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Concept: Saudi Arabia

414

Background In September 2012, the World Health Organization reported the first cases of pneumonia caused by the novel Middle East respiratory syndrome coronavirus (MERS-CoV). We describe a cluster of health care-acquired MERS-CoV infections. Methods Medical records were reviewed for clinical and demographic information and determination of potential contacts and exposures. Case patients and contacts were interviewed. The incubation period and serial interval (the time between the successive onset of symptoms in a chain of transmission) were estimated. Viral RNA was sequenced. Results Between April 1 and May 23, 2013, a total of 23 cases of MERS-CoV infection were reported in the eastern province of Saudi Arabia. Symptoms included fever in 20 patients (87%), cough in 20 (87%), shortness of breath in 11 (48%), and gastrointestinal symptoms in 8 (35%); 20 patients (87%) presented with abnormal chest radiographs. As of June 12, a total of 15 patients (65%) had died, 6 (26%) had recovered, and 2 (9%) remained hospitalized. The median incubation period was 5.2 days (95% confidence interval [CI], 1.9 to 14.7), and the serial interval was 7.6 days (95% CI, 2.5 to 23.1). A total of 21 of the 23 cases were acquired by person-to-person transmission in hemodialysis units, intensive care units, or in-patient units in three different health care facilities. Sequencing data from four isolates revealed a single monophyletic clade. Among 217 household contacts and more than 200 health care worker contacts whom we identified, MERS-CoV infection developed in 5 family members (3 with laboratory-confirmed cases) and in 2 health care workers (both with laboratory-confirmed cases). Conclusions Person-to-person transmission of MERS-CoV can occur in health care settings and may be associated with considerable morbidity. Surveillance and infection-control measures are critical to a global public health response.

Concepts: Health care, Health care provider, Public health, Epidemiology, Disease, Patient, Saudi Arabia, World Health Organization

338

The Middle East respiratory syndrome (MERS) coronavirus has caused recurrent outbreaks in the Arabian Peninsula since 2012. Although MERS has low overall human-to-human transmission potential, there is occasional amplification in the healthcare setting, a pattern reminiscent of the dynamics of the severe acute respiratory syndrome (SARS) outbreaks in 2003. Here we provide a head-to-head comparison of exposure patterns and transmission dynamics of large hospital clusters of MERS and SARS, including the most recent South Korean outbreak of MERS in 2015.

Concepts: Severe acute respiratory syndrome, Saudi Arabia, Arabian Peninsula, United Arab Emirates, Middle East, Jordan

200

A novel coronavirus (MERS-CoV) causing severe, life-threatening respiratory disease has emerged in the Middle East at a time when two international mass gatherings in Saudi Arabia are imminent. While MERS-CoV has already spread to and within other countries, these mass gatherings could further amplify and/or accelerate its international dissemination, especially since the origins and geographic source of the virus remain poorly understood.

Concepts: Saudi Arabia, Arabian Peninsula, Riyadh, United Arab Emirates, Middle East, Qatar, Jordan, Arabic language

195

Behaviours such as smoking, poor diet, physical inactivity, and unhealthy alcohol consumption are leading risk factors for death. We assessed the Canadian burden attributable to these behaviours by developing, validating, and applying a multivariable predictive model for risk of all-cause death.

Concepts: Death, Yeast, Saudi Arabia, Life expectancy, Canada, Ontario, Government of Canada

187

We identified the near-full-genome sequence (29,908 nt, >99%) of Middle East respiratory syndrome coronavirus (MERS-CoV) from a nasal swab specimen from a dromedary camel in Egypt. We found that viruses genetically very similar to human MERS-CoV are infecting dromedaries beyond the Arabian Peninsula, where human MERS-CoV infections have not yet been detected.

