Article

Risk Factors for Fatal Middle East Respiratory Syndrome Coronavirus Infections in Saudi Arabia: Analysis of the WHO Line List, 2013–2018

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Abstract

Objectives. To explore complex associations among demographic factors, risk factors, health care, and fatality rates of Middle East respiratory syndrome coronavirus (MERS-CoV) in the Kingdom of Saudi Arabia. Methods. We based this study on analysis of a publicly accessible line listing of 1256 MERS-CoV cases (2013 to October 2018) available on the World Health Organization’s Web site. For analyses of demographic factors (e.g., age, gender), access to health care, promptness of laboratory services, risk factors (comorbidity, exposure to camels and persons with MERS-CoV), occupation (health care), and outcome (fatality), we used descriptive statistics, risk ratio (RR), and the Pearson χ ² test. Results. Presence of comorbidity (RR = 3; 95% confidence interval [CI] = 2.2, 3.9), being male (RR = 1.6; 95% CI = 1.2, 2.1), exposure to dromedary camels (RR = 1.6; 95% CI = 1.3, 2.3), and consumption of camel milk (RR = 1.5; 95% CI = 0.9, 1.7) can significantly increase risk for fatality. Health care workers have significantly lower fatality (P < .001) than the rest of the persons with MERS-CoV. Conclusions. Policies that promote health awareness for the high-risk population and their prompt seeking of health care should be considered. Publicly accessible line lists of infectious diseases such as MERS-CoV can be valuable sources for epidemiological analysis.

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... Although it is difficult to know the original evolutionary pathway for CoV. If the current pathogenic SARS-CoV-2 or Covid-19 infecting humans comes from animals, this could increase the possibility of future outbreaks [4], [5], [6], [7]. citizens' compliance in carrying out health protocols to prevent transmission between humans, as well as preventing transmission from humans to their petssource of data regarding animals potentially infected with Covid-19 or sources of CoV zoonotc strains, especially regarding the diversity of species and distribution of animals, compliance and management of residents in carrying out health protocols during pandemic for themselves and their pets/livestock. ...
... Droplets that come from people infected with Covid-19, can survive in the environment for hours or even days. Droplets in the environment and contaminating various equipment and free air, have different time variation ranges [4], [14], [15], [16]. ...
... Showing respiratory symptoms as well as several other symptoms such as diarrhea. With veterinary health checks to vet, a pet can be known possibility of contracting the disease non-CoV or CoV by performing rapid test / PCR [4], [9], [17]. ...
... Clinically, it has been reported that the predominant comorbidities included hypertension, diabetes, respiratory, and renal disease, and the fever was the most common complaint [15]. Among other reported risk factors were healthcare workers and higher exposure occupations that bring people into close contact with camels which might be the source of infection for patients with confirmed MERS with no previous exposure to camels [18,19]. A systematic review and metaanalysis studies investigated people from different countries who visited the KSA for Hajj pilgrimage or Umrah had denied any infection by MERS-CoV in their citizens after their return form KSA [20][21][22]. ...
... These borders are mostly deserts in which the camels form the main vehicle across the borders for trading. Earlier epidemiological surveys had affirmed that the MERS-CoV was endemic in Saudi's camels and that Saudi Arabian dromedary camels show significantly higher MERS-CoV carrier rates than dromedary camels imported from Africa [18]. This high prevalence of infection with MERS-CoV actually was responsible for large human MERS-CoV outbreaks in KSA [1,18,27]. ...
... Earlier epidemiological surveys had affirmed that the MERS-CoV was endemic in Saudi's camels and that Saudi Arabian dromedary camels show significantly higher MERS-CoV carrier rates than dromedary camels imported from Africa [18]. This high prevalence of infection with MERS-CoV actually was responsible for large human MERS-CoV outbreaks in KSA [1,18,27]. The presence of high anti-MERS-CoV Ab titer among Iraqi camels probably reflects the presence of high viral load and consequently high shedding of the virus with respiratory secretions and thus high infectivity of these camels. ...
Article
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Background: Middle East respiratory syndrome (MERS) is a zoonotic viral disease transmitted from dromedaries to humans. To date, more than 1500 cases of MERS have been reported and 80% of all cases have occurred in the Kingdom of Saudi Arabia (KSA). This cross-sectional study was carried out to figure out the rate of infection among humans and dromedary camels and to explore the risk factors. Methods: This study was conducted in Diyala Province, Iraq for the period from August 2017 to October 2018. Human subjects included 90 participants; 34 (37.8%) were females and 56 (62.2%) were males. Additionally, 90 dromedary camels were also included, 50 (55.6%) males and 40 (44.4%) females. Serum samples from subjects were collected and tested for the presence of anti-MERS-coronavirus (CoV) immunoglobulin g (IgG). Results: The results revealed that 46 (51.1%) of human subjects were positive for anti-MERS-CoV IgG, (95% confidence interval (CI) for the prevalence rate 40.9-61.3) with a mean titer of anti-MERS-CoV IgG antibodies (Ab) of 81.2 U/mL. The anti-MERS-CoV IgG positivity rate was insignificantly higher, but the mean of anti-MERS-CoV IgG titer was significantly higher among females (p = 0.12 and p < 0.004, respectively). Furthermore, the anti-MERS-CoV IgG positivity rate and Ab titer were significantly higher among those people who visited KSA for Hajj or Umrah (p < 0.001 and p < 0.001, respectively). In camels, 81 (90.0%) were positive for anti-MERS-CoV IgG, (95% CI for the prevalence rate 82.5-94.9), with a mean titer of 99.8 U/mL. Discussion: The MERS-CoV infection rate was high among both Iraqi humans and dromedary camels. Further confirmatory studies are needed, and setting up of national precaution program is essential.
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... Comorbidities such as chronic obstructive pulmonary disease (COPD), diabetes, hypertension, and malignancy predisposed COVID-19 patients to adverse clinical outcomes, similar to those infected with SARS-CoV and MERS-CoV, which caused severe acute respiratory syndromes. [37][38][39][40][41]. It is worth noting that some comorbidities frequently co-exist with each other. ...
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The outbreak of coronavirus disease 2019 (COVID-19) initially occurred in December 2019 and triggered a public health emergency. The increasing number of deaths due to this disease was of great concern. Therefore, our study aimed to explore risk factors associated with COVID-19 deaths. After having searched the PubMed, EMBASE, and CNKI for studies published as of August 10, 2020, we selected articles and extracted data. The meta-analysis was performed using Stata 16.0 software. Nineteen studies were used in our meta-analysis. The proportions of comorbidities such as diabetes, hypertension, malignancies, chronic obstructive pulmonary disease, cardio-cerebrovascular disease, and chronic liver disease were statistically significantly higher in mortal COVID-19 cases. Coagulation and inflammatory markers, such as platelet count, D-dimer, prothrombin time, C-reactive protein, procalcitonin, and interleukin 6, predicted the deterioration of the disease. In addition, extracorporeal membrane oxygenation and mechanical ventilation predicted the poor prognosis during its progression. The COVID-19 pandemic is still evolving, placing a huge burden on healthcare facilities. Certain coagulation indicators, inflammatory indicators, and comorbidities contribute to the prognosis of patients. Our study results may help clinicians optimize the treatment and ultimately reduce the mortality rate.
... Again in 2012, another member belonging to the betacoronavirus subgroup, MERS-CoV (Middle East Respiratory Syndrome Coronavirus (MERS-CoV) caused similar kind of viral outbreak in Saudi Arabia. According to the World Health Organization (WHO) more than 2428 individuals was infected with MERS-CoV with 838 associated deaths [46]. MERS-CoV is phylogenetically more diverse in contrast to other human CoVs. ...
... [ [45][46][47]105,[108][109][110] Nefamostat (synthetic serine protease inhibitor) ...
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Present pandemic situation due to the appearance of COVID-19 has put the world in a miserable condition. More than 2.5 million people have been infected with the causal strain of coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2). The first case of COVID-19 infection was reported in China in December 2019. Scientists are searching the effective tool to combat this virus. The study has been undertaken by the scientists towards finding effective medicine, vaccine as well as robust techniques to detect this virus. Besides development of new treatment, the application of clinical data analytics has also been observed for the off-label use of the already available medications. As a part of the real time application of science and technology, several clinical trials has been in process to extract the best answer against COVID-19. In present article, a comprehensive review has been carried out to conscripting the available knowledge about discovery, genomic structure, mechanism of infection and clinical features of SARS-CoV-2. Presently available procedures for detection of this virus have been highlighted. Besides these, available treatments which have been explored by the researchers worldwide, includes precisely convalescent plasma therapy, monoclonal antibody therapy as well as antiviral medications along with their regulatory status, have been discussed elaborately which will definitely enrich the global understanding as well as proficient ability to combat this pathogens.
... The observed patients having novel CoV had poor health conditions including diabetes, kidney or heart function issues, and hypertension that make them more susceptible for MERS-CoV outbreak, while diabetes, smoking, cardiovascular disease, hypertension, and other chronic illness have also been observed. In the majority of deaths and corresponding to findings in animal models [22], the results indicate that vigilance is essential for these weak patients following SARS-CoV-2 infection [22]. ...
... The observed patients having novel CoV had poor health conditions including diabetes, kidney or heart function issues, and hypertension that make them more susceptible for MERS-CoV outbreak, while diabetes, smoking, cardiovascular disease, hypertension, and other chronic illness have also been observed. In the majority of deaths and corresponding to findings in animal models [22], the results indicate that vigilance is essential for these weak patients following SARS-CoV-2 infection [22]. ...
