Ziad A. Memish

Screening for Middle East respiratory syndrome coronavirus infection in hospital patients and their healthcare worker and family contacts: a prospective descriptive study

n Abstractn n The Saudi Arabian Ministry of Health implemented a pro-active surveillance programme for Middle East respiratory syndrome (MERS) coronavirus (MERS-CoV). We report MERS-CoV data from 5065 Kingdom of Saudi Arabia individuals who were screened for MERS-CoV over a 12-month period. From 1 October 2012 to 30 September 2013, demographic and clinical data were prospectively collected from all laboratory forms received at the Saudi Arabian Virology reference laboratory. Data were analysed by referral type, age, gender, and MERS-CoV real-time PCR test results. Five thousand and 65 individuals were screened for MER-CoV: hospitalized patients with suspected MERS-CoV infection (n = 2908, 57.4%), healthcare worker (HCW) contacts (n = 1695; 33.5%), and family contacts of laboratory-confirmed MERS cases (n = 462; 9.1%). Eleven per cent of persons tested were children (<17 years of age). There were 108 cases (99 adults and nine children) of MERS-CoV infection detected during the 12-month period (108/5065, 2% case detection rate). Of 108 cases, 45 were females (six children and 39 adults) and 63 were males (three children and 60 adults). Of the 99 adults with MERS-CoV infection, 70 were hospitalized patients, 19 were HCW contacts, and ten were family contacts. There were no significant increases in MERS-CoV detection rates over the 12-month period: 2.6% (19/731) in July 2013, 1.7% (19/1100) in August 2013, and 1.69% (21/1238) in September 2013. Male patients had a significantly higher MERS-CoV infection rate (63/2318, 2.7%) than females (45/2747, 1.6%) (p 0.013). MERS-CoV rates remain at low levels, with no significant increase over time. Pro-active surveillance for MERS-CoV in newly diagnosed patients and their contacts will continue.n n

Impact of the hajj on pneumococcal transmission

Over two million Muslim pilgrims assemble annually in Mecca and Medina, Saudi Arabia, to complete the Hajj. The large number of people in a crowded environment increases the potential for pneumococcal carriage amplification. We evaluated pneumococcal carriage prevalence with four cross-sectional studies conducted at beginning-Hajj (Mecca) and end-Hajj (Mina) during 2011 and 2012. A questionnaire was administered and a nasopharyngeal swab was collected. The swab was tested for pneumococcus, serotype and antibiotic resistance. A total of 3203 subjects (1590 at beginning-Hajj and 1613 at end-Hajj) originating from 18 countries in Africa or Asia were enrolled. The overall pneumococcal carriage prevalence was 6.0%. There was an increase in carriage between beginning-Hajj and end-Hajj cohorts for: overall carriage (4.4% versus 7.5%, prevalence ratio (PR) 1.7, 95% CI 1.3-2.3), and carriage of 23-valent pneumococcal polysaccharide vaccine serotypes (2.3% versus 4.1%, PR 1.8, 95% CI 1.2-2.7), 13-valent pneumococcal conjugate vaccine (PCV) serotypes (1.1% versus 3.6%, PR 3.2, 95% CI 1.9-5.6), 10-valent PCV serotypes (0.6% versus 1.6%, PR 2.6, 95% CI 1.2-5.3), antibiotic non-susceptible isolates (2.5% versus 6.1%, PR 2.5, 95% CI 1.7-3.6) and multiple non-susceptible isolates (0.6% versus 2.2%, PR 3.8, 95% CI 1.8-7.9). Fifty-two different serotypes were identified, most commonly serotypes 3 (17%), 19F (5%) and 34 (5%). These results suggest that the Hajj may increase pneumococcal carriage-particularly conjugate vaccine serotypes and antibiotic non-susceptible strains, although the exact mechanism remains unknown. The Hajj may therefore provide a mechanism for the global distribution of pneumococci.

