understood. Genomic analysis indicates it originated in bats and transmitted to camels. Human-to-human transmission occurs in varying frequency, being highest in healthcare environment and to a lesser degree in the community and among family members. Several nosocomial outbreaks of human-to-human transmission have occurred, the largest in Riyadh and Jeddah in 2014 and South Korea in 2015. MERS-CoV remains a high-threat pathogen identified by World Health Organization as a priority pathogen because it causes severe disease that has a high mortality rate, epidemic potential, and no medical countermeasures. MERS-CoV has been identified in dromedaries in several countries in the Middle East, Africa, and South Asia. MERS-CoV-2 causes a wide range of clinical presentations, although the respiratory system is predominantly affected. There are no specific antiviral treatments, although recent trials indicate that combination antivirals may be useful in severely ill patients. Diagnosing MERS-CoV early and implementation infection control measures are critical to preventing hospital-associated outbreaks. Preventing MERS relies on avoiding unpasteurized or uncooked animal products, practicing safe hygiene habits in health care settings and around dromedaries, community education and awareness training for health workers, as well as implementing effective control measures. Effective vaccines for MERS-COV are urgently needed but still under development.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Division of Infectious Disease, Indiana University School of Medicine, Indianapolis, Indiana.,Division of Infectious Disease, Johns Hopkins University, Baltimore, Maryland
| | - Esam I Azhar
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ziad A Memish
- Research and Innovation Centre, King Saud Medical City, Ministry of Health and College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Hubert Department of Global Health, Emory University, Atlanta, Georgia
| | - Alimuddin Zumla
- Division of Infection and Immunity, Department of Infection, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, United Kingdom
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Tsang TK, Wang C, Yang B, Cauchemez S, Cowling BJ. Using secondary cases to characterize the severity of an emerging or re-emerging infection. Nat Commun 2021; 12:6372. [PMID: 34737277 PMCID: PMC8569220 DOI: 10.1038/s41467-021-26709-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/20/2021] [Indexed: 12/14/2022] Open
Abstract
The methods to ascertain cases of an emerging infectious disease are typically biased toward cases with more severe disease, which can bias the average infection-severity profile. Here, we conducted a systematic review to extract information on disease severity among index cases and secondary cases identified by contact tracing of index cases for COVID-19. We identified 38 studies to extract information on measures of clinical severity. The proportion of index cases with fever was 43% higher than for secondary cases. The proportion of symptomatic, hospitalized, and fatal illnesses among index cases were 12%, 126%, and 179% higher than for secondary cases, respectively. We developed a statistical model to utilize the severity difference, and estimate 55% of index cases were missed in Wuhan, China. Information on disease severity in secondary cases should be less susceptible to ascertainment bias and could inform estimates of disease severity and the proportion of missed index cases.
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Affiliation(s)
- Tim K Tsang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong,, Hong Kong, China
- Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong, China
| | - Can Wang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong,, Hong Kong, China
| | - Bingyi Yang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong,, Hong Kong, China
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, CNRS, Paris, France
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong,, Hong Kong, China.
- Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong, China.
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3
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Deng X, Yang J, Wang W, Wang X, Zhou J, Chen Z, Li J, Chen Y, Yan H, Zhang J, Zhang Y, Wang Y, Qiu Q, Gong H, Wei X, Wang L, Sun K, Wu P, Ajelli M, Cowling BJ, Viboud C, Yu H. Case Fatality Risk of the First Pandemic Wave of Coronavirus Disease 2019 (COVID-19) in China. Clin Infect Dis 2021; 73:e79-e85. [PMID: 32409826 PMCID: PMC7239217 DOI: 10.1093/cid/ciaa578] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/12/2020] [Indexed: 01/08/2023] Open
Abstract
Objective To assess the case fatality risk (CFR) of COVID-19 in mainland China, stratified by region and clinical category, and estimate key time-to-event intervals. Methods We collected individual information and aggregated data on COVID-19 cases from publicly available official sources from December 29, 2019 to April 17, 2020. We accounted for right-censoring to estimate the CFR and explored the risk factors for mortality. We fitted Weibull, gamma, and lognormal distributions to time-to-event data using maximum-likelihood estimation. Results We analyzed 82,719 laboratory-confirmed cases reported in mainland China, including 4,632 deaths, and 77,029 discharges. The estimated CFR was 5.65% (95%CI: 5.50%-5.81%) nationally, with highest estimate in Wuhan (7.71%), and lowest in provinces outside Hubei (0.86%). The fatality risk among critical patients was 3.6 times that of all patients, and 0.8-10.3 fold higher than that of mild-to-severe patients. Older age (OR 1.14 per year; 95%CI: 1.11-1.16), and being male (OR 1.83; 95%CI: 1.10-3.04) were risk factors for mortality. The time from symptom onset to first healthcare consultation, time from symptom onset to laboratory confirmation, and time from symptom onset to hospitalization were consistently longer for deceased patients than for those who recovered. Conclusions Our CFR estimates based on laboratory-confirmed cases ascertained in mainland China suggest that COVID-19 is more severe than the 2009 H1N1 influenza pandemic in hospitalized patients, particularly in Wuhan. Our study provides a comprehensive picture of the severity of the first wave of the pandemic in China. Our estimates can help inform models and the global response to COVID-19.
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Affiliation(s)
- Xiaowei Deng
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Juan Yang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Wei Wang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Xiling Wang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Jiaxin Zhou
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Zhiyuan Chen
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Jing Li
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Yinzi Chen
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Han Yan
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Juanjuan Zhang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Yongli Zhang
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China
| | - Yan Wang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Qi Qiu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Hui Gong
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Xianglin Wei
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Lili Wang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Kaiyuan Sun
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Peng Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Marco Ajelli
- Bruno Kessler Foundation, Trento, Italy.,Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, Indiana, USA
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Cecile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Hongjie Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
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Evolutionary Analysis of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Reveals Genomic Divergence with Implications for Universal Vaccine Efficacy. Vaccines (Basel) 2020; 8:vaccines8040591. [PMID: 33050053 PMCID: PMC7720133 DOI: 10.3390/vaccines8040591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/02/2020] [Indexed: 12/13/2022] Open
Abstract
Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is one of the pressing contemporary public health challenges. Investigations into the genomic structure of SARS-CoV-2 may inform ongoing vaccine development efforts and/or provide insights into vaccine efficacy to fight against COVID-19. Evolutionary analysis of 540 genomes spanning 20 different countries/territories was conducted and revealed an increase in the genomic divergence across successive generations. The ancestor of the phylogeny was found to be the isolate from the 2019/2020 Wuhan outbreak. Its transmission was outlined across 20 countries/territories as per genomic similarity. Our results demonstrate faster evolving variations in the genomic structure of SARS-CoV-2 when compared to the isolates from early stages of the pandemic. Genomic alterations were predominantly located and mapped onto the reported vaccine candidates of structural genes, which are the main targets for vaccine candidates. S protein showed 34, N protein 25, E protein 2, and M protein 3 amino acid variations in 246 genomes among 540. Among identified mutations, 23 in S protein, 1 in E, 2 from M, and 7 from N protein were mapped with the reported vaccine candidates explaining the possible implications on universal vaccines. Hence, potential target regions for vaccines would be ideally chosen from the structural regions of the genome that lack high variation. The increasing variations in the genome of SARS-CoV-2 together with our observations in structural genes have important implications for the efficacy of a successful universal vaccine against SARS-CoV-2.
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5
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Al-Ahmadi KH, Alahmadi MH, Al-Zahrani AS, Hemida MG. Spatial variability of Middle East respiratory syndrome coronavirus survival rates and mortality hazard in Saudi Arabia, 2012–2019. PeerJ 2020. [DOI: 10.7717/peerj.9783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
About 83% of laboratory-confirmed Middle East respiratory syndrome coronavirus (MERS-CoV) cases have emerged from Saudi Arabia, which has the highest overall mortality rate worldwide. This retrospective study assesses the impact of spatial/patient characteristics for 14-and 45-day MERS-CoV mortality using 2012–2019 data reported across Saudi regions and provinces. The Kaplan–Meier estimator was employed to estimate MERS-CoV survival rates, Cox proportional-hazards (CPH) models were applied to estimate hazard ratios (HRs) for 14-and 45-day mortality predictors, and univariate local spatial autocorrelation and multivariate spatial clustering analyses were used to assess the spatial correlation. The 14-day, 45-day and overall mortality rates (with estimated survival rates) were 25.52% (70.20%), 32.35% (57.70%) and 37.30% (56.50%), respectively, with no significant rate variations between Saudi regions and provinces. Nationally, the CPH multivariate model identified that being elderly (age ≥ 61), being a non-healthcare worker (non-HCW), and having an underlying comorbidity were significantly related to 14-day mortality (HR = 2.10, 10.12 and 4.11, respectively; p < 0.0001). The 45-day mortality model identified similar risk factors but with an additional factor: patients aged 41–60 (HR = 1.44; p < 0.0001). Risk factors similar to those in the national model were observed in the Central, East and West regions and Riyadh, Makkah, Eastern, Madinah and Qassim provinces but with varying HRs. Spatial clusters of MERS-CoV mortality in the provinces were identified based on the risk factors (r2 = 0.85–0.97): Riyadh (Cluster 1), Eastern, Makkah and Qassim (Cluster 2), and other provinces in the north and south of the country (Cluster 3). The estimated HRs for the 14-and 45-day mortality varied spatially by province. For 45-day mortality, the highest HRs were found in Makkah (age ≥ 61 and non-HCWs), Riyadh (comorbidity) and Madinah (age 41–60). Coming from Makkah (HR = 1.30 and 1.27) or Qassim province (HR = 1.77 and 1.70) was independently related to higher 14-and 45-day mortality, respectively. MERS-CoV patient survival could be improved by implementing appropriate interventions for the elderly, those with comorbidities and non-HCW patients.