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Full-text available
Background. Coronaviruses (CoVs) are enveloped positive-strand RNA viruses which have club-like spikes at the surface with a unique replication process. Coronaviruses are categorized as major pathogenic viruses causing a variety of diseases in birds and mammals including humans (lethal respiratory dysfunctions). Nowadays, a new strain of coronaviruses is identified and named as SARS-CoV-2. Multiple cases of SARS-CoV-2 attacks are being reported all over the world. SARS-CoV-2 showed high death rate; however, no specific treatment is available against SARS-CoV-2. Methods. In the current study, immunoinformatics approaches were employed to predict the antigenic epitopes against SARS-CoV-2 for the development of the coronavirus vaccine. Cytotoxic T-lymphocyte and B-cell epitopes were predicted for SARS-CoV-2 coronavirus protein. Multiple sequence alignment of three genomes (SARS-CoV, MERS-CoV, and SARS-CoV-2) was used to conserved binding domain analysis. Results. The docking complexes of 4 CTL epitopes with antigenic sites were analyzed followed by binding affinity and binding interaction analyses of top-ranked predicted peptides with MHC-I HLA molecule. The molecular docking (Food and Drug Regulatory Authority library) was performed, and four compounds exhibiting least binding energy were identified. The designed epitopes lead to the molecular docking against MHC-I, and interactional analyses of the selected docked complexes were investigated. In conclusion, four CTL epitopes (GTDLEGNFY, TVNVLAWLY, GSVGFNIDY, and QTFSVLACY) and four FDA-scrutinized compounds exhibited potential targets as peptide vaccines and potential biomolecules against deadly SARS-CoV-2, respectively. A multiepitope vaccine was also designed from different epitopes of coronavirus proteins joined by linkers and led by an adjuvant. Conclusion. Our investigations predicted epitopes and the reported molecules that may have the potential to inhibit the SARS-CoV-2 virus. These findings can be a step towards the development of a peptide-based vaccine or natural compound drug target against SARS-CoV-2. 1. Background There are a variety of human diseases with unknown etiology. A viral parentage has been purposed for numerous diseases and also has significance to search new viruses [1]. Various difficulties have been faced which scrutinize new viruses, such as some viruses do not replicate in vitro and have cytopathic effects (CPE). The viruses that are unable to replicate in vitro leads to the failure of virus discovery. The DNA-amplified restriction fragment length polymorphism (cDNA-AFLP 4) technique helps to identify the new viruses including the discovery of new coronavirus [1]. Coronaviruses, a genus of the Coronaviridae family, are enveloped viruses recognized as of large plus RNA strand genome. The size of RNA is 27-32 kb and polyadenylated. There are three groups of coronaviruses that are serologically distinct. Viruses are characterized within each group by their genomic sequence and host range [2]. Coronaviruses have been discovered in mice, turkeys, cats, horse, and humans and cause many diseases including respiratory tract and gastroenteritis [2]. Two human viruses (HCoV-229E, HCoV-OC43) were identified in the mid-1960s and are known to cause the common cold. The recently identified SARS-CoV can cause a life-threatening pneumonia and is the most pathogenic human coronaviruses identified thus far [3]. SARS-CoV is probable to occupy in animal source and recently initiated the epidemic in humans through zoonotic transmission [4]. SARS-CoV is the first membrane of a fourth group of coronaviruses [5]. In Wuhan (Hubei province, China), multiple patients associated to Hunan south China seafood market diagnosed with third zoonotic human coronavirus (CoV) of the century emerged in 31st of December 2019. CoV is similar to severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) infections including fever, lung infiltration, and difficulty breathing [6]. After an extensive speculation about the causative agent of CoV, the identification of novel CoV was announced by the Chinese Center for Disease Control (CDS) on 19th of January 2020 [7]. The novel CoV, SARS-CoV-2, was insulated from a single patient and later corroborated from 16 more patients [8]. The viral pneumonia of SARS-CoV-2 was quickly predicted as the likely causative agent, while not yet confirmed. The first sequence of SARS-CoV-2 has been submitted after its conformation [9]. Later, five more sequences of SARS-CoV-2 were deposited to the GSAID database on 11th of January from Chinese institutes [10] (Supplementary 1); multiple sequence alignment of SARS-CoV, MERS-CoV, and SARS-CoV-2 carried out and conserved part in DNA, as well as protein sequence, was observed. Hundreds of human deaths were linked with infection having significant morbidities with the age>50. Various clinical symptoms have been highlighted such as dry cough, leukopenia, fever, and shortness of breath. The extracorporeal membrane oxygenation of the patients considered severe cases and need supportive care. The infection of SARS-CoV-2 in elderly patients are less virulent as compared to SARS-CoV (10% mortality) and MERS-CoV (35% mortality) [11]. 1.1. Origin The source of the SARS-CoV-2 is still unclear, although the initial cases have been associated with the Huanan South China Seafood Market. The early patients present in the Market got the virus through either human-to-human transmission or a more widespread animal source [11]. The samples from the infected market showed positive results for the novel coronavirus while no specific animal association has been identified [12]. Through codon analyses, it is suggested that the snakes might be the possible source of the viral infection [13], although the assertion has been disputed by others [14] including possible animal vectors, and the researchers are trying to discover the source of SARS-CoV-2. Coronavirus was thought to infect humans and bats more effectively as both are more related to Coronavirus lifecycle [15]. It has been evidenced that several bats are capable of infecting human cells without intermediate adaptation [16]. The human serology data shows the association of bat CoV proteins leads to zoonotic transmission of SARS-like bat coronavirus for deadliest out breaks [17]. MERS-CoV is also a zoonotic virus and have the origin from the bats [18]. The zoonotic contacts of camel has been evidenced in primary cases of MERS-CoV [19]. These lessons from SARS and MERS highlight the importance of rapidly finding source for SARS-CoV-2 in order to stem the ongoing outbreak [19]. 1.2. Susceptible Populations With low patient data, who may be most sensitive to SARS-CoV-2 is difficult to make robust resolution. Disease severity such as SARS-CoV and MERS-CoV equated strongly to host the condition including biological sex, age, and the overall health [20], and similar findings have been observed in early patients of SARS-CoV-2. The SARS- and MERS-CoV infection leads to increase the severity and death rate in people over the age of 50 years [21]. The observed patients having novel CoV had poor health conditions including diabetes, kidney or heart function issues, and hypertension that make them more susceptible for MERS-CoV outbreak, while diabetes, smoking, cardiovascular disease, hypertension, and other chronic illness have also been observed. In the majority of deaths and corresponding to findings in animal models [22], the results indicate that vigilance is essential for these weak patients following SARS-CoV-2 infection [22]. 1.3. Insights from the Sequence Dr. Zhang’s group at Fudan University and many other groups in China instance the dedication and increased the capacity of the scientific infrastructures in China by rapid sequencing of nearly 30,000 nucleotide of the (COVID) genome [23]. The whole genome analyses of SARS-CoV-2 showed ~80% nucleotide identity to the original SARS epidemic virus. The two different bat SARS-like CoVs (ZC45 and ZXC21) shared ~89% identity with the genome of SARS-CoV-2 [24]. It has been observed that the novel CoV showed recombination with previously identified bat coronaviruses through phylogenetic analyses [25]. A CoV sequence of bat (RaTG3) having 92% sequence identity with the novel virus supports the bat origins for the SARS-CoV-2 [14]. The SARS-CoV-2 spike protein has roughly 75% amino acid identity with SARS-CoV [26] while the SARS-CoV-2 receptor-binding domain (RBD) is 73% conserved with spike RBD of SARS-CoV by narrowing analysis relative to the epidemic RBD [27]. The receptor-binding domain of SARS-CoV-2 was capable of binding with ACE2 in the context of the SARS-CoV spike protein [28]. 1.4. Genomic Features and Lifecycle of the Coronavirus Coronaviruses have unique club-like spikes, and the RNA genome is larger than other virus which leads to a unique mode of replication. Coronaviruses contain ~30 kb of positive-strand RNA genome [29]. The significant features of coronavirus genomes include a 5 caped end which plays an important role in the replication of RNA, as 5 end has a leader sequence along with a UTR region, possessing essential loops. The 3 poly-A tail end has essential structures for RNA genome synthesis and replication [30]. These two modifications allow RNA viruses for translation of replication (replicase) proteins [23]. A coronavirus genome has significant parts and helps for the synthesis and replications of whole genome (Figure 1) [31].
... Interestingly, most of the identified cases of COVID-19 in Africa have been imported from Europe and the United States, rather than from the original COVID-19 epicentre China. The continent's weak health care system and a large immune-compromised population owing to high prevalence of malnutrition, anemia, malaria, HIV/AIDs, tuberculosis and poor economic discipline, make it distinct from the other continents that have experienced COVID-19 to date (Rahman and Sarkar, 2019). Experts also anticipated that under these circumstances the pandemic in Africa could be challenging to control, and the consequences could be dismal (Moore et al., (2017). ...
... In almost all the COVID-19 stricken countries,the entire educational, commercial, sports and spiritual institutions were closed in a bid to safe guard the people from contacting and having an indiscriminate spread of the pandemic. Industries suffereda lot as many of these except those related to essential amenities, were closed from business for a long time in many countries (Rahman and Sarkar, 2019). People belonging to the tourism and transportation industry were also facing utmost economic difficulties as people were not allowed to move freely and as such their businesses were closed and no income, revenue or salaries were paid nor received. ...
Article
Covid-19 has threatenedsocio-economic and recreational activities across the world and this have adversely affected the global trade, socioeconomic activities and indeed the tourism industry.This study is therefore carried out to examine the impact of the Covid-19 pandemic on the tourism industry across West African.The study utilized both primary and secondary sources of data collection. The primary source involved the use of telephone survey to elicit information of perception and level of involvement in tourism activities within the study locations while the secondary source involved the use of documented information on the internet, journals, textbooks and bulletins. Six West African countries (Nigeria, Ghana, Gambia, Cape Verde, Cote d'ivoire and Senegal) were purposively selected for the study based on their viability in terms of tourism facilities, event and activities. The study observed that there was a rapid reduction in the activities of the tourism industry due to the lock down in travels, business, socioeconomic and recreational activities.The study advocates that there should be a gradual commencement of economic and recreational activities and that tourist should adhere strictly to the precautions of Covid-19 to ensure that the virus does not spread to avoid another lockdown.
... Interestingly, most of the identified cases of COVID-19 in Africa have been imported from Europe and the United States, rather than from the original COVID-19 epicentre China. The continent's weak health care system and a large immune-compromised population owing to high prevalence of malnutrition, anemia, malaria, HIV/AIDs, tuberculosis and poor economic discipline, make it distinct from the other continents that have experienced COVID-19 to date (Rahman and Sarkar, 2019). Experts also anticipated that under these circumstances the pandemic in Africa could be challenging to control, and the consequences could be dismal (Moore et al., (2017). ...
... In almost all the COVID-19 stricken countries,the entire educational, commercial, sports and spiritual institutions were closed in a bid to safe guard the people from contacting and having an indiscriminate spread of the pandemic. Industries suffereda lot as many of these except those related to essential amenities, were closed from business for a long time in many countries (Rahman and Sarkar, 2019). People belonging to the tourism and transportation industry were also facing utmost economic difficulties as people were not allowed to move freely and as such their businesses were closed and no income, revenue or salaries were paid nor received. ...