Inappropriate antimicrobial use and potential solutions: a Middle Eastern perspective

Addressing the many challenges posed by escalating antimicrobial resistance requires a strategy at institutional, community, national, regional and international levels. Partners in the development of such a strategy should include representatives from clinical and veterinary medicine, public health, microbiology, animal husbandry, the pharmaceutical and agriculture industries as well as behavioral sciences. In the Middle East, antimicrobial resistance is a crisis at the present time. It stems from a wide range of problems; however, there are few studies from this region about factors associated with proliferating resistance. In this article, we explore inappropriate antimicrobial use in this part of the world and suggest possible solutions to mitigate the problem.

How great is the risk of Middle East respiratory syndrome coronavirus to the global population

Since the initial discovery of the Middle East respiratory syndrome coronavirus (MERS-CoV), there has been global concern about its threat to global health security and its pandemic potential. The virus was initially recovered from a patient from the Kingdom of Saudi Arabia (KSA) in September 2012 [1,2]. The virus was originally designated human coronavirus-Erasmus Medical Center [2] and was later called MERSCoV [3]. As of 30 August 2013, there were a total of 104 cases with 49 (47%) death [101]. The majority of these cases occurred in KSA, where 82 cases with 41 (50%) deaths [101]. In Saudi Arabia, there were two periods of disease activity [4]. The initial period was from June 2012 to 1 April 2013, and during that period, nine cases were reported mainly in the central and western part of the country. These cases occurred sporadically and included two family clusters. This reporting period was also significant for the lack of any transmission in health care setting. The second reporting period in Saudi Arabia was from 1 April 2013 to 14 July 2013 [4]. This period showed a cluster of 23 cases and these cases were linked to an outbreak in a health care facility in the eastern part of the country (Al-Hasa) [5]. In addition to Saudi Arabia [2,4–7], additional cases were reported from other countries such as Qatar [1], Jordan [8,102], the UK [9,10], Germany [11], France [12], Tunisia [103], UAE [13] and Italy [104]. MERS-CoV infection so far has three pattern of transmission. The first pattern is the occurrence of sporadic cases in different Middle East countries. The second pattern is nosocomial transmission within health care facilities to health care workers and other patients [4] and the third pattern is the occurrence of transmission as a family cluster [5,6,8,10,14,15]. The severity of reported cases of MERS-CoV ranges from mild disease to fulminant respiratory infection [4,5]. Less severe disease was described within family contacts and hospital clusters [5,6,15]. The clinical spectrum of MERS-CoV infections also includes asymptomatic and subclinical cases [16]. Asymptomatic and/or subclinical MERS-CoV cases are important since these cases may contribute to the transmission of MERS-CoV to close contacts within the community or the hospital setting cases [16]. In addition, the presence of these mild cases would inversely affect the reported high case fatality rates. The potential for respiratory tract infections during mass gatherings is related to the presence of a large number of people from different parts of the world in congested and crowded areas especially during the annual Muslim pilgrimage (the Hajj) [17,18]. Thus, the occurrence of the first cases, MERS-CoV, a few months before the 2012 Hajj season was a concern for international communities [19]. At that time, there was no human-to-human transmission, and there Editorial

Fruit and vegetable consumption among adults in Saudi Arabia, 2013

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Tuberculosis, Public Health Aspects

Tuberculosis (TB) is a leading cause of death among curable infectious diseases despite the availability of a cost-effective strategy, killing thousands of people in their most productive age and having a considerable impact in populations affected by HIV, poverty, malnutrition, poor living conditions, homelessness, as well as the current financial crisis and protracted military conflicts. Large epidemics of multidrug-resistant TB and extensively drug-resistant TB in some settings, the HIV epidemic, outbreaks in prisons, external and internal migration, challenges in weak health systems, and socioeconomic determinants of ill health contribute substantially to the global TB burden. This article discusses the global epidemiology of TB and the strategies to achieve the aspirational goal of TB control and elimination by the year 2050. It will also review progress toward the 2015 international targets established as part of the Millennium Development Goals and by the Stop TB Partnership, as well as the major threats the international community is currently facing.