The Lancet Infect Dis. Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study

[Giuseppe]

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]


The Lancet Infectious Diseases, Early Online Publication, 26 July 2013
doi:10.1016/S1473-3099(13)70204-4

Copyright ? 2013 Elsevier Ltd All rights reserved.

Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study

Original Text


Abdullah Assiri MD a b ?, Jaffar A Al-Tawfiq FACP c?, Abdullah A Al-Rabeeah FRCS a, Fahad A Al-Rabiah MD d, Sami Al-Hajjar MD d, Ali Al-Barrak MD e, Hesham Flemban MD f, Wafa N Al-Nassir MD g, Hanan H Balkhy MD h, Rafat F Al-Hakeem MD a i, Hatem Q Makhdoom PhD j, Prof Alimuddin I Zumla FRCP a k l ?, Prof Ziad A Memish FRCP a m n ?


Summary

Background

Middle East respiratory syndrome (MERS) is a new human disease caused by a novel coronavirus (CoV). Clinical data on MERS-CoV infections are scarce. We report epidemiological, demographic, clinical, and laboratory characteristics of 47 cases of MERS-CoV infections, identify knowledge gaps, and define research priorities.


Methods

We abstracted and analysed epidemiological, demographic, clinical, and laboratory data from confirmed cases of sporadic, household, community, and health-care-associated MERS-CoV infections reported from Saudi Arabia between Sept 1, 2012, and June 15, 2013. Cases were confirmed as having MERS-CoV by real-time RT-PCR.


Findings

47 individuals (46 adults, one child) with laboratory-confirmed MERS-CoV disease were identified; 36 (77%) were male (male:female ratio 3?3:1). 28 patients died, a 60% case-fatality rate. The case-fatality rate rose with increasing age. Only two of the 47 cases were previously healthy; most patients (45 [96%]) had underlying comorbid medical disorders, including diabetes (32 [68%]), hypertension (16 [34%]), chronic cardiac disease (13 [28%]), and chronic renal disease (23 [49%]). Common symptoms at presentation were fever (46 [98%]), fever with chills or rigors (41 [87%]), cough (39 [83%]), shortness of breath (34 [72%]), and myalgia (15 [32%]). Gastrointestinal symptoms were also frequent, including diarrhoea (12 [26%]), vomiting (ten [21%]), and abdominal pain (eight [17%]). All patients had abnormal findings on chest radiography, ranging from subtle to extensive unilateral and bilateral abnormalities. Laboratory analyses showed raised concentrations of lactate dehydrogenase (23 [49%]) and aspartate aminotransferase (seven [15%]) and thrombocytopenia (17 [36%]) and lymphopenia (16 [34%]).


Interpretation

Disease caused by MERS-CoV presents with a wide range of clinical manifestations and is associated with substantial mortality in admitted patients who have medical comorbidities. Major gaps in our knowledge of the epidemiology, community prevalence, and clinical spectrum of infection and disease need urgent definition.


Funding

None.
_________

a Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia; b Infection Prevention and Control Program, Public Health Directorate, Ministry of Health, Riyadh, Saudi Arabia; c Saudi ARAMCO Medical Services Organisation, Dhahran, Saudi Arabia; d King Faisal Specialist Hospital, Riyadh, Saudi Arabia; e Prince Sultan Military Medical City, Riyadh, Saudi Arabia; f Alhada Military Hospital, Riyadh, Saudi Arabia; g Imam Abdulrahman Bin Mohamed Hospital, National Guard Health Affairs, Dammam, Saudi Arabia; h King Abdulaziz Medical City, Riyadh, Saudi Arabia; i Communicable Disease Program, Ministry of Health, Riyadh, Saudi Arabia; j Jeddah Regional Laboratory, Ministry of Health, Jeddah, Saudi Arabia; k Division of Infection and Immunity, University College London, London, UK; l University College London Hospitals NHS Foundation Trust, London, UK; m Public Health Directorate, Ministry of Health, Riyadh, Saudi Arabia; n Al-Faisal University, Riyadh, Saudi Arabia

Correspondence to: Prof Ziad A Memish, Ministry of Health, Riyadh 11176, Saudi Arabia

? These authors contributed equally


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[sharon sanders]

Re: The Lancet Infect Dis. Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study

Lancet: Epidemiological, Demographic & Clinical Characteristics of MERS-CoV



Coronavirus ? Credit CDC PHIL


# 7515

Overnight The Lancet published an analysis of 47 lab confirmed cases of MERS-CoV diagnosed in Saudi Arabia between September 2012 and June 15th 2013.

While the bulk of the study is behind a pay wall, we do have the abstract and several media reports quoting the corresponding author for this study; KSA Deputy Health Minister, Professor Ziad Memish.

Dr. Memish has been quoted by Reuters as stating that, "So far there is little to indicate that MERS will follow a similar path to SARS." At the same time, this new study concedes:

Major gaps in our knowledge of the epidemiology, community prevalence, and clinical spectrum of infection and disease need urgent definition

First stop, a link to the abstract, then a couple of links to media coverage.

Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study

Abdullah Assiri MD a b ?, Jaffar A Al-Tawfiq FACP c ?, Abdullah A Al-Rabeeah FRCS a, Fahad A Al-Rabiah MD d, Sami Al-Hajjar MD d, Ali Al-Barrak MD e, Hesham Flemban MD f, Wafa N Al-Nassir MD g, Hanan H Balkhy MD h, Rafat F Al-Hakeem MD a i, Hatem Q Makhdoom PhD j, Prof Alimuddin I Zumla FRCP a k l ?, Prof Ziad A Memish FRCP a m n
Findings

47 individuals (46 adults, one child) with laboratory-confirmed MERS-CoV disease were identified; 36 (77%) were male (male:female ratio 3?3:1). 28 patients died, a 60% case-fatality rate. The case-fatality rate rose with increasing age.

Only two of the 47 cases were previously healthy; most patients (45 [96%]) had underlying comorbid medical disorders, including diabetes (32 [68%]), hypertension (16 [34%]), chronic cardiac disease (13 [28%]), and chronic renal disease (23 [49%]). Common symptoms at presentation were fever (46 [98%]), fever with chills or rigors (41 [87%]), cough (39 [83%]), shortness of breath (34 [72%]), and myalgia (15 [32%]). Gastrointestinal symptoms were also frequent, including diarrhoea (12 [26%]), vomiting (ten [21%]), and abdominal pain (eight [17%]).

All patients had abnormal findings on chest radiography, ranging from subtle to extensive unilateral and bilateral abnormalities. Laboratory analyses showed raised concentrations of lactate dehydrogenase (23 [49%]) and aspartate aminotransferase (seven [15%]) and thrombocytopenia (17 [36%]) and lymphopenia (16 [34%]).

A key finding is that 96% (45 of 47) of these cases had pre-existing medical conditions.

• diabetes (32 [68%])
• hypertension (16 [34%])
• chronic cardiac disease (13 [28%])
• chronic renal disease (23 [49%])

BBC coverage of this report includes extended comments by Professor Memish, where he compares the threat from MERS-CoV with that of SARS a decade ago.

Mers: New virus 'not following Sars' path'

By James Gallagher Health and science reporter, BBC News
<Excerpt>

The lead researcher and Deputy Minister for Public Health, Prof Ziad Memish, said: "Despite sharing some clinical similarities with Sars, there are also some important differences.

"In contrast to Sars, which was much more infectious especially in healthcare settings and affected the healthier and the younger age group, Mers appears to be more deadly, with 60% of patients with co-existing chronic illnesses dying, compared with the 1% toll of Sars.

"Although this high mortality rate with Mers is probably spurious due to the fact that we are only picking up severe cases and missing a significant number of milder or asymptomatic cases.

"So far there is little to indicate that Mers will follow a similar path to Sars."
(Continue . . . )

In an accompanying article (Is MERS another SARS?), MERS researcher Professor Christian Drosten (see The Lancet: Virological Analysis Of A MERS-CoV Patient & Nature: Receptor For NCoV Found) - as reported in this Medscape articleMERS and SARS: Similar Not Identical- is less sanguine in his analysis.

He notes that the incidence of diabetes among elderly male Saudis is fairly close to that reported among these cases, and that a high rate of chronic kidney disease and hypertension among patients is not unexpected, given that many of these cases were linked to nosocomial spread at a dialysis clinic.

Without broader community seroprevalence studies, Drosten argues that it is premature to regard this virus as primarily a threat to those with underlying disorders.

Complicating matters, since this study?s cut-off date in June, we?ve seen a growing number of asymptomatic cases reported among younger, presumably healthier, individuals.

This from the most recent ECDC Rapid Risk Assessment on MERS-COV.

Ten asymptomatic cases have been reported since 8 June, eight by Saudi Arabia and two by the United Arab Emirates (UAE). Six of these asymptomatic cases have been health care workers. All the new cases reported since the previous update have been reported by Saudi Arabia and UAE.

This broad range of clinical presentation (asymptomatic to severe, even fatal illness) leaves investigators unsure whether the 90+ cases that have so far been identified represent the bulk of the infected cases or are just the `tip of a much larger iceberg?.

Crucial questions for which answers, right now, are frustratingly few.

Posted by Michael Coston at <a class="timestamp-link" href="http://afludiary.blogspot.ca/2013/07/lancet-epidemiological-demographic.html" rel="bookmark" title="permanent link"><abbr class="published" title="2013-07-26T06:56:00-04:00">6:56 AM</abbr>

[Giuseppe]

Re: The Lancet Infect Dis. Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study

We had other mild cases out of ME, namely three in Italy (an index case and two close contacts) and two in Tunisia (close contacts of a probable deceased patient).

Despite casese happened months ago, neither viral isolates nor cases descriptions have been published in journals.

We should ask ourselves the reason behind this delay and whether the results of research into these cases would change the overall picture we were delivered so far about MERS. GM