Coronavirus respiratory illness in Saudi Arabia
Mohammed N. Al-Ahdal1, Ahmed A. Al-Qahtani1,2, Salvatore Rubino3
1Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
2Liver Disease Research Center, King Saud University, Riyadh, Saudi Arabia
3Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, Sassari, Italy
Although viruses that belong to the coronavirus family are known since the 1930s, they only gained public health attention when they were
discovered to be the causative agent of the severe acute respiratory syndrome (SARS) outbreak in China in 2002–2003. On 22 September
2012, the Ministry of Health (MOH) in Saudi Arabia announced the detection of what was described as a “rare pattern” of coronavirus
respiratory infection in three individuals, two Saudi citizens and one person from the Gulf Region. Neither Saudi citizen survived the
infection. Molecular analysis of the isolates showed that the virus belongs to the genus beta-coronavirus. It is not known if the new isolates
are circulating in the population or has recently diverged. The emergence of these novel isolates that resulted in fatal human infection
ascertains that health authorities all over the world must be vigilant for the possibility of new global pandemics due to novel viral infection.
Key words: Coronavirus, Saudi Arabia, Respiratory disease, Hajj Season
J Infect Dev Ctries 2012; 6(10):692-694.
(Received and Accepted 17 October 2012)
Copyright © 2012 Al-Ahdal et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
On 22 September 2012, the Ministry of Health
(MOH) in Saudi Arabia announced that two Saudi
individual have died from clinical complications
associated with an infection of a rare pattern of
The emergence of the SARS CoV virus, the
causative agent of Severe Acute Respiratory
Syndrome (SARS) infection [2,3] in 2002-2003, is still
a fresh reminder that modern air travel can bring an
epidemic to any city in a matter of days or weeks.
Official records from the World Health Organization
(WHO) registered 8,422 SARS cases with 916 deaths
and a mortality of approximately 10% . Fortunately
the last confirmed case of SARS CoV was identified
in China in May 2004 .
The first Saudi case of coronavirus in the current
outbreak was identified in Jeddah from the sputum of
a 60-year-old male Saudi patient with pneumonia. The
virus was identified by using Vero and Rhesus
Monkey Kidney Epithelial (LLC-MK2) cell culture
lines. This work was performed at the Virology
Laboratory of Dr Soliman Fakeeh Hospital . The
case was confirmed in Rotterdam, The Netherlands,
where the virus was sequenced at the Erasmus Medical
Centre (EMC) in a collaborative study (GenBank
accession number: JX869059, termed hCoV-EMC)
. The patient died from acute renal failure in June
2012, some days after admission to the hospital.
No clinical information is available regarding the
other Saudi patient who also died .
The second confirmed case due to the novel
coronavirus was a 49-year-old male of Qatari
nationality. The patient had a recent travel history to
Saudi Arabia from 31 July 2012 to 18 August 2012,
prior to onset of illness on 3 September 2012, when he
reported a mild respiratory illness that became severe
six days later with the development of bilateral
pneumonia. The patient was admitted with acute
respiratory symptoms to an intensive care unit (ICU)
in Doha, Qatar, and then transferred to the United
Kingdom when his condition worsened. The
coronavirus was isolated at the Health Protection
Agency in London . According to Pebody and
coworkers , who studied the clinical case in detail,
the patient acquired the virus in Qatar. This assertion
was made on the basis of the time course of the
patient’s infection. However, molecular analysis of the
PCR amplicon product of the Qatari patient showed a
sequence very closely related to that of the hCoV-
EMC detected in the patient from Saudi Arabia, which
belongs to the genus beta-coronavirus, that is closely
related to bat coronaviruses . Reports of new
Al-Ahdal et al. – Coronavirus in Saudi Arabia J Infect Dev Ctries 2012; 6(10):692-694.
variants of coronavirus that might be harbored in bats
and may have the potential of being transmitted to
animals and humans have recently been made .
A new diagnostic tool based on a real-time
reverse-transcription polymerase chain reaction assays
suitable for qualitative and quantitative detection of
this new infective agent is now available for Public
Health purposes . Coronoviridae is a family of
viruses containing a large number of variants, some of
which cause common cold respiratory diseases to
humans that are self-limiting. Some, such as SARS,
may prove to be pathogenic and infectious [13,14].
Previously in Saudi Arabia, only the Netherlands
human coronavirus (HCoV-NL63) had been isolated
from children with respiratory tract infections ,
and an outbreak of severe respiratory illness of
unknown etiology was reported by the Ministry of
Health in Jordan earlier in 2012 . This new virus,
however, is different from those identified in humans
in the past. Further studies are necessary to determine
whether the novel coronavirus was circulating in the
population in the Middle East Region or if it is a
recent acquisition. Furthermore, it will be crucial to
identify the origin for this novel virus. The World
Health Organization is currently actively seeking
further information on this variant of coronavirus to
assess the local and global public health implications
of this infection.
From a Public Health point of view, serious
attention should be paid to the surveillance of
influenza-like illnesses in the Middle East region, as
the extremely crowded Hajj (pilgrimage to Makkah)
season is starting. Hundreds of thousands of
individuals from all walks of life are now pouring into
the Holy Places in Saudi Arabia (Makkah and
Madinah) through the City of Jeddah, where at least
one of the cases was identified. The Saudi MOH has
assured the public that such occurrences are rare and
the overall health conditions are "reassuring and do not
cause concern” . Personal hygiene and vaccine-
taking must be observed in general for several
infectious diseases as advised by the WHO and the
Saudi MOH .
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Mohammed N. Al-Ahdal, BPharm, PhD
Department of Infection and Immunity
The Research Centre
King Faisal Specialist Hospital and Research Centre
PO Box 3354 (MBC-03), Riyadh 11211, Saudi Arabia
Tel: +966 1 442 4581 / +966 1 442 7867
Fax: +966 1 442 4519
E-Mail: email@example.com or firstname.lastname@example.org
Conflict of interests: No conflict of interests is declared.
of Health (2012)