Risks of Death and Severe Disease in Patients With Middle East Respiratory Syndrome Coronavirus, 2012-2015

Am J Epidemiol. 2016 Sep 15;184(6):460-4. doi: 10.1093/aje/kww013. Epub 2016 Sep 8.


Middle East respiratory syndrome coronavirus (MERS-CoV) is an emerging pathogen, first recognized in 2012, with a high case fatality risk, no vaccine, and no treatment beyond supportive care. We estimated the relative risks of death and severe disease among MERS-CoV patients in the Middle East between 2012 and 2015 for several risk factors, using Poisson regression with robust variance and a bootstrap-based expectation maximization algorithm to handle extensive missing data. Increased age and underlying comorbidity were risk factors for both death and severe disease, while cases arising in Saudi Arabia were more likely to be severe. Cases occurring later in the emergence of MERS-CoV and among health-care workers were less serious. This study represents an attempt to estimate risk factors for an emerging infectious disease using open data and to address some of the uncertainty surrounding MERS-CoV epidemiology.

Keywords: MERS-CoV; Middle East respiratory syndrome coronavirus; coronaviruses; emerging infections; respiratory infections; zoonotic infections.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Animals
  • Child
  • Child, Preschool
  • Communicable Diseases, Emerging / epidemiology*
  • Communicable Diseases, Emerging / mortality
  • Communicable Diseases, Emerging / virology
  • Comorbidity
  • Coronavirus Infections / mortality*
  • Coronavirus Infections / physiopathology
  • Coronavirus Infections / transmission
  • Databases, Factual
  • Female
  • Health Personnel / statistics & numerical data
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Middle East Respiratory Syndrome Coronavirus / pathogenicity
  • Occupational Diseases / epidemiology*
  • Occupational Diseases / mortality
  • Occupational Diseases / virology
  • Poisson Distribution
  • Risk Factors
  • Severity of Illness Index
  • Sex Distribution
  • Young Adult
  • Zoonoses / epidemiology*
  • Zoonoses / mortality
  • Zoonoses / virology