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MERS-CoV Outbreak Investigation in King Khalid University Hospital, Riyadh, Feb-Mar, 2015


On 25th of February 2015, a total of 5 cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) were reported from King Khalid University Hospital (KKUH). This study aims to describe this outbreak, identify possible risk factors and test the possibility of using serum creatinine level in early detection of MERS-CoV.


A nested case-control study was conducted. A case was defined as any patient or healthcare worker present at KKUH during the period from 1st of Feb till 31st of Mar, 2015 who presented with symptoms of Community Acquired Pneumonia (CAP) or Hospital Acquired Pneumonia (HAP), was tested positive for MERS-CoV by nasopharyngeal swab and had elevated creatinine level before onset of symptoms. Data was collected through documented clinical records using a structured data collection instrument and interviews with healthcare personals. Odds ratios and 95% confidence intervals were calculated for hypothesis testing.


A total of 23 cases (13 healthcare workers and 10 non healthcare workers). 65% of the cases were females. 47.8% developed MERS-CoV pneumonia with case/fatality rate of 72.7% (34.8% in total). 91.3% were exposed to another MERS-CoV patient and 65.2% had their exposure in Emergency Room (ER). The most prominent risk factor among cases was hypertension (39.1% in total and 72.7% among pneumonia patients). 75% of MERS-CoV pneumonia cases had elevated creatinine level before onset of symptoms with OR of 67.86 (95%CI 3.116, 1478) when compared to MERS-CoV positives without pneumonia.


Emergency Room was the main medium for viral transmission maybe because of sub-optimal triage and infection control practices. Limiting access to ER was a key factor in limiting transmission of the virus. Results suggests that it might be possible to use creatinine level in early detection of MERS-CoV but it is recommended to perform a planned retrospective study with larger sample size to yield more accurate results.