title: Case characteristics among Middle East respiratory syndrome coronavirus outbreak and non-outbreak cases in Saudi Arabia from 2012 to 2015.
abstract: As of 1 November 2015, the Saudi Ministry of Health had reported 1273 cases of Middle East respiratory syndrome (MERS); among these cases, which included 9 outbreaks at several hospitals, 717 (56%) patients recovered, 14 (1%) remain hospitalised and 543 (43%) died. This study aimed to determine the epidemiological, demographic and clinical characteristics that distinguished cases of MERS contracted during outbreaks from those contracted sporadically (ie, non-outbreak) between 2012 and 2015 in Saudi Arabia.
  
  
  
  Data from the Saudi Ministry of Health of confirmed outbreak and non-outbreak cases of MERS coronavirus (CoV) infections from September 2012 through October 2015 were abstracted and analysed. Univariate and descriptive statistical analyses were conducted, and the time between disease onset and confirmation, onset and notification and onset and death were examined.
  
  
  
  A total of 1250 patients (aged 0-109 years; mean, 50.825 years) were reported infected with MERS-CoV. Approximately two-thirds of all MERS cases were diagnosed in men for outbreak and non-outbreak cases. Healthcare workers comprised 22% of all MERS cases for outbreak and non-outbreak cases. Nosocomial infections comprised one-third of all Saudi MERS cases; however, nosocomial infections occurred more frequently in outbreak than non-outbreak cases (p<0.001). Patients contracting MERS during an outbreak were significantly more likely to die of MERS (p<0.001).
  
  
  
  To date, nosocomial infections have fuelled MERS outbreaks. Given that the Kingdom of Saudi Arabia is a worldwide religious travel destination, localised outbreaks may have massive global implications and effective outbreak preventive measures are needed.
authors.affiliation: Department of Infection and Immunity, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.|College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
authors.forename: F S
authors.initials: FS
authors.lastname: Alhamlan
authors.affiliation: Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.|Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Majumder
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Brownstein
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: J
authors.initials: J
authors.lastname: Hawkins
authors.affiliation: Public Health Deputy, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: H M
authors.initials: HM
authors.lastname: Al-Abdely
authors.affiliation: Public Health Deputy, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: A
authors.initials: A
authors.lastname: Alzahrani
authors.affiliation: Department of Infection and Immunity, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: D A
authors.initials: DA
authors.lastname: Obaid
authors.affiliation: Department of Infection and Immunity, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.|College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.|Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: M N
authors.initials: MN
authors.lastname: Al-Ahdal
authors.affiliation: Public Health Deputy, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: A
authors.initials: A
authors.lastname: BinSaeed
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D018352:Coronavirus Infections / Q000453:epidemiology* / Q000517:prevention & control; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D003625:Data Collection; D003627:Data Interpretation, Statistical; D004196:Disease Outbreaks / Q000517:prevention & control* / Q000706:statistics & numerical data; D005260:Female; D005334:Fever; D006282:Health Personnel; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D065207:Middle East Respiratory Syndrome Coronavirus / Q000472:pathogenicity*; D011159:Population Surveillance; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D014195:Travel
keywords: INFECTIOUS DISEASES