Concepts: Saudi Arabia, Arabian Peninsula, Middle East, Islam, Livestock, Camel, Dromedary, Camelid

185

A human coronavirus, called the Middle East respiratory syndrome coronavirus (MERS-CoV), was first identified in September 2012 in samples obtained from a Saudi Arabian businessman who died from acute respiratory failure. Since then, 49 cases of infections caused by MERS-CoV (previously called a novel coronavirus) with 26 deaths have been reported to date. In this report, we describe a family case cluster of MERS-CoV infection, including the clinical presentation, treatment outcomes, and household relationships of three young men who became ill with MERS-CoV infection after the hospitalization of an elderly male relative, who died of the disease. Twenty-four other family members living in the same household and 124 attending staff members at the hospitals did not become ill. MERS-CoV infection may cause a spectrum of clinical illness. Although an animal reservoir is suspected, none has been discovered. Meanwhile, global concern rests on the ability of MERS-CoV to cause major illness in close contacts of patients.

Concepts: Disease, Severe acute respiratory syndrome, Saudi Arabia, Arabian Peninsula, Riyadh, United Arab Emirates, Middle East, Arabic language

177

Accurate information about the prevalence and types of tobacco use is essential to deliver effective public health policy. We aimed to study the prevalence and modes of tobacco consumption in the United Arab Emirates (UAE), particularly focusing on the use of Midwakh (Arabic traditional pipe).

Concepts: Tobacco, Saudi Arabia, United Arab Emirates, Middle East, Iran, Arab people

167

This study estimates the potential health gains achievable in the United Arab Emirates (UAE) with improved controls on environmental pollution. The UAE is an emerging economy in which population health risks have shifted rapidly from infectious diseases to chronic conditions observed in developed nations. The UAE government commissioned this work as part of an environmental health strategic planning project intended to address this shift in the nature of the country’s disease burden.

Concepts: Medicine, Saudi Arabia, United Arab Emirates, United Nations, Abu Dhabi, Dubai, Arab people, Ras al-Khaimah

167

PURPOSE: Epilepsy is very common in the Kingdom of Saudi Arabia, with a prevalence of 6.54 per 1000. The present study was conducted to investigate the level of public awareness, and the attitudes and knowledge regarding epilepsy in the Saudi population in Riyadh - capital city of Saudi Arabia. METHODS: A survey consisting of 19 questions pertaining to epilepsy awareness was distributed to Saudi citizens living in Riyadh older than 15 years of age in malls, supermarkets, health clubs, mosques, universities and schools. RESULTS: Of the 7078 respondents who completed the questionnaire, 6756 (95.5%) had heard about epilepsy, 3024 (42.7%) had witnessed what they believed to be a seizure and 5164 (73%) would allow their children to interact with an individual who had epilepsy. However, 5382 (76%) respondents would not want their children to marry an individual with epilepsy, 1004 (14.2%) believed that epilepsy was infectious and 574 (8.1%) believed that epilepsy was a type of mental illness. A total of 1509 (21.3%) respondents were not aware of a single potential cause of epilepsy, 3493 (50.6%) would not seek medical advice if one of their relatives had epilepsy, 2221 (31.4%) did not know how to deal with an individual experiencing an epileptic episode and 6554 (92.6%) did not know that surgery was a treatment option for individuals with epilepsy in Saudi Arabia. Of the 7078 respondents, 3237 (45.7%) would not abide by a physician’s advice not to operate a motor vehicle because of their illness, of whom 1631 (50.4%) cited problems with the public transportation system as a reason for disregarding the doctor’s advice. The effect of age and level of education were statistically significant on most of the study variables. CONCLUSION: The level of epilepsy awareness in the Saudi population needs improvement.

Concepts: Saudi Arabia, Arabian Peninsula, Riyadh, Mecca, Jeddah, Ha'il, Dammam, Medina

154

We studied antibody response in 9 healthcare workers in Jeddah, Saudi Arabia, who survived Middle East respiratory syndrome, by using serial ELISA and indirect immunofluorescence assay testing. Among patients who had experienced severe pneumonia, antibody was detected for >18 months after infection. Antibody longevity was more variable in patients who had experienced milder disease.

Concepts: Antibody, Saudi Arabia, Arabian Peninsula, Riyadh, United Arab Emirates, Middle East, Immunofluorescence, Jordan