Risk Factors for Fatal Middle East Respiratory Syndrome Coronavirus Infections in Saudi Arabia: Analysis of the WHO Line List, 2013-2018

Am J Public Health. 2019 Sep;109(9):1288-1293. doi: 10.2105/AJPH.2019.305186. Epub 2019 Jul 18.


Objectives. To explore complex associations among demographic factors, risk factors, health care, and fatality rates of Middle East respiratory syndrome coronavirus (MERS-CoV) in the Kingdom of Saudi Arabia.Methods. We based this study on analysis of a publicly accessible line listing of 1256 MERS-CoV cases (2013 to October 2018) available on the World Health Organization's Web site. For analyses of demographic factors (e.g., age, gender), access to health care, promptness of laboratory services, risk factors (comorbidity, exposure to camels and persons with MERS-CoV), occupation (health care), and outcome (fatality), we used descriptive statistics, risk ratio (RR), and the Pearson χ2 test.Results. Presence of comorbidity (RR = 3; 95% confidence interval [CI] = 2.2, 3.9), being male (RR = 1.6; 95% CI = 1.2, 2.1), exposure to dromedary camels (RR = 1.6; 95% CI = 1.3, 2.3), and consumption of camel milk (RR = 1.5; 95% CI = 0.9, 1.7) can significantly increase risk for fatality. Health care workers have significantly lower fatality (P < .001) than the rest of the persons with MERS-CoV.Conclusions. Policies that promote health awareness for the high-risk population and their prompt seeking of health care should be considered. Publicly accessible line lists of infectious diseases such as MERS-CoV can be valuable sources for epidemiological analysis.

MeSH terms

  • Comorbidity
  • Coronavirus Infections / epidemiology*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle East Respiratory Syndrome Coronavirus*
  • Risk Factors
  • Saudi Arabia / epidemiology