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Volume 25, Number 4—April 2019
Research

Middle East Respiratory Syndrome Coronavirus Infection Dynamics and Antibody Responses among Clinically Diverse Patients, Saudi Arabia

Hail M. Al-Abdely1, Claire M. Midgley1Comments to Author , Abdulrahim M. Alkhamis, Glen R. Abedi, Xiaoyan Lu, Alison M. Binder, Khalid H. Alanazi, Azaibi Tamin, Weam M. Banjar, Sandra Lester, Osman Abdalla, Rebecca M. Dahl, Mutaz Mohammed, Suvang Trivedi, Homoud S. Algarni, Senthilkumar K. Sakthivel, Abdullah Algwizani, Fahad Bafaqeeh, Abdullah Alzahrani, Ali Abraheem Alsharef, Raafat F. Alhakeem, Hani A. Aziz Jokhdar, Sameeh S. Ghazal, Natalie J. Thornburg, Dean D. Erdman, Abdullah M. Assiri, John T. WatsonComments to Author , and Susan I. Gerber
Author affiliations: Ministry of Health, Riyadh, Saudi Arabia (H.M. Al-Abdely, A.M. Alkhamis, K.H. Alanazi, W.M. Banjar, O. Abdalla, M. Mohammed, H.S. Algarni, A. Alzahrani, A.A. Alsharef, R.F. Alhakeem, H.A.A. Jokhdar, A.M. Assiri); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.M. Midgley, G.R. Abedi, X. Lu, A.M. Binder, A. Tamin, S. Lester, R.M. Dahl, S.K. Sakthivel, N.J. Thornburg, D.D. Erdman, J.T. Watson, S.I. Gerber); Princess Nourah Bint Abdulrahman University, Riyadh (W.M. Banjar); Prince Mohammed Bin Abdulaziz Hospital, Riyadh (A. Algwizani, F. Bafaqeeh, S.S. Ghazal)

Main Article

Table 1

Characteristics of MERS-CoV patients, by clinical severity outcome, Saudi Arabia, August 1, 2015–August 31, 2016*

Characteristic No. (%) patients
 p value†
Group 1, 
n = 13 Group 2, 
n = 7 Group 3, 
n = 12 Mortality, 
G1 and G2 vs. G3 Ventilation support, G1 vs. G2
Demographics
Sex
M 7 (54) 6 (86) 7 (58) 0.724 0.329
F 6 (46) 1 (14) 5 (42)
Nationality
Saudi 5 (38) 6 (86) 10 (83) 0.139 0.070
Non-Saudi 8 (62) 1 (14) 2 (17)
Age group, y
25–44 10 (77) 4 (57) 0 <0.001 0.548
45–64 3 (23) 2 (29) 7 (58)
>65 0 1 (14) 5 (42)
Median age (range), y
 33 (26–62)
 41 (30–73)
 62 (55–78)
<0.001
 0.047
Underlying conditions
None reported 10 (77) 0 0 0.004 0.003
Any reported underlying condition 3 (23) 7 (100) 11 (92)
Unknown underlying condition 0 0 1 (8)
DM‡ 3 (23) 4 (80) 11 (100) 0.001 0.047
DM and possible DM§ 3 (23) 6 (86) 12 (100) 0.002 0.047
Hypertension 1 (8) 2 (29) 11 (100) <0.001 0.270
Cardiac disease¶ 0 0 6 (55) 0.001 NA
Pulmonary disease# 0 2 (29) 2 (18) 0.602 0.111
On oxygen at home** 0 1 (14) 1 (9) 1.000 0.350
Renal disease†† 0 0 3 (27)   0.001 NA
Cardiac, pulmonary, or renal disease 0 2 (29) 9 (82) <0.001 0.111
History of cerebrovascular accident 1 (8) 0 3 (27) 0.318 1.000
Cancer in previous 12 mo
 0
 0
 1 (9)
0.355
 NA
Possible preillness exposure
Secondary,‡‡ healthcare personnel 5 (38) 0 0 NA NA
Secondary, household contact 4 (31) 1 (14) 1 (8) NA NA
Secondary, hospital visitor 2 (15) 1 (14) 2 (17) NA NA
Secondary, hospital inpatient 0 0 3 (25) NA NA
Any secondary exposure 11 (85) 2 (29) 6 (50) 0.249 0.022
Direct camel contact 0 0 2 (17)
Multiple possible exposures 0 1 (14) 0
No recognized risks§§ 2 (15) 4 (57) 4 (33)
Primary vs. secondary exposure¶¶
Primary## 2 (15) 4 (67) 6 (50) 0.452
 0.046
Secondary
 11 (85)
 2 (33)
 6 (50)
Symptoms before admission
Absence of symptoms 4 (31) 0 0 NA NA
Any reported symptom 9 (69) 7 (100) 12 (100) NA NA
Fever 8 (62) 6 (86) 11 (92) 0.212 0.354
Cough 7 (54) 6 (86) 10 (83) 0.422 0.329
Dyspnea 1 (8) 7 (100) 11 (92) 0.008 <0.001
Vomiting 4 (31) 2 (29) 2 (17) 0.676 1.000
Diarrhea 2 (15) 1 (14) 4 (33) 0.379 1.000
Sore throat 2 (15) 1 (14) 1 (8) 1.000 1.000
Rhinorrhea 1 (8) 1 (14) 1 (8) 1.000 1.000

*Group 1, on room air; group 2, ventilated but survived; group 3, died. CoV, coronavirus; DM, diabetes mellitus; MERS, Middle East respiratory syndrome; NA, not applicable.
†p values are for Fisher exact or Kruskall–Wallis tests comparing long-term and short-term.
‡Based on documented medical history of DM; comparison excludes 3 patients with possible DM status; group 1, n = 13; group 2, n = 5; group 3, n = 11.
§Includes 18 patients with a documented history of DM and 3 patients with possible DM status who exhibited multiple periods of hyperglycemia (random glucose readings >395 mg/dL) but who had no documented history of DM.
¶Cardiac disease includes congestive heart failure, coronary artery disease, a history of coronary artery bypass, or a history of myocardial infarction. Reports of isolated hypertension were not included.
#Pulmonary disease includes chronic obstructive pulmonary disease, asthma or reactive airway disease, or use of supplemental oxygen at home.
**Patients who were on supplemental oxygen at home (both patients were on bilevel positive airway pressure) required mechanical ventilation when hospitalized.
††Renal disease includes reports of chronic kidney disease.
‡‡Secondary exposure defined as reported contact with a known MERS case-patient.
§§No recognized risks defined as no reported contact with a known MERS case-patient or camel (direct or indirect contact).
¶¶Comparison excludes 1 patient with multiple exposures; group 2, n = 6.
##Primary exposure defined as no reported contact with a known MERS case-patient; includes direct camel contact and patients with no recognized risks.

Main Article

1These first authors contributed equally to this article.

Page created: March 18, 2019
Page updated: March 18, 2019
Page reviewed: March 18, 2019
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