Spatial modelling of contribution of individual level risk factors for mortality from Middle East respiratory syndrome coronavirus in the Arabian Peninsula

Abstract

BackgroundMiddle East respiratory syndrome coronavirus is a contagious respiratory pathogen that is contracted via close contact with an infected subject. Transmission of the pathogen has occurred through animal-to-human contact at first followed by human-to-human contact within families and health care facilities.Data and methodsThis study is based on a retrospective analysis of the Middle East respiratory syndrome coronavirus outbreak in the Kingdom of Saudi Arabia between June 2012 and July 2015. A Geoadditive variable model for binary outcomes was applied to account for both individual level risk factors as well spatial variation via a fully Bayesian approach.ResultsOut of 959 confirmed cases, 642 (67%) were males and 317 (33%) had died. Three hundred and sixty four (38%) cases occurred in Ar Riyad province, while 325 (34%) cases occurred in Makkah. Individuals with some comorbidity had a significantly higher likelihood of dying from MERS-CoV compared with those who did not suffer comorbidity [Odds ratio (OR) = 2.071; 95% confidence interval (CI): 1.307, 3.263]. Health-care workers were significantly less likely to die from the disease compared with non-health workers [OR = 0.372, 95% CI: 0.151, 0.827]. Patients who had fatal clinical experience and those with clinical and subclinical experiences were equally less likely to die from the disease compared with patients who did not have fatal clinical experience and those without clinical and subclinical experiences respectively. The odds of dying from the disease was found to increase as age increased beyond 25 years and was much higher for individuals with any underlying comorbidities.ConclusionInterventions to minimize mortality from the Middle East respiratory syndrome coronavirus should particularly focus individuals with comorbidity, non-health-care workers, patients with no clinical fatal experience, and patients without any clinical and subclinical experiences.

Individual and network characteristic associated with hospital-acquired Middle East Respiratory Syndrome coronavirus

“…Older people seem to have been statistically more exposed to the disease at healthcare facilities than at other places which might be the result of a combination of senior people been admitted to the hospital more frequently due to their advanced age and having less active social interactions than younger people. This is consistent with previous findings that the chances of dying from the MERS grew with increasing age beyond 25 years [10]. It also confirms the common assumption that the danger of infection is greater for senior patients and, therefore, special attention needs to be paid to them.…”

“…By February 2018, a total of 2182 laboratory-confirmed MERS-CoV infections had been reported to the World Health Organization (WHO) [8]. The disease has now spread to over 27 countries with most index patients either residing or recently traveling to areas neighboring the Arabian Peninsula [9,10]. Similarly, the vast majority of the total cases (82%) occurred in KSA [8].…”

“…Forty-five day survival rate was lowest in patients older than 65 years (44.86%) [11]. Also, healthcare workers (HCW) are regularly exposed to MERS due to their regular contacts with MERS patients and are at greater risk of being infected; however, they are less likely to die of the disease [10,[12][13][14].…”

Factors associated with recovery delay in a sample of patients diagnosed by MERS‐CoV rRT‐PCR: A Saudi Arabian multicenter retrospective study

“…This finding could be attributed to several factors. MERS‐CoV is a serious illness and is very common in patients in the older age group and patients with pre‐existing medical conditions, and these seem to increase the risk of early mortality after diagnosis . Furthermore, most MERS‐CoV patients develop severe pneumonia and necessitate mechanical ventilation, which is a risk factor for hospital mortality …”

“…Much research evidence is available on factors associated with a poor prognosis in laboratory‐confirmed MERS‐CoV and non‐MERS‐CoV patients. A high mortality rate was systematically recognized in MERS‐CoV patients of old age, severe illness, underlying condition, and respiratory/gastrointestinal symptoms . However, successful management of MERS‐CoV such as clinical recovery and its predictors has not been given sufficient attention despite the virus having been in circulation since 2012.…”