title: Outbreak of Middle East respiratory syndrome coronavirus in Saudi Arabia: a retrospective study.
abstract: The Middle East respiratory syndrome (MERS) is proposed to be a zoonotic disease. Dromedary camels have been implicated due to reports that some confirmed cases were exposed to camels. Risk factors for MERS coronavirus (MERS-CoV) infections in humans are incompletely understood. This study aimed to describe the demographic characteristics, mortality rate, clinical manifestations and comorbidities with confirmed cases of MERS-CoV.
  
  
  
  Retrospective chart review were performed to identify all laboratory-confirmed cases of MERS-CoV in Saudi Arabia who reported to the Ministry of Health (MOH) of Saudi Arabia and WHO between April 23, 2014 and August 31, 2015. Patients' charts were also reviewed for demographic information, mortality, comorbidities, clinical presentations, health care facility and presented with descriptive and comparative statistics using non parametric binomial test and Chi-square test.
  
  
  
  Confirmed cases of male patients (61.1%) exceeded those of female patients (38.9%). Infections among Saudi patients (62.6%) exceeded those among non-Saudi patients (37.4%; P = 0.001). The majority of the patients were aged 21-40 years (37.4%) or 41-60 years (35.8%); 43 (22.6%) were aged >61 years, and (8) 4.2% were aged 0-20 years. There was a difference in mortality between confirmed MERS-CoV cases (63.7% alive versus 36.3% dead cases, respectively). Furthermore, fever with cough and shortness of breath (SOB) (n = 39; 20.5%), fever with cough (n = 29; 15.3%), fever (n = 18; 9.5%), and fever with SOB (n = 13; 6.8%), were the most common clinical manifestations associated with confirmed MERS-CoV cases.
  
  
  
  MERS-CoV is considered an epidemic in Saudi Arabia. The results of the present study showed that the frequency of cases is higher among men than women, in Saudi patients than non-Saudi, and those between 21 to 60 years are most affected. Further studies are required to improve the surveillance associated with MERS-CoV to get definite and clear answers and better understanding of the MERS-CoV outbreak as well the source, and route of infection transmission in Saudi Arabia.
authors.affiliation: College of Pharmacy, Department of Pharmaceutics, King Saud University, 22452, Riyadh, 11495, Saudi Arabia. faleanizy@ksu.edu.sa.
authors.forename: Fadilah Sfouq
authors.initials: FS
authors.lastname: Aleanizy
authors.affiliation: College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, 12484, Saudi Arabia.
authors.forename: Nahla
authors.initials: N
authors.lastname: Mohmed
authors.affiliation: College of Pharmacy, Department of Pharmaceutics, King Saud University, 22452, Riyadh, 11495, Saudi Arabia.
authors.forename: Fulwah Y
authors.initials: FY
authors.lastname: Alqahtani
authors.affiliation: College of Science, Princess Nourah Bint Abdulrahman University, Riyadh, 12484, Saudi Arabia.|Scientific research, Federal Ministry of Health, Khartoum, 303, Sudan.
authors.forename: Rania Ali
authors.initials: RA
authors.lastname: El Hadi Mohamed
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002162:Camelus; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D018352:Coronavirus Infections / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D004196:Disease Outbreaks; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D065207:Middle East Respiratory Syndrome Coronavirus / Q000472:pathogenicity; D012189:Retrospective Studies; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D055815:Young Adult
keywords: Epidemiology; Middle East respiratory syndrome; Saudi Arabia