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Affiliation(s)
| | | | - Ali Saeed Al-Zahrani
- King Faisal Specialist Hospital and Research Centre, Riyadh, Riyadh, Saudi Arabia
| | - Maged Gomaa Hemida
- Department of Microbiology, College of Veterinary Medicine, King Faisal University, Al-Hufuf, Al-Hasa, Saudi Arabia
- Department of Virology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafrelsheikh, Kafrelsheikh, Egypt
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Design, synthesis and molecular docking of novel triazole derivatives as potential CoV helicase inhibitors. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2020; 70:145-159. [PMID: 31955138 DOI: 10.2478/acph-2020-0024] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/08/2019] [Indexed: 01/19/2023]
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) had emerged and spread because of the worldwide travel and inefficient healthcare provided for the infected patients in several countries. Herein we investigated the anti-MERS-CoV activity of newly synthesized sixteen halogenated triazole compounds through the inhibition of helicase activity using the FRET assay. All new compounds underwent justification for their target structures via microanalytical and spectral data. SAR studies were performed. Biological results revealed that the most potent compounds were 4-(cyclopent-1-en-3-ylamino)-5-(2-(4-iodophenyl)hydrazinyl)-4H-1,2,4-triazole-3-thiol (16) and 4-(cyclopent-1-en-3-ylamino)-5-[2-(4-chlorophenyl)hydrazinyl]-4H-1,2,4-triazole-3-thiol (12). In silico molecular docking of the most potent compounds was performed to the active binding site of MERS-CoV helicase nsp13. Molecular docking results are in agreement with experimental findings.
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7
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Lin Y, Hu Z, Alias H, Wong LP. Knowledge, Attitudes, Impact, and Anxiety Regarding COVID-19 Infection Among the Public in China. Front Public Health 2020; 8:236. [PMID: 32574305 PMCID: PMC7266871 DOI: 10.3389/fpubh.2020.00236] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/18/2020] [Indexed: 01/08/2023] Open
Abstract
Objectives: Sufficient knowledge and positive attitudes are crucial to the prevention of COVID-19. However, little is known about public awareness and attitudes regarding COVID-19 in China. The impact of COVID-19 on the societal well-being and anxiety levels of the public has never been documented. The aim of this study was to survey the knowledge, attitudes, impact, and anxiety levels of the people of China in relation to the COVID-19 outbreak. Method: A cross-sectional population survey using an online questionnaire was undertaken between Jan 24 and Feb 24, 2020. The study participants were residents of mainland China over the age of 18 years. The attitude items in this study measured the perceived threat of COVID-19 based on the Health Belief Model. Anxiety was measured with the State-Trait Anxiety Inventory (STAI), a self-reported questionnaire that measure both state (STAI-S), and trait anxiety (STAI-T) Results: A total of 2,446 completed responses were received. The mean and standard deviation (SD) for the total knowledge score was 20.3 (SD ± 2.9) out of a possible score of 23. The social disruption and household economic impact were notable, particularly in provinces with higher cumulative confirmed cases. The majority of responses indicated a low perceived susceptibility of being infected (86.7% [95%CI 85.4–88.1]), with a fair proportion of respondents perceiving a higher severity (62.9% [95% CI 61.0–64.8]). The mean total impact score was 9.9 (SD ± 3.8) out of a possible score of 15. The mean score for STAI-S was 48.7 (SD ± 10.8), whereas the mean STAI-T score was 45.7 (SD ± 8.5). By demographics, women reported significantly higher odds for higher levels of both STAI-S (OR = 1.67) and STAI-T (OR = 1.30) compared to men. People of a younger age were also more likely to experience higher STAI-S and STAI-T. Higher perceived susceptibility and severity and impact were strong predictors of higher levels of STAI-S and STAI-T. Conclusion: Our findings can assist in tailoring public communication to change people's knowledge and attitudes. The present study also underlined the importance of the promotion of mental health during infectious disease outbreaks to help in moderating the perceived threat, social and household economic impact, targeting the vulnerable segment of the population.
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Affiliation(s)
- Yulan Lin
- Fujian Provincial Key Laboratory of Environment Factors and Cancer, Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Zhijian Hu
- Fujian Provincial Key Laboratory of Environment Factors and Cancer, Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Haridah Alias
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Li Ping Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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8
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Al-Tawfiq JA, Memish ZA. Middle East Respiratory Syndrome Coronavirus and Severe Acute Respiratory Syndrome Coronavirus. Semin Respir Crit Care Med 2020; 41:568-578. [PMID: 32305045 PMCID: PMC7516363 DOI: 10.1055/s-0040-1709160] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Emerging infectious diseases continue to be of a significant importance worldwide with the potential to cause major outbreaks and global pandemics. In 2002, the world had witnessed the appearance of the severe acute respiratory syndrome coronavirus in China which disappeared abruptly within 6 months. About a decade later, a new and emerging novel coronavirus named the Middle East respiratory syndrome coronavirus (MERS-CoV) was described in a patient from Saudi Arabia. These two coronaviruses shared multiple similarities in the epidemiology, clinical presentations, and posed challenges in its prevention and management. Seven years since its discovery, MERS-CoV continues to be a lethal zoonotic pathogen capable of causing severe pneumonia with high case fatality rates and the ability to cause large health care-associated outbreaks.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ziad A Memish
- Director Research & Innovation Center, Research Center Department, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia.,Department of Medicine, Al-Faisal University, Riyadh, Saudi Arabia.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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9
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Alfaraj SH, Al-Tawfiq JA, Assiri AY, Alzahrani NA, Alanazi AA, Memish ZA. Clinical predictors of mortality of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: A cohort study. Travel Med Infect Dis 2019; 29:48-50. [PMID: 30872071 PMCID: PMC7110962 DOI: 10.1016/j.tmaid.2019.03.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/25/2019] [Accepted: 03/06/2019] [Indexed: 12/30/2022]
Abstract
Background Since the emergence of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in 2012, the virus had caused a high case fatality rate. The clinical presentation of MERS varied from asymptomatic to severe bilateral pneumonia, depending on the case definition and surveillance strategies. There are few studies examining the mortality predictors in this disease. In this study, we examined clinical predictors of mortality of Middle East Respiratory Syndrome (MERS) infection. Methods This is a retrospective analysis of symptomatic admitted patients to a large tertiary MERS-CoV center in Saudi Arabia over the period from April 2014 to March 2018. Clinical and laboratory data were collected and analysis was done using a binary regression model. Results A total of 314 symptomatic MERS-CoV patients were included in the analysis, with a mean age of 48 (±17.3) years. Of these cases, 78 (24.8%) died. The following parameters were associated with increased mortality, age, WBC, neutrophil count, serum albumin level, use of a continuous renal replacement therapy (CRRT) and corticosteroid use. The odd ratio for mortality was highest for CRRT and corticosteroid use (4.95 and 3.85, respectively). The use of interferon-ribavirin was not associated with mortality in this cohort. Conclusion Several factors contributed to increased mortality in this cohort of MERS-CoV patients. Of these factors, the use of corticosteroid and CRRT were the most significant. Further studies are needed to evaluate whether these factors were a mark of severe disease or actual contributors to higher mortality.
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Affiliation(s)
- Sarah H Alfaraj
- Corona Center, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia; Infectious Diseases Division, Department of Pediatrics, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia; University of British Columbia, Vancouver, BC, Canada
| | - Jaffar A Al-Tawfiq
- Speciality Internal Medicine Unit and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ayed Y Assiri
- Critical Care Department, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Saudi Arabia
| | - Nojoom A Alzahrani
- Corona Center, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Amal A Alanazi
- Corona Center, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Ziad A Memish
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Infectious Diseases Division, Department of Medicine, Department of Research, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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10
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Alfaraj SH, Al-Tawfiq JA, Gautret P, Alenazi MG, Asiri AY, Memish ZA. Evaluation of visual triage for screening of Middle East respiratory syndrome coronavirus patients. New Microbes New Infect 2018; 26:49-52. [PMID: 30224971 PMCID: PMC6138856 DOI: 10.1016/j.nmni.2018.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 07/07/2018] [Accepted: 08/03/2018] [Indexed: 12/22/2022] Open
Abstract
The emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) in September 2012 in Saudi Arabia had attracted the attention of the global health community. In 2017 the Saudi Ministry of Health released a visual triage system with scoring to alert healthcare workers in emergency departments (EDs) and haemodialysis units for the possibility of occurrence of MERS-CoV infection. We performed a retrospective analysis of this visual score to determine its sensitivity and specificity. The study included all cases from 2014 to 2017 in a MERS-CoV referral centre in Riyadh, Saudi Arabia. During the study period there were a total of 2435 suspected MERS cases. Of these, 1823 (75%) tested negative and the remaining 25% tested positive for MERS-CoV by PCR assay. The application of the visual triage score found a similar percentage of MERS-CoV and non–MERS-CoV patients, with each score from 0 to 11. The percentage of patients with a cutoff score of ≥4 was 75% in patients with MERS-CoV infection and 85% in patients without MERS-CoV infection (p 0.0001). The sensitivity and specificity of this cutoff score for MERS-CoV infection were 74.1% and 18.6%, respectively. The sensitivity and specificity of the scoring system were low, and further refinement of the score is needed for better prediction of MERS-CoV infection.
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Affiliation(s)
- S H Alfaraj
- Corona Center, Infectious Diseases Division, Department of Pediatrics, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Saudi Arabia.,University of British Columbia, Vancouver, Canada
| | - J A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Indiana University School of Medicine, Indianapolis, IN, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P Gautret
- Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE) UM63 CNRS 7278 IRD 198 INSERM U1095, Marseille, France
| | - M G Alenazi
- Pediatric Emergency Medicine, Emergency Department, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Saudi Arabia
| | - A Y Asiri
- Critical Care Department, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Saudi Arabia
| | - Z A Memish
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Infectious Diseases Division, Department of Medicine, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Saudi Arabia
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11
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Majumder MS, Brownstein JS, Finkelstein SN, Larson RC, Bourouiba L. Nosocomial amplification of MERS-coronavirus in South Korea, 2015. Trans R Soc Trop Med Hyg 2018; 111:261-269. [PMID: 29044371 PMCID: PMC6257029 DOI: 10.1093/trstmh/trx046] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/03/2017] [Indexed: 01/25/2023] Open
Abstract
Background Nosocomial amplification resulted in nearly 200 cases of Middle East respiratory syndrome (MERS) during the 2015 South Korean MERS-coronavirus outbreak. It remains unclear whether certain types of cases were more likely to cause secondary infections than others, and if so, why. Methods Publicly available demographic and transmission network data for all cases were collected from the Ministry of Health and Welfare. Statistical analyses were conducted to determine the relationship between demographic characteristics and the likelihood of human-to-human transmission. Findings from the statistical analyses were used to inform a hypothesis-directed literature review, through which mechanistic explanations for nosocomial amplification were developed. Results Cases that failed to recover from MERS were more likely to cause secondary infections than those that did. Increased probability of direct, human-to-human transmission due to clinical manifestations associated with death, as well as indirect transmission via environmental contamination (e.g., fomites and indoor ventilation systems), may serve as mechanistic explanations for nosocomial amplification of MERS-coronavirus in South Korea. Conclusions In addition to closely monitoring contacts of MERS cases that fail to recover during future nosocomial outbreaks, potential fomites with which they may have had contact should be sanitized. Furthermore, indoor ventilation systems that minimize recirculation of pathogen-bearing droplets should be implemented whenever possible.