... [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Meanwhile, for MERS in South Korea, we extract more complex multifeature patient-level data (ie, data in which every row is a patient and every column is a feature), which enable reconstruction of transmission networks and evaluation of risk factors associated with mortality. [31][32][33][34][35][36][37][38][39] METHODS Data on the evolving epidemiology of each outbreak were first manually curated for validation purposes. Summary information for each study is available in Table 1. ...
... Furthermore, these parameters can also be used to model vaccination rates during outbreaks of vaccine-preventable diseases, which can be leveraged to lobby for the resources necessary to vaccinate vulnerable communities. [26][27][28][29][30] Meanwhile, patient-level "line list" data have traditionally been employed to assess risk factors for different outcomes; [31][32][33][34][35][36][37][38] indeed, the data presented in this article for MERS in South Korea have been used precisely in this way to assess risk factors for mortality given MERS-CoV infection, 31,32 as well as for transmission to others following infection. 38 Such analyses allow for improvements to resource allocation both with respect to patient care (ie, preferentially allocate intensive care units to patients who are less likely to survive infection) and with respect to contact-tracing (ie, preferentially allocate resources to contact trace individuals who are more likely to transmit to others following infection), among other applications. . ...
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During infectious disease outbreaks, health agencies often share text-based information about cases and deaths. This information is rarely machine-readable, thus creating challenges for outbreak researchers. Here, we introduce a generalizable data assembly algorithm that automatically curates text-based, outbreak-related information and demonstrate its performance across 3 outbreaks. After developing an algorithm with regular expressions, we automatically curated data from health agencies via 3 information sources: formal reports, email newsletters, and Twitter. A validation data set was also curated manually for each outbreak, and an implementation process was presented for application to future outbreaks. When compared against the validation data sets, the overall cumulative missingness and misidentification of the algorithmically curated data were ≤2% and ≤1%, respectively, for all 3 outbreaks. Within the context of outbreak research, our work successfully addresses the need for generalizable tools that can transform text-based information into machine-readable data across varied information sources and infectious diseases.
... Interestingly, most of the identified cases of COVID-19 in Africa have been imported from Europe and the United States, rather than from the original COVID-19 epicentre China. The continent's weak health care system and a large immune-compromised population owing to high prevalence of malnutrition, anemia, malaria, HIV/AIDs, tuberculosis and poor economic discipline, make it distinct from the other continents that have experienced COVID-19 to date (Rahman and Sarkar, 2019). Experts also anticipated that under these circumstances the pandemic in Africa could be challenging to control, and the consequences could be dismal (Moore et al., (2017). ...
... In almost all the COVID-19 stricken countries,the entire educational, commercial, sports and spiritual institutions were closed in a bid to safe guard the people from contacting and having an indiscriminate spread of the pandemic. Industries suffereda lot as many of these except those related to essential amenities, were closed from business for a long time in many countries (Rahman and Sarkar, 2019). People belonging to the tourism and transportation industry were also facing utmost economic difficulties as people were not allowed to move freely and as such their businesses were closed and no income, revenue or salaries were paid nor received. ...
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Full-text available
Covid-19 has threatenedsocio-economic and recreational activities across the world and this have adversely affected the global trade, socioeconomic activities and indeed the tourism industry.This study is therefore carried out to examine the impact of the Covid-19 pandemic on the tourism industry across West African.The study utilized both primary and secondary sources of data collection. The primary source involved the use of telephone survey to elicit information of perception and level of involvement in tourism activities within the study locations while the secondary source involved the use of documented information on the internet, journals, textbooks and bulletins. Six West African countries (Nigeria, Ghana, Gambia, Cape Verde, Cote d'ivoire and Senegal) were purposively selected for the study based on their viability in terms of tourism facilities, event and activities. The study observed that there was a rapid reduction in the activities of the tourism industry due to the lock down in travels, business, socioeconomic and recreational activities.The study advocates that there should be a gradual commencement of economic and recreational activities and that tourist should adhere strictly to the precautions of Covid-19 to ensure that the virus does not spread to avoid another lockdown.
... Again in 2012, another member belonging to the beta coronavirus subgroup, MERS-CoV (Middle East Respiratory Syndrome Coronavirus (MERS-CoV) caused a similar kind of viral outbreak in Saudi Arabia. According to the World Health Organization (WHO), more than 2428 individuals were infected with MERS-CoV with 838 associated deaths [46]. MERS-CoV is phylogenetically more diverse in contrast to other human CoVs. ...
... Some reports also pointed out the shortcomings of this method. In one case, five individuals infected with COVID-19 were tested negative using the RT-qPCR technique but they were later confirmed to be infected with the virus by positive chest CT scan reports followed by repeated swab tests using RT-qPCR techniques [46]. Apart from that, the method also suffers from a few more disadvantages such as laborious nucleic acid detection method, long waiting time for the results, and the associated biological safety hazards linked with the patient samples. ...
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Full-text available
The present pandemic situation due to the appearance of COVID-19 has put the world in a miserable condition. About 2.5 million people have been infected with the strain of coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) globally. The foremost patient of COVID-19 infection was identified in China in the month of December 2019. Researchers are searching for an effective method to combat this pandemic virus. The investigations have been regulated by the scientists towards finding effective medicine, vaccine as well as robust techniques to detect and combat this virus. Furthermore, the evolution of new treatments, the application of clinical data analytics has also been observed for the off-label use of the already available approved medications. As a real-time application of science and technology, numerous clinical trials have been under process to find out the best medicine against the COVID-19 pandemic. The present study summarizes in the form of a comprehensive review conscripting the available knowledge about identification, genomic structure, and mode of infection, and clinical importance of SARS-CoV-2. Currently, available approaches for the detection of COVID-19 have been highlighted along with available treatments which have been explored by researchers worldwide includes precisely convalescent plasma therapy, monoclonal antibody therapy as well as antiviral agents from natural and synthetic sources, and regulatory status have been discussed elaborately which will enrich the global understanding as well as proficient ability to combat this pandemic pathogen.
... Une décennie plus tard, en 2012, un couple de ressortissants saoudiens a été diagnostiqué avec un autre coronavirus, le virus détecté a été confirmé comme étant membre du coronavirus et nommé coronavirus du syndrome respiratoire du Moyen-Orient (MERS). L'OMS a rapporté que le coronavirus MERS a infecté plus de 2 428 personnes et 838 décès(Rahman et Sarkar, 2019. ). Le MERS fait partie du sous-groupe des bêta-coronavirus et est phylogénétiquement diversifié par rapport aux autres Coronavirus humains. L'infection par le MERS-CoV commence par une légère lésion des voies respiratoires supérieures tandis que la progression entraîne une maladie respiratoire grave. À l'instar du SRAS, les patients infec ...
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... Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) is a modified version of previous strain SARS-CoV whose outbreak had happened in 2003. 1 Earlier, SARS-CoV had spread to 26 different countries and showed a fatality rate of over 10%, then a decade later Middle-east Respiratory Syndrome-Coronavirus (MERS-CoV) emerged in 2012 with a fatality rate of 35%. 2 In a recent third outbreak, SARS-CoV-2 has spread to more than 218 countries and continues further. 3 As of now, ~96 million people have been infected with SARS-CoV-2 and more than 2.0 million people have lost their lives (accessed on 18 th January 2021, https://www.worldometers.info/coronavirus/). ...
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Coronavirus disease 2019 (COVID-19) is an emerging challenging area for the researchers to buckle up against the spread and control of the virus. Since earlier times, the diagnosis has been an important procedure in estimating the fate of epidemics by indicating the extent to which disease has been spread and to the extent, further disease prognosis would occur. The absence of anti-viral therapies and vaccines for COVID-19 at present suggests early diagnosis and isolation of the patients as the only smart approach available as of now. Presently, the increasing death rates, faster rates of transmission, non-availability of vaccines, and treatment have over-pressurized the researchers, health professionals, and government officials to develop effective clinical strategies in diagnosis and to come up with guidelines to be followed during conduction of each diagnostic procedure for maintaining healthcare systems. Since the incubation period of this virus is 2-14 days, a patient can transmit the infection without showing symptoms. Therefore, early diagnosis and isolation of susceptible individuals are the only way to limit the spread of the virus. Significance of diagnosis and triaging, information on specimen collection, safety considerations while handling, transport, and storage of samples have been highlighted in this paper to make people more aware and develop better clinical strategies in the future.
... WHO announced that MERS coronavirus causes infection to more than 2428 individuals and 838 deaths [6]. MERS-CoV is a beta-coronavirus subgroup and genetically varied from other human-CoV. ...
Article
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ABSTRACT: There is no doubt that the immune system of a pregnant mother plays a very important role in the establishment, maintenance, and completion of a healthy pregnancy. Immune cells and cytokines play an important role in the acceptance and development of the fetus by the maternal immune system. A successful pregnancy relies on resistance against any infection and tolerance of the immune system of the mother toward the fetus. Infection during pregnancy may lead to premature delivery, abortion, growth defects, neonatal death, and other adverse outcomes. The COVID-19 has changed lives across the world and these changes that occurred have a psychological effect for all people especially for pregnant women who worry about their pregnancy more than before. The risks of infection of pregnant women and the outcomes of this COVID-19. infection on fetus and mother become a major problem. This review will be based on recently published literature and official documents to demonstrate the effect of COVID-19 on pregnancy and its risks. This review shows a brief to clinical features of COVID-19 and its spreading all over the world with a demonstration of the role of the immune system during pregnancy and against any infection. Also, COVID-19 effect on pregnant women and fetus with its outcomes and how to manage and treat a case of COVID-19 pregnant patient. This review demonstrates pregnant women infected with SARS-CoV-2 in comparison with SARS-CoV and MERS-CoV with their complications. Finally, the scientific research and articles on pregnancy and COVID-19 are insufficient despite papers and documents published on pregnancy and COVID-19. So, fetus and pregnant mother infected with COVID-19 need special attention for the prevention, diagnosis, and management of COVID-19.
... According to WHO, MERS-CoV infected more than 2400 peoples, and almost 838 lost their life due to this coronavirus. 13 MERS-CoV belongs to a beta coronavirus subgroup, and it is phenotypically different from other human CoV. The MERS-CoV infection causes mild respiratory diseases, while the progression of infection may lead to severe respiratory problems. ...
