title: An assessment of the level of concern among hospital-based health-care workers regarding MERS outbreaks in Saudi Arabia.
abstract: Middle East Respiratory Syndrome (MERS) is caused by MERS coronavirus (MERS-CoV). More than 80% of reported cases have occurred in Saudi Arabia, with a mortality exceeding 50%. Health-care workers (HCWs) are at risk of acquiring and transmitting this virus, so the concerns of HCWs in Saudi Arabia regarding MERS were evaluated.
  
  
  
  An anonymous, self-administered, previously validated questionnaire was given to 1031 HCWs at three tertiary hospitals in Saudi Arabia from October to December, 2014. Concerns regarding the disease, its severity and governmental efforts to contain it, as well as disease outcomes were assessed using 31 concern statements in five distinct domains. A total concern score was calculated for each HCW. Multiple regression analyses were used to identify predictors of high concern scores.
  
  
  
  The average age of participants was 37.1 ± 9.0 years, 65.8% were married and 59.1% were nurses. The majority of respondents (70.4%) felt at risk of contracting a MERS-CoV infection at work, 69.1% felt threatened if a colleague contracted MERS-CoV, 60.9% felt obliged to care for patients infected with MERS-CoV and 87.8% did not feel safe at work using standard precautions. In addition, 87.7% believed that the government should isolate patients with MERS in specialized hospitals, 73.7% agreed with travel restriction to and from areas affected by MERS and 65.3% agreed with avoiding inviting expatriates from such areas. After adjustment for covariates, high concern scores were significantly associated with being a Saudi national (p < 0.001), a non-physician (p < 0.001) and working in the central region (p < 0.001).
  
  
  
  The majority of respondents reported concern regarding MERS-CoV infection from exposure at work. The overall level of concern may be influenced by previous experience of MERS outbreaks and related cultural issues. The concerns of HCWs may affect their overall effectiveness in an outbreak and should be addressed by incorporating management strategies in outbreak planning.
authors.affiliation: King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), PO 22490, Riyadh, 11426, Kingdom of Saudi Arabia. mabolfotouh@gmail.com.|King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. mabolfotouh@gmail.com.|King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia. mabolfotouh@gmail.com.
authors.forename: Mostafa A
authors.initials: MA
authors.lastname: Abolfotouh
authors.affiliation: King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), PO 22490, Riyadh, 11426, Kingdom of Saudi Arabia.|King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
authors.forename: Ali A
authors.initials: AA
authors.lastname: AlQarni
authors.affiliation: King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), PO 22490, Riyadh, 11426, Kingdom of Saudi Arabia.|King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
authors.forename: Suliman M
authors.initials: SM
authors.lastname: Al-Ghamdi
authors.affiliation: King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), PO 22490, Riyadh, 11426, Kingdom of Saudi Arabia.|King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Salam
authors.affiliation: King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), PO 22490, Riyadh, 11426, Kingdom of Saudi Arabia.|King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
authors.forename: Mohammed H
authors.initials: MH
authors.lastname: Al-Assiri
authors.affiliation: King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), PO 22490, Riyadh, 11426, Kingdom of Saudi Arabia.|King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.|King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
authors.forename: Hanan H
authors.initials: HH
authors.lastname: Balkhy
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D018352:Coronavirus Infections / Q000453:epidemiology* / Q000523:psychology; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D004644:Emotions; D005260:Female; D006801:Humans; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D065207:Middle East Respiratory Syndrome Coronavirus / Q000302:isolation & purification; D009726:Nurses / Q000523:psychology; D010564:Personnel, Hospital / Q000523:psychology*; D012529:Saudi Arabia / Q000453:epidemiology; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: Attitude; Concern; Health-care worker; MERS-CoV; Saudi Arabia