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Affiliation(s)
- Maimuna S Majumder
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA, USA.,Computational Epidemiology Group, Boston Children's Hospital, Boston, MA, USA
| | - John S Brownstein
- Computational Epidemiology Group, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Stan N Finkelstein
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Richard C Larson
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Lydia Bourouiba
- The Fluid Dynamics of Disease Transmission Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA
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12
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Park JE, Jung S, Kim A, Park JE. MERS transmission and risk factors: a systematic review. BMC Public Health 2018; 18:574. [PMID: 29716568 PMCID: PMC5930778 DOI: 10.1186/s12889-018-5484-8] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/19/2018] [Indexed: 12/12/2022] Open
Abstract
Background Since Middle East respiratory syndrome (MERS) infection was first reported in 2012, many studies have analysed its transmissibility and severity. However, the methodology and results of these studies have varied, and there has been no systematic review of MERS. This study reviews the characteristics and associated risk factors of MERS. Method We searched international (PubMed, ScienceDirect, Cochrane) and Korean databases (DBpia, KISS) for English- or Korean-language articles using the terms “MERS” and “Middle East respiratory syndrome”. Only human studies with > 20 participants were analysed to exclude studies with low representation. Epidemiologic studies with information on transmissibility and severity of MERS as well as studies containing MERS risk factors were included. Result A total of 59 studies were included. Most studies from Saudi Arabia reported higher mortality (22–69.2%) than those from South Korea (20.4%). While the R0 value in Saudi Arabia was < 1 in all but one study, in South Korea, the R0 value was 2.5–8.09 in the early stage and decreased to < 1 in the later stage. The incubation period was 4.5–5.2 days in Saudi Arabia and 6–7.8 days in South Korea. Duration from onset was 4–10 days to confirmation, 2.9–5.3 days to hospitalization, 11–17 days to death, and 14–20 days to discharge. Older age and concomitant disease were the most common factors related to MERS infection, severity, and mortality. Conclusion The transmissibility and severity of MERS differed by outbreak region and patient characteristics. Further studies assessing the risk of MERS should consider these factors.
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Affiliation(s)
- Ji-Eun Park
- Research Center for Korean Medicine Policy, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Soyoung Jung
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Aeran Kim
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Ji-Eun Park
- Herbal Medicine Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea. .,Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Republic of Korea.
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13
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Park JE, Jung S, Kim A, Park JE. MERS transmission and risk factors: a systematic review. BMC Public Health 2018. [PMID: 29716568 DOI: 10.1186/s12889‐018‐5484‐8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Since Middle East respiratory syndrome (MERS) infection was first reported in 2012, many studies have analysed its transmissibility and severity. However, the methodology and results of these studies have varied, and there has been no systematic review of MERS. This study reviews the characteristics and associated risk factors of MERS. METHOD We searched international (PubMed, ScienceDirect, Cochrane) and Korean databases (DBpia, KISS) for English- or Korean-language articles using the terms "MERS" and "Middle East respiratory syndrome". Only human studies with > 20 participants were analysed to exclude studies with low representation. Epidemiologic studies with information on transmissibility and severity of MERS as well as studies containing MERS risk factors were included. RESULT A total of 59 studies were included. Most studies from Saudi Arabia reported higher mortality (22-69.2%) than those from South Korea (20.4%). While the R0 value in Saudi Arabia was < 1 in all but one study, in South Korea, the R0 value was 2.5-8.09 in the early stage and decreased to < 1 in the later stage. The incubation period was 4.5-5.2 days in Saudi Arabia and 6-7.8 days in South Korea. Duration from onset was 4-10 days to confirmation, 2.9-5.3 days to hospitalization, 11-17 days to death, and 14-20 days to discharge. Older age and concomitant disease were the most common factors related to MERS infection, severity, and mortality. CONCLUSION The transmissibility and severity of MERS differed by outbreak region and patient characteristics. Further studies assessing the risk of MERS should consider these factors.
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Affiliation(s)
- Ji-Eun Park
- Research Center for Korean Medicine Policy, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Soyoung Jung
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Aeran Kim
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Ji-Eun Park
- Herbal Medicine Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea. .,Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Republic of Korea.
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14
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Alfaraj SH, Al-Tawfiq JA, Altuwaijri TA, Memish ZA. Middle East respiratory syndrome coronavirus in pediatrics: a report of seven cases from Saudi Arabia. Front Med 2018; 13:126-130. [PMID: 29623560 PMCID: PMC7088593 DOI: 10.1007/s11684-017-0603-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/23/2017] [Indexed: 01/12/2023]
Abstract
Infection with Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012 as an important respiratory disease with high fatality rates of 40%-60%. Despite the increased number of cases over subsequent years, the number of pediatric cases remained low. A review of studies conducted from June 2012 to April 19, 2016 reported 31 pediatric MERS-CoV cases. In this paper, we present the clinical and laboratory features of seven patients with pediatric MERS. Five patients had no underlying medical illnesses, and three patients were asymptomatic. Of the seven cases, four (57%) patients sought medical advice within 1-7 days from the onset of symptoms. The three other patients (43%) were asymptomatic and were in contact with patients with confirmed diagnosis of MERS-CoV. The most common presenting symptoms were fever (57%), cough (14%), shortness of breath (14%), vomiting (28%), and diarrhea (28%). Two (28.6%) patients had platelet counts of < 150 × 109/L, and one patient had an underlying end-stage renal disease. The remaining patients presented with normal blood count, liver function, and urea and creatinine levels. The documented MERS-CoV Ct values were 32-38 for four of the seven cases. Two patients (28.6%) had abnormal chest radiographic findings of bilateral infiltration. One patient (14.3%) required ventilator support, and two patients (28.6%) required oxygen supplementation. All the seven patients were discharged without complications.
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Affiliation(s)
- Sarah H Alfaraj
- University of British Columbia, Vancouver, V6T 1Z4, Canada.,Corona Center, Infectious Diseases Division, Department of Pediatric, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, 11676, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA.,Johns Hopkins Aramco Healthcare, Dhahran, 31311, Saudi Arabia
| | - Talal A Altuwaijri
- Department of Surgery, King Saud University, Riyadh, 11692, Saudi Arabia
| | - Ziad A Memish
- College of Medicine, Alfaisal University, Riyadh, 11533, Saudi Arabia. .,Infectious Diseases Division, Department of Medicine, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, 11676, Saudi Arabia. .,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
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15
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The Middle East Respiratory Syndrome Coronavirus - A Continuing Risk to Global Health Security. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 972:49-60. [PMID: 27966107 PMCID: PMC7119928 DOI: 10.1007/5584_2016_133] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Two new zoonotic coronaviruses causing disease in humans (Zumla et al. 2015a; Hui and Zumla 2015; Peiris et al. 2003; Yu et al. 2014) have been the focus of international attention for the past 14 years due to their epidemic potential; (1) The Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) (Peiris et al. 2003) first discovered in China in 2001 caused a major global epidemic of the Severe Acute Respiratory Syndrome (SARS). (2) The Middle East respiratory syndrome coronavirus (MERS-CoV) is a new corona virus isolated for the first time in a patients who died of severe lower respiratory tract infection in Jeddah (Saudi Arabia) in June 2012 (Zaki et al. 2012). The disease has been named Middle East Respiratory Syndrome (MERS) and it has remained on the radar of global public health authorities because of recurrent nosocomial and community outbreaks, and its association with severe disease and high mortality rates (Assiri et al. 2013a; Al-Abdallat et al. 2014; Memish et al. 2013a; Oboho et al. 2015; The WHO MERS-CoV Research Group 2013; Cotten et al. 2013a; Assiri et al. 2013b; Memish et al. 2013b; Azhar et al. 2014; Kim et al. 2015; Wang et al. 2015; Hui et al. 2015a). Cases of MERS have been reported from all continents and have been linked with travel to the Middle East (Hui et al. 2015a; WHO 2015c). The World Health Organization (WHO) have held nine meetings of the Emergency Committee (EC) convened by the Director-General under the International Health Regulations (IHR 2005) regarding MERS-CoV (WHO 2015c). There is wishful anticipation in the political and scientific communities that MERS-CoV like SARS-CoV will disappear with time. However it’s been nearly 4 years since the first discovery of MERS-CoV, and MERS cases continue to be reported throughout the year from the Middle East (WHO 2015c). There is a large MERS-CoV camel reservoir, and there is no specific treatment or vaccine (Zumla et al. 2015a). With 10 million people visiting Saudi Arabia every year for Umrah and/or Hajj, the potential risk of global spread is ever present (Memish et al. 2014a; McCloskey et al. 2014; Al-Tawfiq et al. 2014a).
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16
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Impact of Comorbidity on Fatality Rate of Patients with Middle East Respiratory Syndrome. Sci Rep 2017; 7:11307. [PMID: 28900101 PMCID: PMC5596001 DOI: 10.1038/s41598-017-10402-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/07/2017] [Indexed: 01/17/2023] Open
Abstract
To date, 1841 cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported worldwide, with 652 deaths. We used a publically available case line list to explore the effect of relevant factors, notably underlying comorbidities, on fatal outcome of Middle East respiratory syndrome (MERS) cases up to the end of October 2016. A Bayesian Weibull proportional hazards regression model was used to assess the effect of comorbidity, age, epidemic period and sex on the fatality rate of MERS cases and its variation across countries. The crude fatality rate of MERS cases was 32.1% (95% credibility interval (CI): 29.9%, 34.3%). Notably, the incremental change of daily death rate was most prominent during the first week since disease onset with an average increase of 13%, but then stabilized in the remaining two weeks when it only increased 3% on average. Neither sex, nor country of infection were found to have a significant impact on fatality rates after taking into account the age and comorbidity status of patients. After adjusting for age, epidemic period, MERS patients with comorbidity had around 4 times the risk for fatal infection than those without (adjusted hazard ratio of 3.74 (95% CI: 2.57, 5.67)).