Article
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The novel coronavirus was emerged from China Wuhan city and spread around the globe within a few days. COVID-19 is rapidly transmitted from one human to another, and it is also a highly pathogenic infection. Genetic analysis confirmed that SARS-CoV 2 is phenotypically related to SARS-CoV; therefore, the possible reservoir for SARS-CoV 2 could be bats. According to WHO more than 20 million individuals infected with SARS-CoV 2 while more than 700,000 peoples lost their lives due to COVID-19 as of 13th August 2020. Up-till now, there is no anti-viral therapy or vaccines available for the treatment and prevention of COVID-19. Although dexamethasone and tocilizumab help in reducing mortality among critical patient infected with COVID-19 However, China, Brazil and USA have developed vaccines which is currently under trial phase. Still, up-till now, there is no clinically approved treatment regimen available against COVID-19.
... The widespread risk of this, however, is likely to be extremely low based on evidence from previous SARS-CoV-1 and MERS-CoV outbreaks(M. (Todd, 2017) (Rahman and Sarkar, 2019). ...
... Finally, the presence of CKD should be regarded as an important factor in future risk stratification models for COVID-19 [13]. Several reports in literature have documented the escalated risks of poorer clinical outcomes in patients with avian influenza, SARS-CoV and MERS-CoV infections [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. The most common comorbidities associated with poorer prognosis include diabetes, hypertension, respiratory diseases, cardiac diseases, pregnancy, renal diseases and malignancy [16,25,28,29]. ...
Article
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Purpose The recent outbreak of COVID-19 rapidly spread worldwide. Comorbid diseases are determinants of the severity of COVID-19 infection and mortality. The aim of this study was to explore the potential association between chronic kidney disease (CKD) and the severity of COVID-19 infection. Methods The study included 609 consecutive adult patients (male: 54.52%, mean age: 59.23 ± 15.55 years) hospitalized with the diagnosis of COVID-19 in a tertiary level hospital. Data were collected from the electronic health records of the hospital. The patients were separated into two groups: Group I included COVID-19-positive patients with CKD stage 1–2, and Group II included COVID-19-positive with CKD stage 3–5. The relationships were examined between CKD stage, laboratory parameters and mortality. Results Significant differences were determined between the groups in respect of the inflammation parameters and the parameters used in prognosis. In Group II, statistically significantly higher rates were determined of comorbid diseases [hypertension ( p < 0.001) and diabetes mellitus ( p < 0.001), acute kidney injury (AKI), which was found to be associated with mortality ( p < 0.001), and mortality ( p < 0.001)]. In multivariate regression analysis, CKD stage 3–5, AKI, male gender, hypertension, DM and malignancy were found to be significant independent variables increasing mortality. Conclusion The prevelance of CKD stage 3–5 on admission is associated with a high risk of in-hospital mortality in patients with COVID-19. Close follow-up can be recommended for patients with a reduced glomerular filtration rate (GFR).
... In addition, medical staff had a lower fatality rate than non-clinical staff for COVID-19 (RR = 0.12; 95% CI, 0.05-0.30) [22,23,24] (Table 3). providers, and elders. ...
Article
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In this study, predictive models are proposed to accurately estimate the confirmed cases and deaths due to of Corona virus 2019 (COVID-19) in Africa. The study proposed the predictive models to determine the spatial and temporal pattern of COVID 19 in Africa. The result of the study has shown that the spatial and temporal pattern of the pandemic is varying across in the study area. The result has shown that cubic model is best outperforming compared to the other six families of exponentials (R2=0.996,F=538.334,DF1=3,DF1=7,b1=13691.949,b2=−824.701,b1=12.956). The adopted cubic algorithm is more robust in predicting the confirmed cases and deaths due to COVID 19. The cubic algorithm is more superior to the state of the art of the works based on the world health organization data. This also entails the best way to mitigate the expansion of COVID 19 is through persistent and strict self-isolation. This pandemic will sustain to grow up, and peak to the highest for which a strong care and public health interventions practically implemented. It is highly recommended for Africans must go beyond theory preparations implementations practically through the public interventions.
... Similarly, the cases that are related to SARS-COV which were experienced in 2002-2003 as Middle East Respiratory Syndrome Coronavirus (MERS CoV) affected typically the people who had physiological issues such as smokers, those with cardiovascular issues, and the ones who had chronic illnesses [31]. Since both viral diseases have a phylogenetic, structural and etiological homology, the patients who are in those circumstances are very likely to be infected with 2019 coronavirus disease. ...
... Older male patients are at higher risk to coronaviruses like SARS, MERS and now SARS-CoV-2. However, the presence of 'X' chromosome and sex hormones in women provides strong natural immunity and make them less susceptible to this virus Jaillon et al., 2019;Rahman & Sarkar, 2019). Our findings from different studies are similar to an early-stage study on the SARS virus and MERS virus. ...
Article
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Coronavirus disease (COVID-19) is presently the most important topic worldwide. However, no vaccine or specific anti-viral treatment for the disease has been shown to be effective. In this emergency, identifying risk factors, preventive measures and estimating challenges which control available drug options for COVID-19 are key to mitigating the severity of the pandemic until specific drugs or vaccines become available. Therefore, this study aims to identify possible factors which affect these drug options. This study searched PubMed database using necessary Boolean operators from December 31st to March 31st 2020 in order to identify common risk factors, preventive measures, information regarding control challenges & evidence on the available drug options against COVID-19. Risk factors were found to be human-animal interactions, males, aged peopleand people with co-morbidity. Furthermore, protective factors comprised of personal hygiene etiquette maintenance, rapid identification, isolation and informing (3I tools) of the COVID-19 cases and media coverage on COVID-19. Till date, anti-viral drugs like remdesivir, chloroquine, lopinavir/ritonavir and traditional Chinese medicine (TCM) are available options to fight against COVID-19. More research is needed to determine other how to control the disease until specific treatment options are available as well as risk factors, and preventive measures.
... [2] The WHO reported that MERS-corona virus infected more than 2428 individuals and resulted in the death of 838 individuals. [3] By the end of 2018, reports of several cases of pneumonia with unfamiliar etiology, were released from the Chinese government to the WHO, It had reportedly originated Hunan live animal market in Wuhan city, and rapidly infected more than 50 individuals. On 12 January 2020, the National Health Commission of China released further details about the epidemic, suggested viral pneumonia. ...
... 11,58 Comorbidities associated with poor outcomes in other outbreaks of severe acute respiratory diseases, such as COPD, HTN, malignancies, and diabetes, may also predispose patients with COVID-19 to more severe cases. 54,56,59,60 However, the strength of this association between COVID-19 prognosis and various comorbidities is unclear as it varies in different reports 61,62 ; for example, the association of CVD with poor clinical outcomes of SARS-CoV, MERS-CoV, or influenza remains uncertain. Apart from diabetes, no other comorbidities have been recognized as prognosticators of poor clinical outcomes in patients with MERS-CoV. ...
Article
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Infection with COVID-19 is associated with significant morbidity, especially in patients with chronic medical conditions. At least one-fifth of cases require supportive care in intensive care units, which have limited availability in most developing countries. A literature search was conducted on PubMed, Medline, Scopus, Embase, and Google Scholar to find articles published by May 7, 2020 on the role of comorbidities in patients with COVID-19 and the impact of comorbidities on the disease. This review highlighted that patients with comorbidities are more likely to experience severe disease than those with no other conditions; that is, comorbidities correlated with greater disease severity in patients with COVID-19. Proper screening of COVID-19 patients should include careful inquiries into their medical history; this will help healthcare providers identify patients who are more likely to develop serious disease or experience adverse outcomes. Better protection should also be given to patients with COVID-19 and comorbidities upon confirmation of the diagnosis. This literature review showed that the comorbidities most often associated with more severe cases of COVID-19 are hypertension, cardiovascular disease, and diabetes. Individuals with these comorbidities should adopt restrictive measures to prevent exposure to COVID-19, given their higher risk of severe disease.
... It belongs to the family of Nidovirales order. After this W.H.O analyzed everything regarding the new virus and found around 1650 active infected cases that were conformed in laboratory and more than 550 people were reported dead [4][5] . So that incident was a nightmare for most of the scientist since 2012. ...
... Global healthcare facilities always been threatening by numerous viral infections. Coronavirus or Middle East respiratory syndrome coronavirus (MERS-CoV) being counted as a danger to public health [1]. The mode of communications and transmission of this significant threat to humans poorly characterized. ...
... This outbreak resulted in more than 2400 infections and 838 deaths. 23,24 In December 2019, the SARS-CoV-2 outbreak was witnessed in China, which has reported 90% of the cases till date. These viruses use different animals as their reservoirs with a common origin, bat. ...
Article
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The world has witnessed COVID-19 or SARS-CoV-2 as one of the most hazardous viral outbreak in the history of mankind. Since its emergence in December 2019,it has been affecting the global health with no reported pharmacotherapeutic agent that can neutralize its substantial pathogenicity and escalation around the world. This is attributed to its remarkable molecular pathways followed in course of its life cycle, which is completed in and around the host cell. With the usage of these evolved mechanisms, the virus can effectively invade and replicate in the host cell. The complete analysis of life cycle has resulted in reporting of some molecular targets, which can be neutralised with the usage of pharmacotherapeutic agents. These agents tend to bind to their targets to inactivate them. This review focusses on those targets as well as the potent drugs that currently have been employed to reduce the viral load, in the perspective of its life cycle and pathogenicity. Alongside the drugs that are currently being used, we also report potent drugs that are yet to clear the clinical investigation.
... Regardless of the fact that the majority of confirmed patients were considered to be mild or moderate, 5% were critical and 14% severe on the basis of the largest survey of 72,314 patients to date (4). As with SARS-CoV (5) and Middle East Respiratory Syndrome coronavirus (MERS-CoV) (6), COVID-19 is more easily predisposed to acute respiratory distress syndrome, respiratory failure, heart failure, septic shock and even death among susceptible cases (7). Accumulated evidence from the latest studies indicates the risk factors concerning fatality of COVID-19 are heterogeneous and may include male, older age, comorbidity, smoking, elevated D-dimer level, coagulopathy, neutrophilia and organ dysfunction (8)(9)(10)(11)(12)(13). ...
