title: The pattern of Middle East respiratory syndrome coronavirus in Saudi Arabia: a descriptive epidemiological analysis of data from the Saudi Ministry of Health.
abstract: OBJECTIVE
  This study describes the epidemiology of Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia.
  
  
  METHODS
  Epidemiological analysis was performed on data from all MERS-CoV cases recorded by the Saudi Ministry of Health between June 6, 2013 and May 14, 2014. The frequency of cases and deaths was calculated and adjusted by month, sex, age group, and region. The average monthly temperature and humidity of infected regions throughout the year was also calculated.
  
  
  RESULTS
  A total of 425 cases were recorded over the study period. The highest number of cases and deaths occurred between April and May 2014. Disease occurrence among men (260 cases [62%]) was higher than in women (162 cases [38%]), and the case fatality rate was higher for men (52%) than for women (23%). In addition, those in the 45-59 years and ≥60 years age groups were most likely to be infected, and the case fatality rate for these people was higher than for other groups. The highest number of cases and deaths were reported in Riyadh (169 cases; 43 deaths), followed by Jeddah (156 cases; 36 deaths) and the Eastern Region (24 cases; 22 deaths). The highest case fatality rate was in the Eastern Region (92%), followed by Medinah (36%) and Najran (33%). MERS-CoV infection actively causes disease in environments with low relative humidity (<20%) and high temperature (15°C-35°C).
  
  
  CONCLUSIONS
  MERS-CoV is considered an epidemic in Saudi Arabia. The frequency of cases and deaths is higher among men than women, and those above 45 years of age are most affected. Low relative humidity and high temperature can enhance the spread of this disease in the entire population. Further analytical studies are required to determine the source and mode of infection in Saudi Arabia.
authors.affiliation: University of Lincoln, Brayford Pool, Lincoln, UK ; University of Al-Baha, Al-Baha, Kingdom of Saudi Arabia.
authors.forename: Ibrahim G
authors.initials: IG
authors.lastname: Alghamdi
authors.affiliation: University of Lincoln, Brayford Pool, Lincoln, UK.
authors.forename: Issam I
authors.initials: II
authors.lastname: Hussain
authors.affiliation: University of Al-Baha, Al-Baha, Kingdom of Saudi Arabia.
authors.forename: Shaia S
authors.initials: SS
authors.lastname: Almalki
authors.affiliation: General Directorate of Health Affairs, Ministry of Health, Al-Baha, Kingdom of Saudi Arabia.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Alghamdi
authors.affiliation: King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia.
authors.forename: Mansour M
authors.initials: MM
authors.lastname: Alghamdi
authors.affiliation: Research and Development, Lincoln Hospital, United Lincolnshire Hospitals National Health Service Trust, Lincoln, UK.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: El-Sheemy
keywords: Middle East respiratory syndrome; case fatality rate; descriptive epidemiology; humidity; temperature