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17
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Prem K, Cook AR, Jit M. Projecting social contact matrices in 152 countries using contact surveys and demographic data. PLoS Comput Biol 2017; 13:e1005697. [PMID: 28898249 PMCID: PMC5609774 DOI: 10.1371/journal.pcbi.1005697] [Citation(s) in RCA: 436] [Impact Index Per Article: 62.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 09/22/2017] [Accepted: 07/25/2017] [Indexed: 11/19/2022] Open
Abstract
Heterogeneities in contact networks have a major effect in determining whether a pathogen can become epidemic or persist at endemic levels. Epidemic models that determine which interventions can successfully prevent an outbreak need to account for social structure and mixing patterns. Contact patterns vary across age and locations (e.g. home, work, and school), and including them as predictors in transmission dynamic models of pathogens that spread socially will improve the models' realism. Data from population-based contact diaries in eight European countries from the POLYMOD study were projected to 144 other countries using a Bayesian hierarchical model that estimated the proclivity of age-and-location-specific contact patterns for the countries, using Markov chain Monte Carlo simulation. Household level data from the Demographic and Health Surveys for nine lower-income countries and socio-demographic factors from several on-line databases for 152 countries were used to quantify similarity of countries to estimate contact patterns in the home, work, school and other locations for countries for which no contact data are available, accounting for demographic structure, household structure where known, and a variety of metrics including workforce participation and school enrolment. Contacts are highly assortative with age across all countries considered, but pronounced regional differences in the age-specific contacts at home were noticeable, with more inter-generational contacts in Asian countries than in other settings. Moreover, there were variations in contact patterns by location, with work-place contacts being least assortative. These variations led to differences in the effect of social distancing measures in an age structured epidemic model. Contacts have an important role in transmission dynamic models that use contact rates to characterize the spread of contact-transmissible diseases. This study provides estimates of mixing patterns for societies for which contact data such as POLYMOD are not yet available.
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Affiliation(s)
- Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Alex R. Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Statistics and Applied Probability, National University of Singapore, Singapore, Singapore
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Modelling and Economics Unit, Health Protection Agency Centre for Infections, London, United Kingdom
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18
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Yang S, Cho SI. Middle East respiratory syndrome risk perception among students at a university in South Korea, 2015. Am J Infect Control 2017; 45:e53-e60. [PMID: 28385465 PMCID: PMC7115287 DOI: 10.1016/j.ajic.2017.02.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/12/2017] [Accepted: 02/12/2017] [Indexed: 11/30/2022]
Abstract
Background The 2015 Middle East respiratory syndrome (MERS) outbreak in South Korea was a serious threat to public health, and was exacerbated by the inappropriate responses of major institutions and the public. This study examined the sources of confusion during the MERS outbreak and identified the factors that can affect people's behavior. Methods An online survey of the risk perception of university students in South Korea was performed after the epidemic had peaked. The questionnaire addressed the major social determinants in South Korea during the MERS epidemic. The analysis included data from 1,470 subjects who provided complete answers. Results The students had 53.5% of the essential knowledge about MERS. Women showed higher risk perception than men, and trust in the media was positively associated with risk perception (P < .001). Additionally, risk perception was positively associated with overreaction by the public (odds ratio, 2.80; 95% confidence interval, 2.17-3.60; P < .001). These findings suggest that media content affected the public's perception of MERS risk and that perception of a high level of risk led to overreaction. Conclusions Risk perception was associated with most of the social factors examined and overreaction by the public. Therefore, providing accurate information and data to the public, establishing trust, and facilitating the development of an attitude will all be important in future crises.
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Affiliation(s)
- Seongwoo Yang
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Sung-Il Cho
- Department of Public Health Science, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea.
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19
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Mitsuda T. [Progress in Diagnostic Technology and Management of Infectious Diseases. Topics IV. Measures for Infection Control: 3. Prevent Health Care-Associated Infections (HAIs): Up-to-date information]. ACTA ACUST UNITED AC 2016; 103:2748-53. [PMID: 27522816 DOI: 10.2169/naika.103.2748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Malik A, El Masry KM, Ravi M, Sayed F. Middle East Respiratory Syndrome Coronavirus during Pregnancy, Abu Dhabi, United Arab Emirates, 2013. Emerg Infect Dis 2016; 22:515-7. [PMID: 26890613 PMCID: PMC4766880 DOI: 10.3201/eid2203.151049] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
As of June 19, 2015, the World Health Organization had received 1,338 notifications of laboratory-confirmed infection with Middle East respiratory syndrome coronavirus (MERS-CoV). Little is known about the course of or treatment for MERS-CoV in pregnant women. We report a fatal case of MERS-CoV in a pregnant woman administered combination ribavirin-peginterferon-α therapy.
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21
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Lim PL. Middle East respiratory syndrome (MERS) in Asia: lessons gleaned from the South Korean outbreak. Trans R Soc Trop Med Hyg 2016; 109:541-2. [PMID: 26286944 PMCID: PMC7107261 DOI: 10.1093/trstmh/trv064] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Poh Lian Lim
- Department of Infectious Diseases, Institute of Infectious Diseases & Epidemiology, Tan Tock Seng Hospital, Singapore 308433, SingaporeLee Kong Chian School of Medicine, Singapore 308232, Singapore
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22
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Zumla A, Chan JFW, Azhar EI, Hui DSC, Yuen KY. Coronaviruses - drug discovery and therapeutic options. Nat Rev Drug Discov 2016. [PMID: 26868298 DOI: 10.1038/nrd201537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
In humans, infections with the human coronavirus (HCoV) strains HCoV-229E, HCoV-OC43, HCoV-NL63 and HCoV-HKU1 usually result in mild, self-limiting upper respiratory tract infections, such as the common cold. By contrast, the CoVs responsible for severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which were discovered in Hong Kong, China, in 2003, and in Saudi Arabia in 2012, respectively, have received global attention over the past 12 years owing to their ability to cause community and health-care-associated outbreaks of severe infections in human populations. These two viruses pose major challenges to clinical management because there are no specific antiviral drugs available. In this Review, we summarize the epidemiology, virology, clinical features and current treatment strategies of SARS and MERS, and discuss the discovery and development of new virus-based and host-based therapeutic options for CoV infections.
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Affiliation(s)
- Alimuddin Zumla
- Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, 307 Euston Road, London NW1 3AD, UK
| | - Jasper F W Chan
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Research Centre of Infection and Immunology, Department of Microbiology, University Pathology Building, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region of the People's Republic of China
| | - Esam I Azhar
- Special Infectious Agents Unit, King Fahd Medical Research Centre, and Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O. Box 128442, Jeddah - 21362, Kingdom of Saudi Arabia
| | - David S C Hui
- Division of Respiratory Medicine and Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region of the People's Republic of China
| | - Kwok-Yung Yuen
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Research Centre of Infection and Immunology, Department of Microbiology, University Pathology Building, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region of the People's Republic of China
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23
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Zumla A, Chan JFW, Azhar EI, Hui DSC, Yuen KY. Coronaviruses - drug discovery and therapeutic options. Nat Rev Drug Discov 2016; 15:327-47. [PMID: 26868298 PMCID: PMC7097181 DOI: 10.1038/nrd.2015.37] [Citation(s) in RCA: 1125] [Impact Index Per Article: 140.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) are examples of emerging zoonotic coronavirus infections capable of person-to-person transmission that result in large-scale epidemics with substantial effects on patient health and socioeconomic factors. Unlike patients with mild illnesses that are caused by other human-pathogenic coronaviruses, patients with SARS or MERS coronavirus infections may develop severe acute respiratory disease with multi-organ failure. The case–fatality rates of SARS and MERS are approximately 10% and 35%, respectively. Both SARS and MERS pose major clinical management challenges because there is no specific antiviral treatment that has been proven to be effective in randomized clinical trials for either infection. Substantial efforts are underway to discover new therapeutic agents for coronavirus infections. Virus-based therapies include monoclonal antibodies and antiviral peptides that target the viral spike glycoprotein, viral enzyme inhibitors, viral nucleic acid synthesis inhibitors and inhibitors of other viral structural and accessory proteins. Host-based therapies include agents that potentiate the interferon response or affect either host signalling pathways involved in viral replication or host factors utilized by coronaviruses for viral replication. The major challenges in the clinical development of novel anti-coronavirus drugs include the limited number of suitable animal models for the evaluation of potential treatments for SARS and MERS, the current absence of new SARS cases, the limited number of MERS cases — which are also predominantly geographically confined to the Middle East — as well as the lack of industrial incentives to develop antivirals for mild infections caused by other, less pathogenic coronaviruses. The continuing threat of MERS-CoV to global health 3 years after its discovery presents a golden opportunity to tackle current obstacles in the development of new anti-coronavirus drugs. A well-organized, multidisciplinary, international collaborative network consisting of clinicians, virologists and drug developers, coupled to political commitment, should be formed to carry out clinical trials using anti-coronavirus drugs that have already been shown to be safe and effective in vitro and/or in animal models, particularly lopinavir–ritonavir, interferon beta-1b and monoclonal antibodies and antiviral peptides targeting the viral spike glycoprotein.
Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which are caused by coronaviruses, have attracted substantial attention owing to their high mortality rates and potential to cause epidemics. Yuen and colleagues discuss progress with treatment options for these syndromes, including virus- and host-targeted drugs, and the challenges that need to be overcome in their further development. In humans, infections with the human coronavirus (HCoV) strains HCoV-229E, HCoV-OC43, HCoV-NL63 and HCoV-HKU1 usually result in mild, self-limiting upper respiratory tract infections, such as the common cold. By contrast, the CoVs responsible for severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which were discovered in Hong Kong, China, in 2003, and in Saudi Arabia in 2012, respectively, have received global attention over the past 12 years owing to their ability to cause community and health-care-associated outbreaks of severe infections in human populations. These two viruses pose major challenges to clinical management because there are no specific antiviral drugs available. In this Review, we summarize the epidemiology, virology, clinical features and current treatment strategies of SARS and MERS, and discuss the discovery and development of new virus-based and host-based therapeutic options for CoV infections.