Article
Background: Coronavirus disease 2019 (COVID-19) has resulted in an overwhelmed challenge to the healthcare system worldwide. Methods: A case-control study of COVID-19 patients in Wuhan Third Hospital was conducted. 96 deceased COVID-19 patients and 230 discharged patients were included as the case group and control group, respectively. Demographic, epidemiological, clinical and laboratory variables on admission were collected from electronic medical records. Univariate and multivariate logistic regression were adopted to investigate the independent predictors of mortality. A nomogram was formed for predicting the mortality risk. Results: The multivariate stepwise logistic model demonstrated that age of 60+ years (OR =4.426, 95% CI: 1.955-10.019), comorbidity of cerebrovascular disease (OR =7.084, 95% CI: 1.545-32.471), white blood cell (WBC) count >9.5×109 /L (OR =7.308, 95% CI: 1.650-32.358), platelet count <125×109/L (OR =5.128, 95% CI: 2.157-12.191), aspartate aminotransferase (AST) >40 U/L (OR =2.554, 95% CI: 1.253-5.206), cystatin C >1.1 mg/L (OR =4.132, 95% CI: 2.118-8.059), C reactive protein (CRP) ≥100 mg/L (OR =2.830, 95% CI: 1.311-6.109), creatine kinase isoenzymes (CK-MB) >24 U/L (OR =6.015, 95% CI: 2.119-17.07) and D-dimer >5 μg/L (OR =4.917, 95% CI: 1.619-14.933) were independent predictors of mortality of COVID-19 patients. The nomogram demonstrated a well discriminatory accuracy for mortality prediction with a C-index of 0.903. Conclusions: The determinants identified may help to determine patients at high risk of death at an early stage and guide the optimal treatment.
... In 2012, a similar case was identified in Saudi Arabia, thus it was renamed Middle East Respiratory Syndrome Coronavirus (MERS-Cov). The disease infected 2,428 people and killed 838 people (Trichel, 2021;Rahman & Sarkar, 2019). It started slowly with the United States playing power politics with China where the first case was spotted (Amin & Rafique, 2021, deLisle, 2021. ...
Conference Paper
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This article examines the extent to which COVID-19 limits the movement of people or migration and the implication of this restriction for nation-building. It argues that the more people comply with the COVID-19 social distance order, the greater the implications for national integration and social cohesion in Africa. Indeed, extant studies on COVID-19 and migration have been able to establish that COVID-19 has had a significant effect on migration. However, there is little evidence of the effects of COVID-19 on nation-building in Africa. This article contends that the COVID-19 lockdown which prohibits social gatherings and the movement of people negates the drive for national integration and social mobilization for meaningful projects that can promote socio-economic development amid COVID-19 in Africa. Relying on qualitative data, the article specifically examines the connection between COVID-19 and nation-building in South Africa and the rest of Africa. The findings advanced knowledge of how the various COVID-19 safety protocols impugned nation-building. It concludes that travel restrictions are likely to have an adverse reaction that will prove retrogressive on nation-building. It contributes to the current debate on the post-covid-19 world order and nation-building.
... Current studies indicate that COVID-19 has multiple site mutations, and the epidemic has still not been completely controlled [3][4][5]. Epidemiological data show that a large portion of the population is susceptible to COVID-19, but disease incidence appears to be positively correlated with age and underlying diseases, (i.e., hypertension, diabetes, and cardiovascular disease) [6]. There were 500,186,525 confirmed COVID-19 cases worldwide and 6,190,349 deaths attributed to the disease as of April 15, 2022 [7]. ...
Article
Purpose: Studies have found that erectile dysfunction (ED) may be a short-term or long-term complication in coronavirus disease 2019 (COVID-19) patients, but no relevant studies have completed a pooled analysis of this claim. The purpose of the review was to comprehensively search the relevant literature, summarize the prevalence of ED in COVID-19 patients, assess risk factors for its development, and explore the effect of the COVID-19 infection on erectile function. Methods: Medline, Embase, and the Cochrane Library was performed from database inception until April 14, 2022. Heterogeneity was analyzed by χ2 tests and I2 was used as a quantitative test of heterogeneity. Subgroup analyses, meta-regression, and sensitivity analyses were used to analyze sources of heterogeneity. Results: Our review included 8 studies, 4 of which functioned as a control group. There were 250,606 COVID-19 patients (mean age: 31-47.1 years, sample size: 23-246,990). The control group consisted of 10,844,200 individuals (mean age: 32.76-42.4 years, sample size 75-10,836,663). The prevalence of ED was 33% (95% CI 18-47%, I2 = 99.48%) in COVID-19 patients. The prevalence of ED based on the international coding of diseases (ICD-10) was 9% (95% CI 2-19%), which was significantly lower than the prevalence of ED diagnosed based on the International Index of Erectile Function (IIEF-5) (46%, 95% CI 22-71%, I2 = 96.72%). The pooling prevalence of ED was 50% (95% CI 34-67%, I2 = 81.54%) for articles published in 2021, significantly higher than that for articles published in 2022 (17%, 95% CI 7-30%, I2 = 99.55%). The relative risk of developing ED was 2.64 times in COVID-19 patients higher than in non-COVID-19 patients (RR: 2.64, 95% CI 1.01-6.88). The GRADE-pro score showed that the mean incidence of ED events in COVID-19 patients was 1,333/50,606 (2.6%) compared with 52,937/844,200 (0.4%) in controls; the absolute impact of COVID-19 on ED was 656/100,000 (ranging from 4/100,000 to 2352/100,000). Anxiety (OR: 1.13, 95% CI 1.03-1.26, I2 = 0.0%) in COVID-19 patients was a risk factor for ED. Conclusion: COVID-19 patients have a high risk and prevalence of ED, mainly driven by anxiety. Attention should be paid to patient's erectile functioning when treating COVID-19.
... According to Vandergriendt (2020) human beings contact MERS -CoV through infected camels and through close contact with an infected person. Between 2012 -2019, 27 countries of the world reported more than 2,428 MERS cases with 838 deaths (Rahman and Sarkar, 2019). Although MERS-CoV is still ongoing in some parts of the world, it does not spread rapidly and kills very fast like the present SARS-CoV-2. ...
Article
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Purpose: The study examined sensitization of rural communities on COVID-19 pandemic: assessment of the roles of public librarians in Nsukka Local Government Area of Enugu state. Methodology: A survey research design was adopted. The population is 417,700 consisting the rural dwellers in the eighteen towns in Nsukka Local Government Area. A multi stage sampling technique was used. These include cluster sampling technique, random sampling technique and purposive sampling technique. The purposive sampling technique was used to select a sample size of 300 respondents. Data were collected using interview, focus group discussion, and questionnaire. Results were analyzed using mean and standard deviation. Findings: The findings of the study reveal various methods used in sensitizing rural communities on COVID-19 pandemic among which are organizing awareness programf (=3.06) and mounting posters on strategic places (=3.04). Some protective measures like the use of face mask (=3.17), maintaining social distancing (=3.17) and regular washing of hands with soap (=3.02) with standard deviation 0.94, 1.05 and 0.87 respectively were also disclose by the study. Implication: Despite the relevance of the programme various challenges to effective implementation of the protective measures were identify to include limited access to water, poor internet connectivity, and poor health condition among others. Originality/value: There is need to increase pipe-bone water supply and install boreholes in the rural communities; improved communication networks and internet connectivity to ensure adequate flow of information concerning COVID-19 in Nsukka Local Government Area.
... Since then, the virus has spread globally, affected approximately all 80% identical nature with the earlier reported human CoVs (SARS-like bat CoV) according to the phylogenetic tree depicted in Fig. (2) [8,9]. Thus, bats are considered the critical reservoir of CoVs [10,11]. ...
Article
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A more focused approach is needed to understand the SARS-CoV-2 virulence, structure, and genomics to devise more effective diagnostic and treatment interventions as this virus can evade the immune attack and causes life-threatening complications such as cytokine storm. The spread of the virus is still amplifying and causing thousands of new cases worldwide. It is essential to review current diagnostics and treatment approaches to pave the way to correct or modify our current practices to make more effective interventions against COVID-19. COVID-19 vaccine development has moved at a breakneck pace since the outbreak began, utilizing practically all possible platforms or tactics to ensure the success of vaccines. A total of 42 vaccine candidates have already entered clinical trials, including promising results from numerous vaccine candidates in phase 1 or phase 2 trials. Further, many existing drugs are being explored on broad-spectrum antiviral medications for their use in clinical recovery against COVID- 19. The present review attempts to re-examine the SARS-CoV-2 structure, its viral life cycle, clinical symptoms and pathogenesis, mode of transmission, diagnostics, and treatment strategies that may be useful for resorting to more effective approaches for controlling COVID-19. Various antiviral drugs and vaccination strategies with their strengths and weaknesses are also discussed in the paper to augment our understanding of COVID-19 management.
... In comparison during the MERS-CoV outbreak most Susceptible Populations were the smokers and who have a cardiovascular disease, diabetes, hypertension and other chronic illnesses. 18 The National Institutes of Health (NIH) suggest that several groups of people have the highest risk of developing complications due to COVID-19. These groups include: young children people aged 65 years or older women who are pregnant ...
... Going back to the previous cases of corona virus outbreak across the globe, the 2003 SARS-CoV came to existence from Guangdong province (China), infecting patients with pneumonia and alveolar injury, progressing into acute respiratory distress syndrome (Adnan et al. 2020). After this outbreak in 2012, MERS-CoV took hold of Saudi Arabian population infecting about 2428 people, causing death of 838 individuals with 36% mortality rate, according to WHO reports, deteriorating human health from mild to severe conditions that also led to kidney failure and ARDS (Rahman and Sarkar 2019). The present day scenario revealed a similar condition emerged in 2019, with many cases of pneumonia with unknown etiology. ...
