Objectives The COVID-19 pandemic has had a substantial impact on health systems. The WHO Antimicrobial Resistance (AMR) Surveillance and Quality Assessment Collaborating Centres Network conducted a survey to assess the effects of COVID-19 on AMR surveillance, prevention and control. Methods From October to December 2020, WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) national focal points completed a questionnaire, including Likert scales and open-ended questions. Data were descriptively analysed, income/regional differences were assessed and free-text questions were thematically analysed. Results Seventy-three countries across income levels participated. During the COVID-19 pandemic, 67% reported limited ability to work with AMR partnerships; decreases in funding were frequently reported by low- and middle-income countries (LMICs; P < 0.01). Reduced availability of nursing, medical and public health staff for AMR was reported by 71%, 69% and 64%, respectively, whereas 67% reported stable cleaning staff availability. The majority (58%) reported reduced reagents/consumables, particularly LMICs (P < 0.01). Decreased numbers of cultures, elective procedures, chronically ill admissions and outpatients and increased ICU admissions reported could bias AMR data. Reported overall infection prevention and control (IPC) improvement could decrease AMR rates, whereas increases in selected inappropriate IPC practices and antimicrobial prescribing could increase rates. Most did not yet have complete data on changing AMR rates due to COVID-19. Conclusions This was the first survey to explore the global impact of COVID-19 on AMR among GLASS countries. Responses highlight important actions to help ensure that AMR remains a global health priority, including engaging with GLASS to facilitate reliable AMR surveillance data, seizing the opportunity to develop more sustainable IPC programmes, promoting integrated antibiotic stewardship guidance, leveraging increased laboratory capabilities and other system-strengthening efforts.

BACKGROUND Since the first isolation of Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia in 2012, sporadic cases, clusters, and sometimes large outbreaks have been reported. OBJECTIVE To describe the recent (2015) MERS-CoV outbreak at a large tertiary care hospital in Riyadh, Saudi Arabia. METHODS We conducted an epidemiologic outbreak investigation, including case finding and contact tracing and screening. MERS-CoV cases were categorized as suspected, probable, and confirmed. A confirmed case was defined as positive reverse transcription polymerase chain reaction test for MERS-CoV. RESULTS Of the 130 suspected cases, 81 (62%) were confirmed and 49 (38%) were probable. These included 87 patients (67%) and 43 healthcare workers (33%). Older age (mean [SD], 64.4 [18.3] vs 40.1 [11.3] years, P<.001), symptoms (97% vs 58%, P<.001), and comorbidity (99% vs 42%, P<.001) were more common in patients than healthcare workers. Almost all patients (97%) were hospitalized whereas most healthcare workers (72%) were home isolated. Among 96 hospitalized cases, 63 (66%) required intensive care unit management and 60 (63%) required mechanical ventilation. Among all 130 cases, 51 (39%) died; all were patients (51 [59%]) with no deaths among healthcare workers. More than half (54%) of infections were believed to be caught at the emergency department. Strict infection control measures, including isolation and closure of the emergency department, were implemented to interrupt the chain of transmission and end the outbreak. CONCLUSION MERS-CoV remains a major healthcare threat. Early recognition of cases and rapid implementation of infection control measures are necessary. Infect Control Hosp Epidemiol 2016;1-9.

Since the first diagnosis of Middle East respiratory syndrome (MERS) caused by the MERS coronavirus (MERS-CoV) in the Kingdom of Saudi Arabia in 2012, sporadic cases and clusters have occurred throughout the country (1). During June-August, 2015, a large MERS outbreak occurred at King Abulaziz Medical City, a 1,200-bed tertiary-care hospital that includes a 150-bed emergency department that registers 250,000 visits per year.In late June 2015, approximately 3 months after the last previously recognized MERS case in the hospital, a man aged 67 years with multiple comorbidities (diabetes, hypertension, congestive heart failure, and a history of coronary artery bypass graft surgery) and a 10-day history of fever and cough was evaluated in the emergency department ( Figure). The patient had no identified exposure to camels. A nasopharyngeal swab from the patient tested positive for MERS-CoV by reverse transcription-polymerase chain reaction (RT-PCR) (2). The patient was admitted and died in the hospital after 31 days. Although this patient's hospitalization overlapped with the onset of subsequent hospital-associated MERS cases, no direct links between this first case and any of the subsequent cases were identified.Approximately 3 weeks after the first patient's admission, a second patient, a man aged 56 years, with multiple comorbidities (diabetes with hypothyroidism, coronary artery disease, and hypertension with a history of coronary artery bypass surgery) and a history of camel exposure was evaluated in the emergency department for fever, cough, and shortness of breath. His nasopharyngeal specimen tested positive for MERS-CoV by RT-PCR. Three additional cases of MERS were epidemiologically linked to this patient's illness during his first week of hospitalization, including infections in two health care workers from the emergency department. An outbreak investigation was conducted by the hospital's infection control program to identify risk factors for infection and to develop and implement control measures. A suspected MERS case was defined as the occurrence of respiratory symptoms in a person with or without documented exposure to a patient with confirmed or probable MERS infection, but without confirmation by laboratory test results. A probable case was the occurrence of respiratory symptoms in a person with history of exposure to a patient with confirmed or probable MERS infection, but with inconclusive laboratory results (such as positive results by PCR on only one of the two genomic targets). A confirmed case was a suspected or probable case that was subsequently confirmed by a positive RT-PCR test for MERS-CoV. Contacts of persons with confirmed and probable cases were screened and persons with suspected cases were tested.A total of 130 MERS cases were detected at King Abulaziz Medical City during late June-late August. Among these cases, 81 (62%) were confirmed and 49 (38%) were probable, including 43 (33%) cases in health care workers; 20 of these 43 cases (47%) occurred in emergency department health care...

Aims/hypothesis At the same level of BMI, white people have less visceral adipose tissue (VAT) and are less susceptible to developing type 2 diabetes than Japanese people. No previous population-based studies have compared insulin resistance and insulin secretion between these two races in a standardised manner that accounts for VAT. We compared HOMA-IR, HOMA of beta cell function (HOMA-β%) and disposition index (DI) in US white men and Japanese men in Japan. Methods We conducted a population-based, cross-sectional study, comprising 298 white men and 294 Japanese men aged 40–49 years without diabetes. Insulin, glucose, VAT and other measurements were performed at the University of Pittsburgh. We used ANCOVA to compare geometric means of HOMA-IR, HOMA-β% and DI, adjusting for VAT and other covariates. Results White men had higher HOMA-IR, HOMA-β% and DI than Japanese men, and the difference remained significant (p<0.01) after adjusting for VAT (geometric mean [95% CI]): 3.1 (2.9, 3.2) vs 2.5 (2.4, 2.6), 130.8 (124.6, 137.3) vs 86.7 (82.5, 91.0), and 42.4 (41.0, 44.0) vs 34.8 (33.6, 36.0), respectively. Moreover, HOMA-IR, HOMA-β% and DI were significantly higher in white men even after further adjustment for BMI, impaired fasting glucose and other risk factors. Conclusions/interpretation The higher VAT-adjusted DI in white men than Japanese men may partly explain lower susceptibility of white people than Japanese people to developing type 2 diabetes. The results, however, should be interpreted with caution because the assessment of insulin indices was made using fasting samples and adjustment was not made for baseline glucose tolerance. Further studies using formal methods to evaluate insulin indices are warranted.