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Affiliation(s)
- Alimuddin Zumla
- Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, 307 Euston Road, London NW1 3AD, UK
| | - Jasper F W Chan
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Research Centre of Infection and Immunology, Department of Microbiology, University Pathology Building, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region of the People's Republic of China
| | - Esam I Azhar
- Special Infectious Agents Unit, King Fahd Medical Research Centre, and Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, P.O. Box 128442, Jeddah - 21362, Kingdom of Saudi Arabia
| | - David S C Hui
- Division of Respiratory Medicine and Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region of the People's Republic of China
| | - Kwok-Yung Yuen
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Research Centre of Infection and Immunology, Department of Microbiology, University Pathology Building, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region of the People's Republic of China
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Baseler L, de Wit E, Feldmann H. A Comparative Review of Animal Models of Middle East Respiratory Syndrome Coronavirus Infection. Vet Pathol 2016; 53:521-31. [PMID: 26869154 DOI: 10.1177/0300985815620845] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) was initially isolated from a Saudi Arabian man with fatal pneumonia. Since the original case in 2012, MERS-CoV infections have been reported in >1500 humans, and the case fatality rate is currently 35%. This lineage C betacoronavirus has been reported to cause a wide range of disease severity in humans, ranging from asymptomatic to progressive fatal pneumonia that may be accompanied by renal or multiorgan failure. Although the clinical presentation of human MERS-CoV infection has been documented, many facets of this emerging disease are still unknown and could be studied with animal models. Several animal models of MERS-CoV have been developed, including New Zealand white rabbits, transduced or transgenic mice that express human dipeptidyl peptidase 4, rhesus macaques, and common marmosets. This review provides an overview of the current state of knowledge on human MERS-CoV infections, the probable origin of MERS-CoV, and the available animal models of MERS-CoV infection. Evaluation of the benefits and limitations of these models will aid in appropriate model selection for studying viral pathogenesis and transmission, as well as for testing vaccines and antivirals against MERS-CoV.
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Affiliation(s)
- L Baseler
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, USA Department of Veterinary Medicine and Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - E de Wit
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - H Feldmann
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
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25
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Mackay IM, Arden KE. MERS coronavirus: diagnostics, epidemiology and transmission. Virol J 2015; 12:222. [PMID: 26695637 PMCID: PMC4687373 DOI: 10.1186/s12985-015-0439-5] [Citation(s) in RCA: 228] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/27/2015] [Indexed: 01/04/2023] Open
Abstract
The first known cases of Middle East respiratory syndrome (MERS), associated with infection by a novel coronavirus (CoV), occurred in 2012 in Jordan but were reported retrospectively. The case first to be publicly reported was from Jeddah, in the Kingdom of Saudi Arabia (KSA). Since then, MERS-CoV sequences have been found in a bat and in many dromedary camels (DC). MERS-CoV is enzootic in DC across the Arabian Peninsula and in parts of Africa, causing mild upper respiratory tract illness in its camel reservoir and sporadic, but relatively rare human infections. Precisely how virus transmits to humans remains unknown but close and lengthy exposure appears to be a requirement. The KSA is the focal point of MERS, with the majority of human cases. In humans, MERS is mostly known as a lower respiratory tract (LRT) disease involving fever, cough, breathing difficulties and pneumonia that may progress to acute respiratory distress syndrome, multiorgan failure and death in 20% to 40% of those infected. However, MERS-CoV has also been detected in mild and influenza-like illnesses and in those with no signs or symptoms. Older males most obviously suffer severe disease and MERS patients often have comorbidities. Compared to severe acute respiratory syndrome (SARS), another sometimes- fatal zoonotic coronavirus disease that has since disappeared, MERS progresses more rapidly to respiratory failure and acute kidney injury (it also has an affinity for growth in kidney cells under laboratory conditions), is more frequently reported in patients with underlying disease and is more often fatal. Most human cases of MERS have been linked to lapses in infection prevention and control (IPC) in healthcare settings, with approximately 20% of all virus detections reported among healthcare workers (HCWs) and higher exposures in those with occupations that bring them into close contact with camels. Sero-surveys have found widespread evidence of past infection in adult camels and limited past exposure among humans. Sensitive, validated reverse transcriptase real-time polymerase chain reaction (RT-rtPCR)-based diagnostics have been available almost from the start of the emergence of MERS. While the basic virology of MERS-CoV has advanced over the past three years, understanding of the interplay between camel, environment, and human remains limited.
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Affiliation(s)
- Ian M Mackay
- Department of Health, Public and Environmental Health Virology Laboratory, Forensic and Scientific Services, Archerfield, QLD, Australia.
- The University of Queensland, St Lucia, QLD, Australia.
- Queensland University of Technology, George St, Brisbane, QLD, Australia.
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Bin SY, Heo JY, Song MS, Lee J, Kim EH, Park SJ, Kwon HI, Kim SM, Kim YI, Si YJ, Lee IW, Baek YH, Choi WS, Min J, Jeong HW, Choi YK. Environmental Contamination and Viral Shedding in MERS Patients During MERS-CoV Outbreak in South Korea. Clin Infect Dis 2015; 62:755-60. [PMID: 26679623 PMCID: PMC7108026 DOI: 10.1093/cid/civ1020] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/04/2015] [Indexed: 12/13/2022] Open
Abstract
Background. Although Middle East Respiratory Syndrome coronavirus (MERS-CoV) is characterized by a risk of nosocomial transmission, the detailed mode of transmission and period of virus shedding from infected patients are poorly understood. The aims of this study were to investigate the potential role of environmental contamination by MERS-CoV in healthcare settings and to define the period of viable virus shedding from MERS patients. Methods. We investigated environmental contamination from 4 patients in MERS-CoV units of 2 hospitals. MERS-CoV was detected by reverse transcription polymerase chain reaction (PCR) and viable virus was isolated by cultures. Results. Many environmental surfaces of MERS patient rooms, including points frequently touched by patients or healthcare workers, were contaminated by MERS-CoV. Viral RNA was detected up to five days from environmental surfaces following the last positive PCR from patients’ respiratory specimens. MERS-CoV RNA was detected in samples from anterooms, medical devices, and air-ventilating equipment. In addition, MERS-CoV was isolated from environmental objects such as bed sheets, bedrails, IV fluid hangers, and X-ray devices. During the late clinical phase of MERS, viable virus could be isolated in 3 of the 4 enrolled patients on day 18 to day 25 after symptom onset. Conclusions. Most of touchable surfaces in MERS units were contaminated by patients and health care workers and the viable virus could shed through respiratory secretion from clinically fully recovered patients. These results emphasize the need for strict environmental surface hygiene practices, and sufficient isolation period based on laboratory results rather than solely on clinical symptoms.
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Affiliation(s)
- Seo Yu Bin
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon
| | | | - Min-Suk Song
- Microbiology, College of Medicine and Medical Research Institute, and
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon
| | - Eun-Ha Kim
- Microbiology, College of Medicine and Medical Research Institute, and
| | - Su-Jin Park
- Microbiology, College of Medicine and Medical Research Institute, and Zoonotic Infectious Diseases Research Center, Chungbuk National University, Seowon-Gu, Cheongju, Republic of Korea
| | - Hyeok-Il Kwon
- Microbiology, College of Medicine and Medical Research Institute, and Zoonotic Infectious Diseases Research Center, Chungbuk National University, Seowon-Gu, Cheongju, Republic of Korea
| | - Se Mi Kim
- Microbiology, College of Medicine and Medical Research Institute, and Zoonotic Infectious Diseases Research Center, Chungbuk National University, Seowon-Gu, Cheongju, Republic of Korea
| | - Young-Il Kim
- Microbiology, College of Medicine and Medical Research Institute, and Zoonotic Infectious Diseases Research Center, Chungbuk National University, Seowon-Gu, Cheongju, Republic of Korea
| | - Young-Jae Si
- Microbiology, College of Medicine and Medical Research Institute, and Zoonotic Infectious Diseases Research Center, Chungbuk National University, Seowon-Gu, Cheongju, Republic of Korea
| | - In-Won Lee
- Microbiology, College of Medicine and Medical Research Institute, and Zoonotic Infectious Diseases Research Center, Chungbuk National University, Seowon-Gu, Cheongju, Republic of Korea
| | - Yun Hee Baek
- Microbiology, College of Medicine and Medical Research Institute, and
| | - Won-Suk Choi
- Microbiology, College of Medicine and Medical Research Institute, and
| | | | | | - Young Ki Choi
- Microbiology, College of Medicine and Medical Research Institute, and Zoonotic Infectious Diseases Research Center, Chungbuk National University, Seowon-Gu, Cheongju, Republic of Korea
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Abstract
In response to the severe acute respiratory syndrome (SARS) pandemic of 2003 and the influenza pandemic of 2009, many countries instituted border measures as a means of stopping or slowing the spread of disease. The measures, usually consisting of a combination of border entry/exit screening, quarantine, isolation, and communications, were resource intensive, and modeling and observational studies indicate that border screening is not effective at detecting infectious persons. Moreover, border screening has high opportunity costs, financially and in terms of the use of scarce public health staff resources during a time of high need. We discuss the border-screening experiences with SARS and influenza and propose an approach to decision-making for future pandemics. We conclude that outbreak-associated communications for travelers at border entry points, together with effective communication with clinicians and more effective disease control measures in the community, may be a more effective approach to the international control of communicable diseases.
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Middle East respiratory syndrome coronavirus: another zoonotic betacoronavirus causing SARS-like disease. Clin Microbiol Rev 2015; 28:465-522. [PMID: 25810418 DOI: 10.1128/cmr.00102-14] [Citation(s) in RCA: 599] [Impact Index Per Article: 66.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The source of the severe acute respiratory syndrome (SARS) epidemic was traced to wildlife market civets and ultimately to bats. Subsequent hunting for novel coronaviruses (CoVs) led to the discovery of two additional human and over 40 animal CoVs, including the prototype lineage C betacoronaviruses, Tylonycteris bat CoV HKU4 and Pipistrellus bat CoV HKU5; these are phylogenetically closely related to the Middle East respiratory syndrome (MERS) CoV, which has affected more than 1,000 patients with over 35% fatality since its emergence in 2012. All primary cases of MERS are epidemiologically linked to the Middle East. Some of these patients had contacted camels which shed virus and/or had positive serology. Most secondary cases are related to health care-associated clusters. The disease is especially severe in elderly men with comorbidities. Clinical severity may be related to MERS-CoV's ability to infect a broad range of cells with DPP4 expression, evade the host innate immune response, and induce cytokine dysregulation. Reverse transcription-PCR on respiratory and/or extrapulmonary specimens rapidly establishes diagnosis. Supportive treatment with extracorporeal membrane oxygenation and dialysis is often required in patients with organ failure. Antivirals with potent in vitro activities include neutralizing monoclonal antibodies, antiviral peptides, interferons, mycophenolic acid, and lopinavir. They should be evaluated in suitable animal models before clinical trials. Developing an effective camel MERS-CoV vaccine and implementing appropriate infection control measures may control the continuing epidemic.