Article
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The 2019 outbreak of corona virus disease began from Wuhan (China), transforming into a leading pandemic, posing an immense threat to the global population. The WHO coined the term nCOVID-19 for the disease on 11th February, 2020 and the International Committee of Taxonomy of Viruses named it SARS-CoV-2, on account of its similarity with SARS-CoV-1 of 2003. The infection is associated with fever, cough, pneumonia, lung damage, and ARDS along with clinical implications of lung opacities. Brief understanding of the entry target of virus, i.e., ACE2 receptors has enabled numerous treatment options as discussed in this review. The manuscript provides a holistic picture of treatment options in COVID-19, such as non-specific anti-viral drugs, immunosuppressive agents, anti-inflammatory candidates, anti-HCV, nucleotide inhibitors, antibodies and anti-parasitic, RNA-dependent RNA polymerase inhibitors, anti-retroviral, vitamins and hormones, JAK inhibitors, and blood plasma therapy. The text targets to enlist the investigations conducted on all the above categories of drugs, with respect to the COVID-19 pandemic, to accelerate their significance in hindering the disease progression. The data collected primarily targets recently published articles and most recent records of clinical trials, focusing on the last 10-year database. The current review provides a comprehensive view on the critical need of finding a suitable treatment for the currently prevalent COVID-19 disease, and an opportunity for the researchers to investigate the varying possibilities to find and optimized treatment approach to mitigate and ameliorate the chaos created by the pandemic worldwide.
... A wide range of disease symptoms can be observed in cases of confirmed and reported COVID-19 infection [16]. The common symptoms of COVID-19 infection include fever, shortness of breath, cough, chills, sore throat, diarrhea, muscle aches, unexplained loss of smell or taste, and headache [17]. These symptoms begin from mild to severe over 5-7 days. ...
Article
The spread of this COVID-19 is fastidious and it spread all over the globe increasingly in a short period. It is a novel pathogen for humans. There is a need of studying effective treatment and prevention to overcome the pandemic situation due to the COVID-19 virus. In concern to COVID-19 or (SARS-CoV-2) infection, immunometabolism triggers activation of the immune system after Covid-19 infection. In this article, we focused on various immunometabolism activity that occurs from the beginning of infection to the changes that occur after vaccination. We also focus on comorbidities and their effect on increasing the risk of COVID-19 virus infection. This study also represents the worldwide distribution and uptake of different vaccines.
... Previous literature has documented the increased risk of worse clinical outcomes in patients with avian influenza [34][35][36][37][38], SARS-CoV [39], and MERS-CoV infections [40][41][42][43][44][45][46][47][48]. Among the most common comorbidities related with poor prognosis are hypertension [48], diabetes [41,45], respiratory diseases [39,49], heart disease [35,44], pregnancy [32], kidney disease [48], and malignancy [39]. ...
Article
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Comorbidity is the coexistence of two or more diseases in a certain period. Severe COVID-19 can occur in healthy individuals of any age but predominantly in adults of advanced age or with underlying medical comorbidity. Comorbidities are identified as the main determinants of poor outcomes. This meta-analysis aims to examine the effect of comorbidity on mortality in patients with a diagnosis of COVID-19. Materials and Methods: The studies published between 2019-2020 from Google Scholar, Pub Med, Medline, Scopus, Science Direct, and Web of Science databases were scanned. Inter-rater agreement was calculated with Kappa statistics, effect size "Odds Ratio", heterogeneity between studies with Cochran's Q statistics. The study's effect size and publication bias included in the meta-analysis were calculated using the CMA 3 (Comprehensive Meta-Analysis) program. Results: A total of 24 studies were included in the study. According to the random-effects model, the overall effect size of comorbid factors on mortality development in patients diagnosed with COVID-19 was found to be statistically significant with a value of 2.537 (G.A; 2.078-2.098; p <0.05). In conclusion, cancers, chronic respiratory diseases, diabetes, hypertension, and especially cardiovascular comorbidities are important risk factors for COVID-19 related mortality for COVID-19. There are controversial results in the literature; Further studies involving larger patient groups and examining the specific impact of certain comorbid conditions are needed in order to reach more precise conclusions.
... Previous studies have reported that those with severe disease tend to have respiratory failure, acute kidney disease, acute liver injury, and cardiac arrhythmias [7,27,41,45]. The rate of death was associated with the presence of comorbidities (RR = 3), male sex (RR = 1.6), occupational camel exposure (RR = 1.6), and raw milk consumption (RR = 1.5) [46]. In this study, we revealed the differences in presentations and outcomes of MERS-CoV among male and female patients. ...
Article
Full-text available
Emergency departments have been implicated as a source of index cases of the Middle East Respiratory Syndrome (MERS) coronavirus infection. We describe the epidemiological characteristics and initial clinical presentation of patients with Middle East respiratory syndrome coronavirus infection in an emergency department at a hospital in Riyadh, in the Kingdom of Saudi Arabia. The records of all patients presenting to the emergency department who tested positive for Middle East respiratory syndrome coronavirus infection on real-time reverse transcriptase polymerase chain reaction testing from April 2014 to November 2019 were reviewed, and the outcomes were assessed. The clinical presentations and outcomes were compared according to sex. A total of 68 patients with Middle East respiratory syndrome coronavirus infection were identified, of whom 40 (58.8%) were female, and 28 (41.2%) were male. The mean age was 50.7 (standard deviation: 16.4) years, and female patients were younger (44.7 ± 13.1 years) than male patients (59.4 ± 16.9 years). Nineteen of the 68 patients (27.9%) were asymptomatic of whom the majority (16/19, 84%) were female (p = 0.012). The most common symptoms were fever (n = 29, 42.6%), cough (n = 25, 36.8%), upper respiratory tract infection (n = 23, 33.8%), and pneumonia (n = 15, 22.1%). Pneumonia, diarrhea, dyspnea, and vomiting/diarrhea were more common among male patients. Male patients were more likely than female patients to require hospital admission (78.6% vs. 30.0%), intensive care unit admission (64.3% vs. 15.0%), and invasive mechanical ventilation (32.1% vs. 10.0%). The most common presentation of Middle East respiratory syndrome coronavirus infection in this cohort was asymptomatic infection. A high proportion of asymptomatic infections has not been reported previously. The study did not identify typical clinical features of MERS patients. Male patients tended to develop more severe disease than female patients. A larger study is needed to confirm these findings.
... MERS coronavirus (MERS-CoV) enters the human population through indirect or direct contact with infected dromedary camels as well as infected persons [21]. The single-humped, Arabian dromedary camel has been strongly implicated as the MERS-CoV reservoir in which the disease is either asymptomatic or manifested as a mild respiratory infection. ...
... With a 10-15% mortality rate, SARS-CoV affected 8422 cases in 32 countries and resulted in 961 deaths [18]. The MERS-CoV epidemic outbreak first surfaced in Saudi Arabia in 2012 [19][20], but a significant outbreak occurred in the Republic of Korea in 2015 [21]. This virus affected a total number of 1401 individuals and lead to 543 deaths registering 39% of fatalities worldwide, while in Saudi Arabia alone, mortality was 37.5% [22]. ...
Article
While the vaccination is now available to many countries and will slowly dissipate to others, effective therapeutics for COVID-19 is still illusive. The SARS-CoV-2 pandemic has posed an unprecedented challenge to researchers, scientists, and clinicians and affected the wellbeing of millions of people worldwide. Since the beginning of the pandemic, a multitude of existing anti-viral, antibiotic, antimalarial, and anticancer drugs have been tested, and some have shown potency in the treatment and management of COVID-19, albeit others failed to leave any positive impact and a few also became controversial as they showed mixed clinical outcomes. In the present article, we have brought together some of the candidate therapeutic drugs being repurposed or used in the clinical trials and discussed their safety and efficacy for the treatment of COVID-19.
... Mortality risk factor and disease severity data have been reported by various studies involving patients in South Korea and the Middle East [278][279][280][281][282][283][284]. Daily MERS-CoV case information published by the Saudi Arabian Ministry of Health online was collected and studied by Ahmed and colleagues. ...
Article
Middle East respiratory syndrome (MERS) is a lethal respiratory disease with its first case reported back in 2012 (Jeddah, Saudi Arabia). It is a novel, single-stranded, positive-sense RNA beta coronavirus (MERS-CoV) that was isolated from a patient who died from a severe respiratory illness. Later, it was found that this patient was infected with MERS. MERS is endemic to countries in the Middle East regions, such as Saudi Arabia, Jordan, Qatar, Oman, Kuwait and the United Arab Emirates. It has been reported that the MERS virus originated from bats and dromedary camels, the natural hosts of MERS-CoV. The transmission of the virus to humans has been thought to be either direct or indirect. Few camel-to-human transmissions were reported earlier. However, the mode of transmission of how the virus affects humans remains unanswered. Moreover, outbreaks in either family-based or hospital-based settings were observed with high mortality rates, especially in individuals who did not receive proper management or those with underlying comorbidities, such as diabetes and renal failure. Since then, there have been numerous reports hypothesising complications in fatal cases of MERS. Over the years, various diagnostic methods, treatment strategies and preventive measures have been strategised in containing the MERS infection. Evidence from multiple sources implicated that no treatment options and vaccines have been developed in specific, for the direct management of MERS-CoV infection. Nevertheless, there are supportive measures outlined in response to symptom-related management. Health authorities should stress more on infection and prevention control measures, to ensure that MERS remains as a low-level threat to public health.
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End 2019, the zoonotic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), named COVID-19 for coronavirus disease 2019, is the third adaptation of a contagious virus following the severe acute respiratory syndrome coronavirus in 2002, SARS-CoV, and the Middle East respiratory syndrome virus in 2012, MERS-CoV. COVID-19 is highly infectious and virulent compared to previous outbreaks. We review sources, contagious routes, preventive measures, pandemic, outbreak, epidemiology of SARS-CoV, MERS-CoV and SARS-CoV-2 from 2002 to 2020 using a Medline search. We discuss the chronology of the three coronaviruses, the vulnerability of healthcare workers, coronaviruses on surface and in wastewater, diagnostics and cures, and measures to prevent spreading.
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Coronaviruses are enveloped non-segmented positive-sense RNA viruses belonging to the family Coronaviridae. The human coronavirus infections are mild; the epidemics of the two β-coronaviruses, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) have caused more than ten thousand cumulative cases in the past twodecades. There is a new public health crisis threatening the world with the emergence and spread of 2019 novel coronavirus (2019-nCoV). The virus originated in bats and was transmitted to humans through yet unknown intermediary animals in Wuhan, Hubei province in China during the month of December 2019. Till date around 7,823,289 reported cases of coronavirus disease 2019 (COVID-2019) and 431,541 reported deaths till date. The disease is transmitted by inhalation or contact with infected droplets with incubation period of 2 to 14 days. The symptoms are usually fever, sore throat, dry cough, breathlessness, fatigue while many people are asymptomatic. Coronavirus (2019-nCoV) may progress to pneumonia, acute respiratory distress syndrome (ARDS) and can cause multi-organ dysfunction. Currently diagnosis is done by demonstration of the virus in respiratory secretions by special molecular tests like real-time reverse-transcription–polymerase-chain-reaction (RT-PCR), Radiological examinations (chest CT). Common laboratory tests like white cell counts and C-reactive protein (CRP) and measure symptoms can be used as preliminary screening at large scale after lock down the area or country. Treatment is essentially supportive; role of antiviral agents is yet to be established. It is paramount to implement infection control practices by infection source controlling, transmission route blocking, and susceptible population protection. Early preventive measures can be home isolation of suspected cases and those with mild illnesses and strict infection control measures at hospitals that include contact and droplet precautions. The worldwide impact of this Coronavirus new epidemic is yet uncertain.
