With more than 1,700 laboratory-confirmed infections, Middle East respiratory syndrome coronavirus (MERS-CoV) remains a significant threat for public health. However, the lack of detailed data on modes of transmission from the animal reservoir and between humans means that the drivers of MERS-CoV epidemics remain poorly characterized. Here, we develop a statistical framework to provide a comprehensive analysis of the transmission patterns underlying the 681 MERS-CoV cases detected in the Kingdom of Saudi Arabia (KSA) between January 2013 and July 2014. We assess how infections from the animal reservoir, the different levels of mixing, and heterogeneities in transmission have contributed to the buildup of MERS-CoV epidemics in KSA. We estimate that 12% [95% credible interval (CI): 9%, 15%] of cases were infected from the reservoir, the rest via human-to-human transmission in clusters (60%; CI: 57%, 63%), within (23%; CI: 20%, 27%), or between (5%; CI: 2%, 8%) regions. The reproduction number at the start of a cluster was 0.45 (CI: 0.33, 0.58) on average, but with large SD (0.53; CI: 0.35, 0.78). It was >1 in 12% (CI: 6%, 18%) of clusters but fell by approximately one-half (47% CI: 34%, 63%) its original value after 10 cases on average. The ongoing exposure of humans to MERS-CoV from the reservoir is of major concern, given the continued risk of substantial outbreaks in health care systems. The approach we present allows the study of infectious disease transmission when data linking cases to each other remain limited and uncertain.epidemic dynamics | mathematical modeling | zoonotic virus | animal reservoir | outbreaks

Background Coronavirus disease 2019 (COVID-19) is a contagious disease that is caused by severe acute respiratory coronavirus 2 (SARS-CoV-2). With the rapid spread of this pandemic, vaccination has been a breakthrough solution. At the time of conducting the study, COVID-19 vaccines were only approved for adults 18 years and older. Therefore, the aim of the study was to assess the parents’ likelihood of vaccinating their children once the recommendation for pediatric vaccination is established. Methods This was a cross-sectional study in which a self-administered survey was distributed to all parents visiting National Guard primary healthcare centers in Riyadh, Saudi Arabia. The questionnaires were distributed to parents attending primary care clinics. Data collected in the questionnaire include demographics (gender, marital status, educational level, and age), questions assessing parental perception towards the COVID-19 vaccine, and willingness to offer the vaccine to their children. Results A total of 333 respondents completed the survey with a response rate of 83.3%. Half of the participants were males and the other half were females with the majority (45.6%) aged between 31 and 40 years old. In terms of parental acceptability of vaccinating their children against COVID-19, 53.7% of the parents were willing to vaccinate their children as opposed to 27% who were reluctant to do so. Of those who refused, 97.5% and 96.6% cited lack of information and evidence, respectively, as the most common reasons for not accepting COVID-19 vaccine. We have found that age of the parents, especially those 31-40 years old, age of their children, especially 4-12 years old, and previous acceptance of the seasonal influenza vaccine were significantly associated with higher parental acceptability of COVID-19 vaccine. In contrast, gender, marital status and educational level were not statistically significant factors. Conclusion As COVID-19 spread globally and made people's lives in danger, vaccination became a highly important measure to halt the spread of the disease. Parents are now given the choice of protecting their beloved children from COVID-19 infection and its possible complications. Based on our findings, we noticed that majority of parents are going to vaccinate their children. In addition, some certain age groups of parents and children were significantly associated with decreased vaccine hesitancy to take the COVID-19 vaccine.

Objective: To explore the pediatricians' attitudes and perceptions toward do-not-resuscitate (DNR) orders in a specific region of the world not fully explored before. Methods: A cross-sectional study was conducted between March 4 and May 30, 2018. Pediatricians from three public hospitals in the city of Riyadh were asked to respond to a questionnaire consisting of 22 questions designed to meet the objectives of our study. Results: A total of 203 pediatricians (51.2% female) completed the questionnaire, both junior pediatricians (JPs) and senior pediatricians (SPs). A majority (58.9% of JPs and 61.4% of SPs) thought patients have the right to demand intensive care, despite their terminal illness. Half the participants in both groups thought that DNR is a physician's decision. Only 9.3% of JPs and 12.5% of SPs felt comfortable discussing DNR with patients/families. Medical school was also a source of knowledge on DNR issues, mainly for JPs (40.2% of JPs vs 20.8% of SPs, P=0.005). Half the participants felt that DNR is consistent with Islamic beliefs, while 57.9% of JPs vs 41.7% of SPs felt they are legally protected. Hospital policy was clear to 48.6% of JPs vs 66.7% of SPs, while procedure was clear to 35.5% of JPs vs 49% of SPs. Conclusion: Several factors are present that may hinder DNR implementation, such as doubts concerning being legally protected, doubts concerning consistency with Islamic sharia, unclear policies and procedures, and lack of training and orientation on DNR issues. Policies may need to include patients as decision-makers.

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