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Mackay IM, Arden KE. Middle East respiratory syndrome: An emerging coronavirus infection tracked by the crowd. Virus Res 2015; 202:60-88. [PMID: 25656066 PMCID: PMC7114422 DOI: 10.1016/j.virusres.2015.01.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 01/22/2015] [Accepted: 01/23/2015] [Indexed: 12/20/2022]
Abstract
In 2012 in Jordan, infection by a novel coronavirus (CoV) caused the first known cases of Middle East respiratory syndrome (MERS). MERS-CoV sequences have since been found in a bat and the virus appears to be enzootic among dromedary camels across the Arabian Peninsula and in parts of Africa. The majority of human cases have occurred in the Kingdom of Saudi Arabia (KSA). In humans, the etiologic agent, MERS-CoV, has been detected in severe, mild and influenza-like illness and in those without any obvious signs or symptoms of disease. MERS is often a lower respiratory tract disease associated with fever, cough, breathing difficulties, pneumonia that can progress to acute respiratory distress syndrome, multiorgan failure and death among more than a third of those infected. Severe disease is usually found in older males and comorbidities are frequently present in cases of MERS. Compared to SARS, MERS progresses more rapidly to respiratory failure and acute kidney injury, is more often observed as severe disease in patients with underlying illnesses and is more often fatal. MERS-CoV has a broader tropism than SARS-CoV, rapidly triggers cellular damage, employs a different receptor and induces a delayed proinflammatory response in cells. Most human cases have been linked to lapses in infection prevention and control in healthcare settings, with a fifth of virus detections reported among healthcare workers. This review sets out what is currently known about MERS and the MERS-CoV, summarises the new phenomenon of crowd-sourced epidemiology and lists some of the many questions that remain unanswered, nearly three years after the first reported case.
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Affiliation(s)
- Ian M Mackay
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia.
| | - Katherine E Arden
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia
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Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) was first recognized in 2012 and since then has resulted in cases in 23 countries in four continents. The majority of these cases were reported from the Kingdom of Saudi Arabia. The disease caused a spectrum of illness, from asymptomatic to severe and possibly fatal disease. Recent studies showed that the transmission of MERS-CoV among family contacts remains relatively low. Currently, there are no approved vaccines or therapeutics for MERS-CoV.
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Dabrera G, Said B, Kirkbride H. Evaluation of the surveillance system for undiagnosed serious infectious illness (USII) in intensive care units, England, 2011 to 2013. ACTA ACUST UNITED AC 2014; 19. [PMID: 25425512 DOI: 10.2807/1560-7917.es2014.19.46.20961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Emerging infections are a potential risk during mass gathering events due to the congregation of large numbers of international travellers. To mitigate this risk for the London 2012 Olympic and Paralympic Games, a sentinel surveillance system was developed to identify clusters of emerging infections presenting as undiagnosed serious infectious illness (USII) in intensive care units (ICUs). Following a six month pilot period, which had begun in January 2011, the surveillance was operational for a further 18 months spanning the Games. The surveillance system and reported USII cases were reviewed and evaluated after this 18 month operational period including assessment of positive predictive value (PPV), timeliness, acceptability and sensitivity of the system. Surveillance records were used to review reported cases and calculate the PPV and median reporting times of USII surveillance. Sensitivity was assessed through comparison with the pilot period. Participating clinicians completed a five-point Likert scale questionnaire about the acceptability of surveillance. Between 11 July 2011 and 10 January 2013, 34 cases were reported. Of these, 22 remained classified as USII at the time of the evaluation, none of which were still hospitalised. No clusters were identified. The 22 USII cases had no association with the Games, suggesting that they represented the background level of USII in the area covered by the surveillance. This corresponded to an annualised rate of 0.39 cases/100,000 population and a PPV of 65%. Clinicians involved in the surveillance reported high acceptability levels. The USII surveillance model could be a useful public health tool in other countries and during mass gathering events for identifying potential clusters of emerging infections.
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Affiliation(s)
- G Dabrera
- UK Field Epidemiology Training Programme, Public Health England, London, United Kingdom
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Al-Tawfiq JA, Memish ZA. Middle East respiratory syndrome coronavirus: epidemiology and disease control measures. Infect Drug Resist 2014; 7:281-7. [PMID: 25395865 PMCID: PMC4226520 DOI: 10.2147/idr.s51283] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in
2012 resulted in an increased concern of the spread of the infection globally. MERS-CoV
infection had previously caused multiple health-care-associated outbreaks and resulted in
transmission of the virus within families. Community onset MERS-CoV cases continue to
occur. Dromedary camels are currently the most likely animal to be linked to human
MERS-CoV cases. Serologic tests showed significant infection in adult camels compared to
juvenile camels. The control of MERS-CoV infection relies on prompt identification of
cases within health care facilities, with institutions applying appropriate infection
control measures. In addition, determining the exact route of transmission from camels to
humans would further add to the control measures of MERS-CoV infection.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia ; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ziad A Memish
- Ministry of Health, Riyadh, Saudi Arabia ; Alfaisal University, Riyadh, Saudi Arabia
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Chowell G, Blumberg S, Simonsen L, Miller MA, Viboud C. Synthesizing data and models for the spread of MERS-CoV, 2013: key role of index cases and hospital transmission. Epidemics 2014; 9:40-51. [PMID: 25480133 PMCID: PMC4258236 DOI: 10.1016/j.epidem.2014.09.011] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 08/29/2014] [Accepted: 09/29/2014] [Indexed: 01/18/2023] Open
Abstract
Transmission models for the MERS-CoV outbreak during April–October 2013. MERS-CoV transmission models with index and secondary cases. MERS-CoV transmission models with community and hospital compartments. Calibration of MERS-CoV transmission models using MCMC methods. Data indicate a strong support for R
< 1 in the first stage of the outbreak in 2013.
The outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) has caused 209 deaths and 699 laboratory-confirmed cases in the Arabian Peninsula as of June 11, 2014. Preparedness efforts are hampered by considerable uncertainty about the nature and intensity of human-to-human transmission, with previous reproduction number estimates ranging from 0.4 to 1.5. Here we synthesize epidemiological data and transmission models for the MERS-CoV outbreak during April–October 2013 to resolve uncertainties in epidemic risk, while considering the impact of observation bias. We match the progression of MERS-CoV cases in 2013 to a dynamic transmission model that incorporates community and hospital compartments, and distinguishes transmission by zoonotic (index) cases and secondary cases. When observation bias is assumed to account for the fact that all reported zoonotic cases are severe, but only ∼57% of secondary cases are symptomatic, the average reproduction number of MERS-CoV is estimated to be 0.45 (95% CI:0.29–0.61). Alternatively, if these epidemiological observations are taken at face value, index cases are estimated to transmit substantially more effectively than secondary cases, (Ri = 0.84 (0.58-1.20) vs Rs = 0.36 (0.24–0.51)). In both scenarios the relative contribution of hospital-based transmission is over four times higher than that of community transmission, indicating that disease control should be focused on hospitalized patients. Adjusting previously published estimates for observation bias confirms a strong support for the average R < 1 in the first stage of the outbreak in 2013 and thus, transmissibility of secondary cases of MERS-CoV remained well below the epidemic threshold. More information on the observation process is needed to clarify whether MERS-CoV is intrinsically weakly transmissible between people or whether existing control measures have contributed meaningfully to reducing the transmissibility of secondary cases. Our results could help evaluate the progression of MERS-CoV in recent months in response to changes in disease surveillance, control interventions, or viral adaptation.
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Affiliation(s)
- Gerardo Chowell
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA; Center for Global Health & Mathematical, Computational, and Modeling Sciences Center, School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA.
| | - Seth Blumberg
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA; Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Lone Simonsen
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA; Department of Global Health, School of Public Health and Health Services, George Washington University, Washington, DC, USA
| | - Mark A Miller
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Cécile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
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McCloskey B, Dar O, Zumla A, Heymann DL. Emerging infectious diseases and pandemic potential: status quo and reducing risk of global spread. THE LANCET. INFECTIOUS DISEASES 2014; 14:1001-10. [PMID: 25189351 PMCID: PMC7106439 DOI: 10.1016/s1473-3099(14)70846-1] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Emerging infectious diseases are an important public health threat and infections with pandemic potential are a major global risk. Although much has been learned from previous events the evidence for mitigating actions is not definitive and pandemic preparedness remains a political and scientific challenge. A need exists to develop trust and effective meaningful collaboration between countries to help with rapid detection of potential pandemic infections and initiate public health actions. This collaboration should be within the framework of the International Health Regulations. Collaboration between countries should be encouraged in a way that acknowledges the benefits that derive from sharing biological material and establishing equitable collaborative research partnerships. The focus of pandemic preparedness should include upstream prevention through better collaboration between human and animal health sciences to enhance capacity to identify potential pathogens before they become serious human threats, and to prevent their emergence where possible. The one-health approach provides a means to develop this and could potentially enhance alignment of global health and trade priorities.
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Affiliation(s)
- Brian McCloskey
- Global Health and WHO Collaborating Centre on Mass Gatherings, and Public Health England, London, UK.
| | - Osman Dar
- Chatham House and London School of Hygiene & Tropical Medicine, London, UK
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London, London, UK; NIHR Biomedical Research Center, University College London Hospitals, London, UK
| | - David L Heymann
- Chatham House and London School of Hygiene & Tropical Medicine, London, UK
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Lloyd-Smith JO, Funk S, McLean AR, Riley S, Wood JLN. Nine challenges in modelling the emergence of novel pathogens. Epidemics 2014; 10:35-9. [PMID: 25843380 PMCID: PMC4715032 DOI: 10.1016/j.epidem.2014.09.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 08/19/2014] [Accepted: 09/08/2014] [Indexed: 12/28/2022] Open
Abstract
We summarize key challenges in modeling the emergence of novel infectious agents. We focus on connections to data, including epidemiologic and genetic data. Zoonoses are emphasized, because they are the source of most new human pathogens. Challenges span reservoir dynamics, cross-species spillover, and outbreak dynamics. Estimation of fatality rates and overall risk assessment are also addressed.
Studying the emergence of novel infectious agents involves many processes spanning host species, spatial scales, and scientific disciplines. Mathematical models play an essential role in combining insights from these investigations and drawing robust inferences from field and experimental data. We describe nine challenges in modelling the emergence of novel pathogens, emphasizing the interface between models and data.