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End 2019, the zoonotic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), named COVID-19 for coronavirus disease 2019, is the third adaptation of a contagious virus following the severe acute respiratory syndrome coronavirus in 2002, SARS-CoV, and the Middle East respiratory syndrome virus in 2012, MERS-CoV. COVID-19 is highly infectious and virulent compared to previous outbreaks. We review sources, contagious routes, preventive measures, pandemic, outbreak, epidemiology of SARS-CoV, MERS-CoV and SARS-CoV-2 from 2002 to 2020 using a Medline search. We discuss the chronology of the three coronaviruses, the vulnerability of healthcare workers, coronaviruses on surface and in wastewater, diagnostics and cures, and measures to prevent spreading.
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In this chapter, we will discuss the infection history and epidemiology, the viral structure of COVID 19 or SARS-CoV-2, mode of transmission, virulence, and pathogenesis of disease, and we also discuss how it was started and its relation to other coronaviruses. Then we will mention the relation to pregnancy, how it can affect pregnant female, sequelae on pregnancy course and labor, and effect on fetus and neonates.
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Various individuals, community organizations and institutions must be involved in planning and developing a cure for the COVID-19 flu pandemic. In addition to governmental organizations, those who need to be involved in the process are responsible for implementing pandemic plans. There should be a balance between centralized national control and regional and local communities through the effective implementation of the guidelines. There is a need to introduce social distancing and to study and isolate cases to contain disease spread. Due to the amendment and tightening of the law "SARS-CoV-2" in many countries, special attention should be paid to respect for citizens, especially national minorities. That is why it is necessary to protect freedom statements and providing access to critical information; make sure that quarantines, locks and travel bans comply with legal standards; persons.
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Coronavirus Drug Discovery SARS-CoV-2 (COVID-19) Prevention, Diagnosis, and Treatment
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The Middle East respiratory syndrome coronavirus (MERS-CoV) is one of the newly identified viral infections affecting humans. It was recently reported in the Arabian Peninsula (AP), particularly Saudi Arabia. The virus primarily causes respiratory failure in affected patients, but can also sometimes cause renal failure. The main reservoir of this virus is dromedary camels. Although a lot is known about the diseases pattern, pathogenesis, and immunity of MERS-CoV infection in humans, very little is known about these parameters in camels. The main goals of this book chapter are to discuss the current understandings about MERS-CoV infection in animals, particularly the dromedary camels. Special attention should be paid to the clinical pattern of MERS-CoV infection in animals, including clinical signs, pathological changes during virus infection, various methods of clinical and laboratory diagnosis, and the recent advances related to the control of MERS-CoV.
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The zoonotic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the end of 2019, also named COVID-19 for coronavirus disease 2019, is the third adaptation of a contagious virus following the severe acute respiratory syndrome coronavirus in 2002, SARS-CoV, and the Middle East respiratory syndrome virus in 2012, MERS-CoV. COVID-19 is highly infectious and virulent compared to previous outbreaks. We review sources, contagious routes, preventive measures, pandemic, outbreak, epidemiology of SARS-CoV, MERS-CoV and SARS-CoV-2 from 2002 to 2020 using a Medline search. We discuss the chronology of the three coronaviruses, the vulnerability of healthcare workers, coronaviruses on the surface and in wastewater, diagnostics and cures, and measures to prevent spreading.
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Background Middle East respiratory syndrome coronavirus (MERS-CoV) is endemic in dromedary camels in the Arabian Peninsula, and zoonotic transmission to people is a sporadic event. In the absence of epidemiological data on the reservoir species, patterns of zoonotic transmission have largely been approximated from primary human cases. This study aimed to identify meteorological factors that may increase the risk of primary MERS infections in humans. Methods A case-crossover design was used to identify associations between primary MERS cases and preceding weather conditions within the 2-week incubation period in Saudi Arabia using univariable conditional logistic regression. Cases with symptom onset between January 2015 – December 2017 were obtained from a publicly available line list of human MERS cases maintained by the World Health Organization. The complete case dataset (N = 1191) was reduced to approximate the cases most likely to represent spillover transmission from camels (N = 446). Data from meteorological stations closest to the largest city in each province were used to calculate the daily mean, minimum, and maximum temperature (οC), relative humidity (%), wind speed (m/s), and visibility (m). Weather variables were categorized according to strata; temperature and humidity into tertiles, and visibility and wind speed into halves. Results Lowest temperature (Odds Ratio = 1.27; 95% Confidence Interval = 1.04–1.56) and humidity (OR = 1.35; 95% CI = 1.10–1.65) were associated with increased cases 8–10 days later. High visibility was associated with an increased number of cases 7 days later (OR = 1.26; 95% CI = 1.01–1.57), while wind speed also showed statistically significant associations with cases 5–6 days later. Conclusions Results suggest that primary MERS human cases in Saudi Arabia are more likely to occur when conditions are relatively cold and dry. This is similar to seasonal patterns that have been described for other respiratory diseases in temperate climates. It was hypothesized that low visibility would be positively associated with primary cases of MERS, however the opposite relationship was seen. This may reflect behavioural changes in different weather conditions. This analysis provides key initial evidence of an environmental component contributing to the development of primary MERS-CoV infections.
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The emergence of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infections has become a global issue of dire concerns. MERS-CoV infections have been identified in many countries all over the world whereas high level occurrences have been documented in the Middle East and Korea. MERS-CoV is mainly spreading across the geographical region of the Middle East, especially in the Arabian Peninsula, while some imported sporadic cases were reported from the Europe, North America, Africa, and lately Asia. The prevalence of MERS-CoV infections across the Gulf Corporation Council (GCC) countries still remains unclear. Therefore, the objective of the current study was to report the prevalence of MERS-CoV in the GCC countries and to also elucidate on its demographics in the Arabian Peninsula. To date, the World Health Organization (WHO) has reported 1,797 laboratory-confirmed cases of MERS-CoV infection since June 2012, involving 687 deaths in 27 different countries worldwide. Within a time span of 4 years from June 2012 to July 2016, we collect samples form MERS-CoV infected individuals from National Guard Hospital, Riyadh, and Ministry of health Saudi Arabia and other GCC countries. Our data comprise a total of 1550 cases (67.1% male and 32.9% female). The age-specific prevalence and distribution of MERS-CoV was as follow:
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To date, 1841 cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported worldwide, with 652 deaths. We used a publically available case line list to explore the effect of relevant factors, notably underlying comorbidities, on fatal outcome of Middle East respiratory syndrome (MERS) cases up to the end of October 2016. A Bayesian Weibull proportional hazards regression model was used to assess the effect of comorbidity, age, epidemic period and sex on the fatality rate of MERS cases and its variation across countries. The crude fatality rate of MERS cases was 32.1% (95% credibility interval (CI): 29.9%, 34.3%). Notably, the incremental change of daily death rate was most prominent during the first week since disease onset with an average increase of 13%, but then stabilized in the remaining two weeks when it only increased 3% on average. Neither sex, nor country of infection were found to have a significant impact on fatality rates after taking into account the age and comorbidity status of patients. After adjusting for age, epidemic period, MERS patients with comorbidity had around 4 times the risk for fatal infection than those without (adjusted hazard ratio of 3.74 (95% CI: 2.57, 5.67)).
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Middle East respiratory syndrome coronavirus (MERS-CoV) is an emerging pathogen, first recognized in 2012, with a high case fatality risk, no vaccine, and no treatment beyond supportive care. We estimated the relative risks of death and severe disease among MERS-CoV patients in the Middle East between 2012 and 2015 for several risk factors, using Poisson regression with robust variance and a bootstrap-based expectation maximization algorithm to handle extensive missing data. Increased age and underlying comorbidity were risk factors for both death and severe disease, while cases arising in Saudi Arabia were more likely to be severe. Cases occurring later in the emergence of MERS-CoV and among health-care workers were less serious. This study represents an attempt to estimate risk factors for an emerging infectious disease using open data and to address some of the uncertainty surrounding MERS-CoV epidemiology.
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Not all persons infected with Middle East respiratory syndrome coronavirus (MERS-CoV) develop severe symptoms, which likely leads to an underestimation of the number of people infected and an overestimation of the severity. To estimate the number of MERS-CoV infections that have occurred in the Kingdom of Saudi Arabia, we applied a statistical model to a line list describing 721 MERS-CoV infections detected between June 7, 2012, and July 25, 2014. We estimated that 1,528 (95% confidence interval (CI): 1,327, 1,883) MERS-CoV infections occurred in this interval, which is 2.1 (95% CI: 1.8, 2.6) times the number reported. The probability of developing symptoms ranged from 11% (95% CI: 4, 25) in persons under 10 years of age to 88% (95% CI: 72, 97) in those 70 years of age or older. An estimated 22% (95% CI: 18, 25) of those infected with MERS-CoV died. MERS-CoV is deadly, but this work shows that its clinical severity differs markedly between groups and that many cases likely go undiagnosed.
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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. © 2016, Centers for Disease Control and Prevention (CDC). All rights reseved.
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The distinct characteristic of Korean MERS outbreak is that it not only shows intra-hospital transmission, but it also shows hospital-to-hospital transmission. It is the largest MERS outbreak outside the Middle East: 186 confirmed cases and 36 fatal cases. All confirmed cases suspected of hospital acquired infection except one case of household transmission and two cases of under examination. The Korean health care system became the major factor for the outbreak. Taking this as an opportunity, Korea should carefully assess the base problems of the vulnerability in the hospital infection and make short- as well as long-term plans for countermeasures. In addition, it is hoped that this journal, Epidemiology and Health becomes a place of discussion where various topics regarding MERS are being discussed and shared.
