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Risk factors for primary Middle East respiratory syndrome Coronavirus illness in humans, Saudi Arabia, 2014.

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  • Risk factors for primary Middle East respiratory syndrome Coronavirus illness in humans, Saudi Arabia, 2014.

    http://wwwnc.cdc.gov/eid/article/22/1/15-1340_article
    Alraddadi BM, Watson JT, Almarashi A, Abedi GR, Turkistani A, Sadran M, et al. Risk factors for primary Middle East respiratory syndrome Coronavirus illness in humans, Saudi Arabia, 2014. Emerg Infect Dis. 2016 Jan [date cited]. http://dx.doi.org/10.3201/eid2201.151340 DOI: 10.3201/eid2201.151340

    Abstract

    Risk factors for primary Middle East respiratory syndrome coronavirus (MERS-CoV) illness in humans are incompletely understood. We identified all primary MERS-CoV cases reported in Saudi Arabia during March–November 2014 by excluding those with history of exposure to other cases of MERS-CoV or acute respiratory illness of unknown cause or exposure to healthcare settings within 14 days before illness onset. Using a case–control design, we assessed differences in underlying medical conditions and environmental exposures among primary case-patients and 2–4 controls matched by age, sex, and neighborhood. Using multivariable analysis, we found that direct exposure to dromedary camels during the 2 weeks before illness onset, as well as diabetes mellitus, heart disease, and smoking, were each independently associated with MERS-CoV illness. Further investigation is needed to better understand animal-to-human transmission of MERS-CoV.

    Median age of case-patients was 49 years; 97% were male (Table 1). Rate of ownership of a barn or farm with animals was similar between case-patients and controls, but income was higher for case-patients than for controls (53% vs. 34%, respectively, had a monthly income of >6,000 SAR [US $1,600]; 2013 gross national income per capita is $2,188/month in Saudi Arabia [27]).Median age of case-patients was 49 years; 97% were male (Table 1). Rate of ownership of a barn or farm with animals was similar between case-patients and controls, but income was higher for case-patients than for controls (53% vs. 34%, respectively, had a monthly income of >6,000 SAR [US $1,600]; 2013 gross national income per capita is $2,188/month in Saudi Arabia [27]).
    Several exposures were associated with MERS-CoV by univariate analysis (Table 2). During the 14 days before illness onset, case-patients were more likely than controls to have had direct dromedary exposure (33% vs. 15%, OR 3.73, 95% CI 1.24–11.80); to keep dromedaries in or around the home (30% vs. 15%, OR 3.34, 95% CI 1.04–10.98); or to have visited a farm where dromedaries were present (90% vs. 53%, OR 11.57, 95% CI 2.67–∞)...
    ...
    Case-patients were no more likely than controls to report exposure to bats, goats, horses, sheep, or the products of these animals; however, direct cattle exposure was significantly associated with illness...
    In our study, direct contact with dromedaries in the 2 weeks before illness onset was associated with MERS-CoV illness. The proportions reporting direct contact with dromedaries was limited among both case-patients and controls (33% vs. 15%). Among specific direct exposures that we investigated, only milking dromedaries was significantly associated with illness. However, we noted a significant association when considering together all reported activities that involve direct dromedary exposure. When we controlled for underlying conditions, direct exposure to dromedaries (whether in the previous 2 weeks or in the previous 6 months) remained an independent risk factor for MERS-CoV illness. Additionally, living in the same household with persons who reported working on or visiting a farm where dromedaries were kept was a risk factor for illness; although the numbers were small, the highest risks were associated with other relatives and domestic helpers. Indirect contact with dromedaries might explain primary MERS-CoV illness in case-patients without direct dromedary contact and should be further explored. Other potential explanations of MERS-CoV illness in primary case-patients who did not have direct contact with dromedaries include unrecognized community exposure to patients with mild or subclinical MERS-CoV infection or exposure to other sources of primary MERS-CoV infection not ascertained in our study. A recent nationwide serosurvey from Saudi Arabia estimated that >44,000 persons might be seropositive for MERS-CoV and might be the source of infection to patients with confirmed primary MERS-CoV illness but with no dromedary exposure (8). Although we found that direct and indirect dromedary exposure were significantly associated with MERS-CoV illness, our study had limited power to detect specific behaviors or practices associated with illness. Future studies should be designed to further explore this association.
    Case-patients in our study were significantly more likely than controls to report diabetes; this finding provides epidemiologic evidence of diabetes as a risk factor for MERS-CoV illness. Smoking and heart disease were also significantly associated with MERS-CoV illness. Of note was the overwhelming male preponderance in our study; only 1 of the 30 case-patients with primary infection was female. The fact that men in Saudi Arabia are much more likely than women to have contact with dromedaries might explain this observation. Previous studies have reported some male preponderance, but those findings were not as striking as our results, probably because MERS-CoV infections in most patients in other studies were healthcare associated and transmitted from human to human (2,4)...
    Last edited by Gert van der Hoek; January 4th, 2016, 03:09 AM. Reason: Added bolding
    “‘i love myself.’ the quietest. simplest. most powerful. revolution ever.” ---- nayyirah waheed

    Avatar: Franz Marc, Liegender Hund im Schnee 1911 (My posts are not intended as advice or professional assessments of any kind.)
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