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Affiliation(s)
- James O Lloyd-Smith
- Department of Ecology and Evolutionary Biology, University of California, Los Angeles, Los Angeles, CA, USA; Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
| | - Sebastian Funk
- Center for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Angela R McLean
- Department of Zoology, Oxford Martin School, University of Oxford, Oxford, United Kingdom
| | - Steven Riley
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA; MRC Centre for Outbreak Analysis and Disease Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, United Kingdom
| | - James L N Wood
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA; Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
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Human coronaviruses associated with upper respiratory tract infections in three rural areas of Ghana. PLoS One 2014; 9:e99782. [PMID: 25080241 PMCID: PMC4117488 DOI: 10.1371/journal.pone.0099782] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/19/2014] [Indexed: 01/07/2023] Open
Abstract
Background Acute respiratory tract infections (ARI) are the leading cause of morbidity and mortality in developing countries, especially in Africa. This study sought to determine whether human coronaviruses (HCoVs) are associated with upper respiratory tract infections among older children and adults in Ghana. Methods We conducted a case control study among older children and adults in three rural areas of Ghana using asymptomatic subjects as controls. Nasal/Nasopharyngeal swabs were tested for Middle East respiratory syndrome coronavirus (MERS-CoV), HCoV-22E, HCoV-OC43, HCoV-NL63 and HCoV-HKU1 using Reverse Transcriptase Real-Time Polymerase Chain Reaction. Results Out of 1,213 subjects recruited, 150 (12.4%) were positive for one or more viruses. Of these, single virus detections occurred in 146 subjects (12.0%) and multiple detections occurred in 4 (0.3%). Compared with control subjects, infections with HCoV-229E (OR = 5.15, 95%CI = 2.24–11.78), HCoV-OC43 (OR = 6.16, 95%CI = 1.77–21.65) and combine HCoVs (OR = 2.36, 95%CI = 1.5 = 3.72) were associated with upper respiratory tract infections. HCoVs were found to be seasonally dependent with significant detections in the harmattan season (mainly HCoV-229E) and wet season (mainly HCoV-NL63). A comparison of the obtained sequences resulted in no differences to sequences already published in GenBank. Conclusion HCoVs could play significant role in causing upper respiratory tract infections among adults and older children in rural areas of Ghana.
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Milne‐Price S, Miazgowicz KL, Munster VJ. The emergence of the Middle East respiratory syndrome coronavirus. Pathog Dis 2014; 71:121-36. [PMID: 24585737 PMCID: PMC4106996 DOI: 10.1111/2049-632x.12166] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/08/2014] [Accepted: 02/17/2014] [Indexed: 12/20/2022] Open
Abstract
On September 20, 2012, a Saudi Arabian physician reported the isolation of a novel coronavirus from a patient with pneumonia on ProMED-mail. Within a few days, the same virus was detected in a Qatari patient receiving intensive care in a London hospital, a situation reminiscent of the role air travel played in the spread of severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002. SARS-CoV originated in China's Guangdong Province and affected more than 8000 patients in 26 countries before it was contained 6 months later. Over a year after the emergence of this novel coronavirus--Middle East respiratory syndrome coronavirus (MERS-CoV)--it has caused 178 laboratory-confirmed cases and 76 deaths. The emergence of a second highly pathogenic coronavirus within a decade highlights the importance of a coordinated global response incorporating reservoir surveillance, high-containment capacity with fundamental and applied research programs, and dependable communication pathways to ensure outbreak containment. Here, we review the current state of knowledge on the epidemiology, ecology, molecular biology, clinical features, and intervention strategies of the novel coronavirus, MERS-CoV.
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Affiliation(s)
- Shauna Milne‐Price
- Division of Intramural ResearchLaboratory of VirologyNational Institute of Allergy and Infectious DiseasesNational Institutes of HealthHamiltonMTUSA
| | - Kerri L. Miazgowicz
- Division of Intramural ResearchLaboratory of VirologyNational Institute of Allergy and Infectious DiseasesNational Institutes of HealthHamiltonMTUSA
| | - Vincent J. Munster
- Division of Intramural ResearchLaboratory of VirologyNational Institute of Allergy and Infectious DiseasesNational Institutes of HealthHamiltonMTUSA
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Memish ZA, Assiri A, Alhakeem R, Yezli S, Almasri M, Zumla A, Al-Tawfiq JA, Drosten C, Albarrak A, Petersen E. Middle East respiratory syndrome corona virus, MERS-CoV. Conclusions from the 2nd Scientific Advisory Board Meeting of the WHO Collaborating Center for Mass Gathering Medicine, Riyadh. Int J Infect Dis 2014; 24:51-3. [PMID: 24818990 PMCID: PMC7128856 DOI: 10.1016/j.ijid.2014.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ziad A Memish
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
| | - Abdullah Assiri
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Rafaat Alhakeem
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Saber Yezli
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Malak Almasri
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Alimuddin Zumla
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia; Division of Infection and Immunity, University College London, and UCL Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jaffar A Al-Tawfiq
- Saudi Aramco Medical Services Organization, Saudi Aramco, Dhahran, Kingdom of Saudi Arabia and Indiana University School of Medicine, Indianapolis, IN (USA)
| | - Christian Drosten
- Institute of Virology, University of Bonn Medical Centre, 53127 Bonn, Germany
| | | | - Eskild Petersen
- Institute of Clinical Medicine, Departments of Infectious Diseases and Clinical Microbiology, Aarhus University Hospital, Denmark
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Memish ZA, Cotten M, Watson SJ, Kellam P, Zumla A, Alhakeem RF, Assiri A, Rabeeah AAA, Al-Tawfiq JA. Community case clusters of Middle East respiratory syndrome coronavirus in Hafr Al-Batin, Kingdom of Saudi Arabia: a descriptive genomic study. Int J Infect Dis 2014; 23:63-8. [PMID: 24699184 PMCID: PMC4441753 DOI: 10.1016/j.ijid.2014.03.1372] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The Middle East respiratory syndrome coronavirus (MERS-CoV) was first described in September 2012 and to date 86 deaths from a total of 206 cases of MERS-CoV infection have been reported to the WHO. Camels have been implicated as the reservoir of MERS-CoV, but the exact source and mode of transmission for most patients remain unknown. During a 3 month period, June to August 2013, there were 12 positive MERS-CoV cases reported from the Hafr Al-Batin region district in the north east region of the Kingdom of Saudi Arabia. In addition to the different regional camel festivals in neighboring countries, Hafr Al-Batin has the biggest camel market in the entire Kingdom and hosts an annual camel festival. Thus, we conducted a detailed epidemiological, clinical and genomic study to ascertain common exposure and transmission patterns of all cases of MERS-CoV reported from Hafr Al-Batin. Analysis of previously reported genetic data indicated that at least two of the infected contacts could not have been directly infected from the index patient and alternate source should be considered. While camels appear as the likely source, other sources have not been ruled out. More detailed case control studies with detailed case histories, epidemiological information and genomic analysis are being conducted to delineate the missing pieces in the transmission dynamics of MERS-CoV outbreak.
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Affiliation(s)
- Ziad A Memish
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia (KSA); College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
| | - Matthew Cotten
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Simon J Watson
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Paul Kellam
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom; Division of Infection and Immunity, University College London, and UCL Hospitals NHS Foundation Trust, London, United Kingdom
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London, and UCL Hospitals NHS Foundation Trust, London, United Kingdom
| | - Rafat F Alhakeem
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia (KSA)
| | - Abdullah Assiri
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia (KSA)
| | - Abdullah A Al Rabeeah
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia (KSA)
| | - Jaffar A Al-Tawfiq
- Saudi Aramco Medical Services Organization, Saudi Aramco, Dhahran, Kingdom of Saudi Arabia and Indiana University School of Medicine, Indianapolis, IN (USA)
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Sprenger M, Coulombier D. Middle East Respiratory Syndrome coronavirus - two years into the epidemic. ACTA ACUST UNITED AC 2014; 19:20783. [PMID: 24786257 DOI: 10.2807/1560-7917.es2014.19.16.20783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- M Sprenger
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Al-Tawfiq JA, Hinedi K, Ghandour J, Khairalla H, Musleh S, Ujayli A, Memish ZA. Middle East respiratory syndrome coronavirus: a case-control study of hospitalized patients. Clin Infect Dis 2014; 59:160-5. [PMID: 24723278 PMCID: PMC7108071 DOI: 10.1093/cid/ciu226] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
This case-control study of hospitalized patients compared underlying conditions, symptoms, signs, laboratory data, and radiographic presentations between Middle East respiratory syndrome coronavirus (MERS-CoV)–positive and –negative patients. Those with MERS-CoV were more likely to be overweight and to have diabetes mellitus, end-stage renal disease, tachypnea, and a normal white blood cell count on bivariate analysis. Background. There is a paucity of data regarding the differentiating characteristics of patients with laboratory-confirmed and those negative for Middle East respiratory syndrome coronavirus (MERS-CoV). Methods. This is a hospital-based case-control study comparing MERS-CoV–positive patients (cases) with MERS-CoV–negative controls. Results. A total of 17 case patients and 82 controls with a mean age of 60.7 years and 57 years, respectively (P = .553), were included. No statistical differences were observed in relation to sex, the presence of a fever or cough, and the presence of a single or multilobar infiltrate on chest radiography. The case patients were more likely to be overweight than the control group (mean body mass index, 32 vs 27.8; P = .035), to have diabetes mellitus (87% vs 47%; odds ratio [OR], 7.24; P = .015), and to have end-stage renal disease (33% vs 7%; OR, 7; P = .012). At the time of admission, tachypnea (27% vs 60%; OR, 0.24; P = .031) and respiratory distress (15% vs 51%; OR, 0.15; P = .012) were less frequent among case patients. MERS-CoV patients were more likely to have a normal white blood cell count than the control group (82% vs 52%; OR, 4.33; P = .029). Admission chest radiography with interstitial infiltrates was more frequent in case patients than in controls (67% vs 20%; OR, 8.13; P = .001). Case patients were more likely to be admitted to the intensive care unit (53% vs 20%; OR, 4.65; P = .025) and to have a high mortality rate (76% vs 15%; OR, 18.96; P < .001). Conclusions. Few clinical predictors could enhance the ability to predict which patients with pneumonia would have MERS-CoV. However, further prospective analysis and matched case-control studies may shed light on other predictors of infection.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Medical Department, Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia Indiana University School of Medicine, Indianapolis
| | - Kareem Hinedi
- Medical Department, Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia
| | - Jihad Ghandour
- Medical Department, Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia
| | - Hanan Khairalla
- Medical Department, Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia
| | - Samir Musleh
- Medical Department, Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia
| | - Alaa Ujayli
- Medical Department, Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia
| | - Ziad A Memish
- World Health Organization Collaborating Center for Mass Gathering Medicine, Saudi Arabian Ministry of Health Al-Faisal University, Riyadh, Saudi Arabia
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Corman VM, Ölschläger S, Wendtner CM, Drexler JF, Hess M, Drosten C. Performance and clinical validation of the RealStar MERS-CoV Kit for detection of Middle East respiratory syndrome coronavirus RNA. J Clin Virol 2014; 60:168-71. [PMID: 24726679 PMCID: PMC7106532 DOI: 10.1016/j.jcv.2014.03.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/17/2014] [Accepted: 03/19/2014] [Indexed: 11/25/2022]
Abstract
Background A highly pathogenic human coronavirus causing respiratory disease emerged in the Middle East region in 2012. In-house molecular diagnostic methods for this virus termed Middle East respiratory syndrome coronavirus (MERS-CoV) allowed sensitive MERS-CoV RNA detection in patient samples. Fast diagnosis is important to manage human cases and trace possible contacts. Objectives The aim of this study was to improve the availability of existing nucleic acid amplification-based diagnostic methods for MERS-CoV infections by providing a real-time RT-PCR kit, including an internal control and two target regions recommended by the World Health Organization (WHO). And to validate this kit (RealStar® MERS-CoV RT-PCR kit 1.0, Altona Diagnostics GmbH, Hamburg, Germany) using clinical samples of one MERS-CoV case from Munich and respiratory samples of patients with other respiratory diseases. Study design An internal amplification control was included into the RT-PCR assays targeting the genomic region upstream of the Envelope gene (upE) and within open reading frame (ORF) 1A. Based on these assays, a ready-to-use real-time RT-PCR kit featuring both the upE and ORF1A assays was developed, validated and compared to the established in-house versions. Results The performance of both RT-PCR assays included in the kit is comparable to the in-house assays. They show high analytical sensitivity (upE: 5.3 copies/reaction; ORF1A: 9.3 copies/reaction), no cross-reactivity with other respiratory pathogens and detected MERS-CoV RNA in patient samples in almost the same manner as the in-house versions. Conclusion The kit is a valuable tool for assisting in the rapid diagnosis, patient management and epidemiology of suspected MERS-CoV cases.