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Background: A marked increase in the number of cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection occurred in Jeddah, Saudi Arabia, in early 2014. We evaluated patients with MERS-CoV infection in Jeddah to explore reasons for this increase and to assess the epidemiologic and clinical features of this disease. Methods: We identified all cases of laboratory-confirmed MERS-CoV infection in Jeddah that were reported to the Saudi Arabian Ministry of Health from January 1 through May 16, 2014. We conducted telephone interviews with symptomatic patients who were not health care personnel, and we reviewed hospital records. We identified patients who were reported as being asymptomatic and interviewed them regarding a history of symptoms in the month before testing. Descriptive analyses were performed. Results: Of 255 patients with laboratory-confirmed MERS-CoV infection, 93 died (case fatality rate, 36.5%). The median age of all patients was 45 years (interquartile range, 30 to 59), and 174 patients (68.2%) were male. A total of 64 patients (25.1%) were reported to be asymptomatic. Of the 191 symptomatic patients, 40 (20.9%) were health care personnel. Among the 151 symptomatic patients who were not health care personnel, 112 (74.2%) had data that could be assessed, and 109 (97.3%) of these patients had had contact with a health care facility, a person with a confirmed case of MERS-CoV infection, or someone with severe respiratory illness in the 14 days before the onset of illness. The remaining 3 patients (2.7%) reported no such contacts. Of the 64 patients who had been reported as asymptomatic, 33 (52%) were interviewed, and 26 of these 33 (79%) reported at least one symptom that was consistent with a viral respiratory illness. Conclusions: The majority of patients in the Jeddah MERS-CoV outbreak had contact with a health care facility, other patients, or both. This highlights the role of health care-associated transmission. (Supported by the Ministry of Health, Saudi Arabia, and by the U.S. Centers for Disease Control and Prevention.).
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Background: Strategies to contain the Middle East respiratory syndrome coronavirus (MERS-CoV) depend on knowledge of the rate of human-to-human transmission, including subclinical infections. A lack of serologic tools has hindered targeted studies of transmission. Methods: We studied 26 index patients with MERS-CoV infection and their 280 household contacts. The median time from the onset of symptoms in index patients to the latest blood sampling in contact patients was 17.5 days (range, 5 to 216; mean, 34.4). Probable cases of secondary transmission were identified on the basis of reactivity in two reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assays with independent RNA extraction from throat swabs or reactivity on enzyme-linked immunosorbent assay against MERS-CoV S1 antigen, supported by reactivity on recombinant S-protein immunofluorescence and demonstration of neutralization of more than 50% of the infectious virus seed dose on plaque-reduction neutralization testing. Results: Among the 280 household contacts of the 26 index patients, there were 12 probable cases of secondary transmission (4%; 95% confidence interval, 2 to 7). Of these cases, 7 were identified by means of RT-PCR, all in samples obtained within 14 days after the onset of symptoms in index patients, and 5 were identified by means of serologic analysis, all in samples obtained 13 days or more after symptom onset in index patients. Probable cases of secondary transmission occurred in 6 of 26 clusters (23%). Serologic results in contacts who were sampled 13 days or more after exposure were similar to overall study results for combined RT-PCR and serologic testing. Conclusions: The rate of secondary transmission among household contacts of patients with MERS-CoV infection has been approximately 5%. Our data provide insight into the rate of subclinical transmission of MERS-CoV in the home.
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We describe the isolation and sequencing of Middle East respiratory syndrome coronavirus (MERS-CoV) obtained from a dromedary camel and from a patient who died of laboratory-confirmed MERS-CoV infection after close contact with camels that had rhinorrhea. Nasal swabs collected from the patient and from one of his nine camels were positive for MERS-CoV RNA. In addition, MERS-CoV was isolated from the patient and the camel. The full genome sequences of the two isolates were identical. Serologic data indicated that MERS-CoV was circulating in the camels but not in the patient before the human infection occurred. These data suggest that this fatal case of human MERS-CoV infection was transmitted through close contact with an infected camel.
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The novel Middle East respiratory syndrome coronavirus (MERS-CoV) had, as of Aug 8, 2013, caused 111 virologically confirmed or probable human cases of infection worldwide. We analysed epidemiological and genetic data to assess the extent of human infection, the performance of case detection, and the transmission potential of MERS-CoV with and without control measures. We assembled a comprehensive database of all confirmed and probable cases from public sources and estimated the incubation period and generation time from case cluster data. Using data of numbers of visitors to the Middle East and their duration of stay, we estimated the number of symptomatic cases in the Middle East. We did independent analyses, looking at the growth in incident clusters, the growth in viral population, the reproduction number of cluster index cases, and cluster sizes to characterise the dynamical properties of the epidemic and the transmission scenario. The estimated number of symptomatic cases up to Aug 8, 2013, is 940 (95% CI 290-2200), indicating that at least 62% of human symptomatic cases have not been detected. We find that the case-fatality ratio of primary cases detected via routine surveillance (74%; 95% CI 49-91) is biased upwards because of detection bias; the case-fatality ratio of secondary cases was 20% (7-42). Detection of milder cases (or clinical management) seemed to have improved in recent months. Analysis of human clusters indicated that chains of transmission were not self-sustaining when infection control was implemented, but that R in the absence of controls was in the range 0·8-1·3. Three independent data sources provide evidence that R cannot be much above 1, with an upper bound of 1·2-1·5. By showing that a slowly growing epidemic is underway either in human beings or in an animal reservoir, quantification of uncertainty in transmissibility estimates, and provision of the first estimates of the scale of the epidemic and extent of case detection biases, we provide valuable information for more informed risk assessment. Medical Research Council, Bill & Melinda Gates Foundation, EU FP7, and National Institute of General Medical Sciences.
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The Middle East respiratory syndrome is caused by a coronavirus that was first identified in Saudi Arabia in 2012. Periodic outbreaks continue to occur in the Middle East and elsewhere. This report provides the latest information on MERS.
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South Korea is experiencing the largest outbreak of Middle East respiratory syndrome coronavirus infections outside the Arabian Peninsula, with 166 laboratory- confirmed cases, including 24 deaths up to 19 June 2015. We estimated that the mean incubation period was 6.7 days and the mean serial interval 12.6 days. We found it unlikely that infectiousness precedes symptom onset. Based on currently available data, we predict an overall case fatality risk of 21% (95% credible interval: 14–31). © 2015 European Centre for Disease Prevention and Control (ECDC). All rights reserved.
Article
Background: Scientific evidence suggests that dromedary camels are the intermediary host for the Middle East respiratory syndrome coronavirus (MERS-CoV). However, the actual number of infections in people who have had contact with camels is unknown and most index patients cannot recall any such contact. We aimed to do a nationwide serosurvey in Saudi Arabia to establish the prevalence of MERS-CoV antibodies, both in the general population and in populations of individuals who have maximum exposure to camels. Methods: In the cross-sectional serosurvey, we tested human serum samples obtained from healthy individuals older than 15 years who attended primary health-care centres or participated in a national burden-of-disease study in all 13 provinces of Saudi Arabia. Additionally, we tested serum samples from shepherds and abattoir workers with occupational exposure to camels. Samples were screened by recombinant ELISA and MERS-CoV seropositivity was confirmed by recombinant immunofluorescence and plaque reduction neutralisation tests. We used two-tailed Mann Whitney U exact tests, χ(2), and Fisher's exact tests to analyse the data. Findings: Between Dec 1, 2012, and Dec 1, 2013, we obtained individual serum samples from 10,009 individuals. Anti-MERS-CoV antibodies were confirmed in 15 (0·15%; 95% CI 0·09-0·24) of 10,009 people in six of the 13 provinces. The mean age of seropositive individuals was significantly younger than that of patients with reported, laboratory-confirmed, primary Middle Eastern respiratory syndrome (43·5 years [SD 17·3] vs 53·8 years [17·5]; p=0·008). Men had a higher antibody prevalence than did women (11 [0·25%] of 4341 vs two [0·05%] of 4378; p=0·028) and antibody prevalence was significantly higher in central versus coastal provinces (14 [0·26%] of 5479 vs one [0·02%] of 4529; p=0·003). Compared with the general population, seroprevalence of MERS-CoV antibodies was significantly increased by 15 times in shepherds (two [2·3%] of 87, p=0·0004) and by 23 times in slaughterhouse workers (five [3·6%] of 140; p<0·0001). Interpretation: Seroprevalence of MERS-CoV antibodies was significantly higher in camel-exposed individuals than in the general population. By simple multiplication, a projected 44,951 (95% CI 26,971-71,922) individuals older than 15 years might be seropositive for MERS-CoV in Saudi Arabia. These individuals might be the source of infection for patients with confirmed MERS who had no previous exposure to camels. Funding: European Union, German Centre for Infection Research, Federal Ministry of Education and Research, German Research Council, and Ministry of Health of Saudi Arabia.
Article
Abstract Applications of modern methods for analyzing data with missing values, based primarily on multiple imputation, have in the last half-decade become common in American politics and political behavior. Scholars in these fields have thus increasingly avoided the biases and ineciencies,caused by ad hoc methods like listwise deletion and best guess imputation. However, researchers in much of comparative politics and international relations, and others with similar data, have been unable to do the same because the best available imputation methods work poorly with the time-series cross-section data structures common in these fields. We attempt to rectify this situation. First, we build a multiple imputation model that allows smooth time trends, shifts across cross-sectional units, and correlations over time and space, resulting in far more accurate imputations. Second, we build nonignorable missingness models by enabling analysts to incorporate knowledge from area studies experts via priors on individual missing cell values, rather than on dicult-tointerpret model parameters. Third, because these tasks could not be accomplished within existing imputation algorithms, in that they cannot handle as many variables as needed even in the simpler cross-sectional data for which they were designed, we also develop a new algorithm that substantially expands the range of computationally feasible data types and sizes for which multiple imputation can be used. These developments also made it possible to implement the methods introduced here in freely available open source software that is considerably more reliable than existing algorithms.
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Relative risk is usually the parameter of interest in epidemiologic and medical studies. In this paper, the author proposes a modified Poisson regression approach (i.e., Poisson regression with a robust error variance) to estimate this effect measure directly. A simple 2-by-2 table is used to justify the validity of this approach. Results from a limited simulation study indicate that this approach is very reliable even with total sample sizes as small as 100. The method is illustrated with two data sets.