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Affiliation(s)
- Victor Max Corman
- Institute of Virology, University of Bonn Medical Centre, 53127 Bonn, Germany.
| | | | | | - Jan Felix Drexler
- Institute of Virology, University of Bonn Medical Centre, 53127 Bonn, Germany
| | - Markus Hess
- Altona Diagnostics GmbH, Mörkenstrasse 12, 22767 Hamburg, Germany
| | - Christian Drosten
- Institute of Virology, University of Bonn Medical Centre, 53127 Bonn, Germany
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Abstract
Since the initial description of Middle East Respiratory Syndrome-coronavirus (MERS-CoV), the disease has been associated with a high case-fatality rate. There is a lack of proven effective medications for therapy of MERS-CoV. The current knowledge of therapeutic options for MERS-CoV is based on the experience from SARS-CoV and from in vitro studies. In this article we review the different therapeutics available for MERS-CoV from SARS experience, in vitro and animal studies of this emerging disease.
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Al-Tawfiq JA, Momattin H, Dib J, Memish ZA. Ribavirin and interferon therapy in patients infected with the Middle East respiratory syndrome coronavirus: an observational study. Int J Infect Dis 2014; 20:42-6. [PMID: 24406736 PMCID: PMC7110882 DOI: 10.1016/j.ijid.2013.12.003] [Citation(s) in RCA: 235] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 12/09/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Middle East respiratory syndrome coronavirus (MERS-CoV) has been reported to have a high case-fatality rate. Currently, there is no specific therapy or vaccine with proven effectiveness for MERS-CoV infections. METHODS A combination of ribavirin and interferon therapy was used for the treatment of five MERS-CoV-positive patients. We reviewed the therapeutic schedule and the outcome of these patients. RESULTS All patients were critically ill with acute respiratory distress syndrome treated with adjunctive corticosteroids and were on mechanical ventilation at the time of initiation of therapy. The median time from admission to therapy with ribavirin and interferon was 19 (range 10-22) days. None of the patients responded to the supportive or therapeutic interventions and all died of their illness. CONCLUSIONS While ribavirin and interferon may be effective in some patients, our practical experience suggests that critically ill patients with multiple comorbidities who are diagnosed late in the course of their illness may not benefit from combination antiviral therapy as preclinical data suggest. There is clearly an urgent need for a novel effective antiviral therapy for this emerging global threat.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Internal Medicine, Saudi Aramco Medical Services Organization, PO Box 76, Room A-428-2, Building 61, Dhahran Health Center, Dhahran 31311, Saudi Arabia; Indiana University School of Medicine, Indiana, USA.
| | - Hisham Momattin
- Pharmacy Services Division, Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia
| | - Jean Dib
- Pharmacy Services Division, Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia
| | - Ziad A Memish
- WHO Collaborating Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Al-Faisal University, Riyadh, Saudi Arabia
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Memish ZA, Al-Tawfiq JA, Makhdoom HQ, Al-Rabeeah AA, Assiri A, Alhakeem RF, AlRabiah FA, Al Hajjar S, Albarrak A, Flemban H, Balkhy H, Barry M, Alhassan S, Alsubaie S, Zumla A. Screening for Middle East respiratory syndrome coronavirus infection in hospital patients and their healthcare worker and family contacts: a prospective descriptive study. Clin Microbiol Infect 2014; 20:469-74. [PMID: 24460984 PMCID: PMC7128421 DOI: 10.1111/1469-0691.12562] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 01/17/2014] [Indexed: 12/20/2022]
Abstract
The Saudi Arabian Ministry of Health implemented a pro-active surveillance programme for Middle East respiratory syndrome (MERS) coronavirus (MERS-CoV). We report MERS-CoV data from 5065 Kingdom of Saudi Arabia individuals who were screened for MERS-CoV over a 12-month period. From 1 October 2012 to 30 September 2013, demographic and clinical data were prospectively collected from all laboratory forms received at the Saudi Arabian Virology reference laboratory. Data were analysed by referral type, age, gender, and MERS-CoV real-time PCR test results. Five thousand and 65 individuals were screened for MER-CoV: hospitalized patients with suspected MERS-CoV infection (n = 2908, 57.4%), healthcare worker (HCW) contacts (n = 1695; 33.5%), and family contacts of laboratory-confirmed MERS cases (n = 462; 9.1%). Eleven per cent of persons tested were children (<17 years of age). There were 108 cases (99 adults and nine children) of MERS-CoV infection detected during the 12-month period (108/5065, 2% case detection rate). Of 108 cases, 45 were females (six children and 39 adults) and 63 were males (three children and 60 adults). Of the 99 adults with MERS-CoV infection, 70 were hospitalized patients, 19 were HCW contacts, and ten were family contacts. There were no significant increases in MERS-CoV detection rates over the 12-month period: 2.6% (19/731) in July 2013, 1.7% (19/1100) in August 2013, and 1.69% (21/1238) in September 2013. Male patients had a significantly higher MERS-CoV infection rate (63/2318, 2.7%) than females (45/2747, 1.6%) (p 0.013). MERS-CoV rates remain at low levels, with no significant increase over time. Pro-active surveillance for MERS-CoV in newly diagnosed patients and their contacts will continue.
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Affiliation(s)
- Z A Memish
- Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Saudi Arabia
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Al-Tawfiq JA, Memish ZA. Emerging respiratory viral infections: MERS-CoV and influenza. THE LANCET. RESPIRATORY MEDICINE 2014; 2:23-5. [PMID: 24461892 PMCID: PMC7129131 DOI: 10.1016/s2213-2600(13)70255-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jaffar A Al-Tawfiq
- Saudi Aramco Medical Services Organization, Saudi ARAMCO, Dhahran, Saudi Arabia; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ziad A Memish
- Global Centre for Mass Gathering Medicine, Public Health Directorate, Ministry of Health, Riyadh 11176, Saudi Arabia; Department of Medicine, Al-Faisal University, Riyadh 11176, Saudi Arabia.
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Reusken CB, Ababneh M, Raj VS, Meyer B, Eljarah A, Abutarbush S, Godeke GJ, Bestebroer TM, Zutt I, Muller MA, Bosch BJ, Rottier PJ, Osterhaus AD, Drosten C, Haagmans BL, Koopmans MP. Middle East Respiratory Syndrome coronavirus (MERS-CoV) serology in major livestock species in an affected region in Jordan, June to September 2013. ACTA ACUST UNITED AC 2013; 18:20662. [PMID: 24342516 DOI: 10.2807/1560-7917.es2013.18.50.20662] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Between June and September 2013, sera from 11 dromedary camels, 150 goats, 126 sheep and 91 cows were collected in Jordan, where the first human Middle-East respiratory syndrome (MERS) cluster appeared in 2012. All sera were tested for MERS-coronavirus (MERS-CoV) specific antibodies by protein microarray with confirmation by virus neutralisation. Neutralising antibodies were found in all camel sera while sera from goats and cattle tested negative. Although six sheep sera reacted with MERS-CoV antigen, neutralising antibodies were not detected.
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Affiliation(s)
- C B Reusken
- These authors contributed equally to this work
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Affiliation(s)
- David N Fisman
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 586, Toronto, ON M5T 3M7, Canada.
| | - Ashleigh R Tuite
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 586, Toronto, ON M5T 3M7, Canada
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Gautret P, Benkouiten S, Salaheddine I, Belhouchat K, Drali T, Parola P, Brouqui P. Hajj pilgrims knowledge about Middle East respiratory syndrome coronavirus, August to September 2013. ACTA ACUST UNITED AC 2013; 18:20604. [PMID: 24135123 DOI: 10.2807/1560-7917.es2013.18.41.20604] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In preparation for Hajj 2013, 360 French pilgrims were interviewed regarding their knowledge about Middle East respiratory syndrome (MERS). Respondents were aged 20–85 years, male-female ratio was 1.05:1;64.7% were aware of the MERS situation in Saudi Arabia; 35.3% knew about the Saudi Ministry of Health recommendations for at-risk pilgrims to postpone participation in the 2013 Hajj. None of 179 at-risk individuals(49.9%) decided to cancel their Hajj participation even after advice during consultation.
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Affiliation(s)
- P Gautret
- Aix Marseille Universite, Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Marseille, France
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Affiliation(s)
- Sami Al Hajjar
- Prof. Sami Al Hajjar, Head, Pediatric Infectious Diseases,, Department of Pediatrics,, King Faisal Specialist Hospital & Research Centre,, PO Box 3354, Riyadh 11211 Saudi Arabia, T: +966 1 4647271, F: +9661 4427784,
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