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Risk Factors for Acquiring Middle East Respiratory Syndrome (MERS-CoV) at Emergency Rooms (ER) in a Major Hospital in Riyadh, Saudi Arabia


Commodities are important risk factors for Middle East Respiratory Syndrome from coronavirus (MERS-CoV), but the relative importance of different commodities has not been estimated. From June-September, 2015 an outbreak of MERS-CoV occurred in the Emergency Department (ED) of a hospital in Riyadh, Saudi Arabia. We assessed risk factors including 16 commodities for acquiring MERS-CoV from this ED outbreak.


All the 87 patients who developed pneumonia with a MERS-CoV positive RT-PCR were selected as cases. From the remaining 22,253 ED patients during the outbreak we selected 165 controls at random. We extracted comorbidities and exposures from medical records. Bivariate and multivariate (logistic regression) were used to estimate odds rations (OR) to quantitate the risk.


Bivariate analysis revealed associations of cases with the following: per location change in ED (OR=1.7, 95% CI: 1.4-2.0), and per each hour of stay in ED before symptoms of MERS (OR=1.3, 95% CI: .02-1.03), cancer (OR=18.4, 95% CI: 4.1-81.9), benign prostatic hypertrophy (OR=12.1, 95% CI: 1.4-102.6), kidney disease (OR=9.1, 95% CI: 4.1-20.4), chronic obstructive pulmonary (OR=8.25, 95% CI: 1.7-39.8), hypertension (OR=7.7, 95% CI: 4.3 -13.8), bed bound (OR=7.1, 95% CI: 1.5-35.1), heart disease (OR=6.6, 95% CI: 3.5-12.7), diabetes mellitus (OR=5.4, 95% CI: 1=3.1-9.5), hypothyroidism (OR=5.2, 95% CI: 1.6-17.2), cerebrovascular accident (OR=3.8, 95% CI: 1.5-9.4) and lung disease (OR=2.8, 95% CI: 1.3-5.8). Dyslipidemia, anemia, rheumatoid disease, obesity, and liver diseases were not associated. Multivariate analysis adjusted for age identified five associated comorbidities: hypothyroidism (OR = 22.3, p-value=0.002), cancer (OR = 8.2, p-value=0.036), kidney disease (OR = 4.8, p-value=0.014), heart disease (OR = 3.7, p-value= 0.026) and hypertension (OR = 3.4, p-value=0.031). 8.1% of cases had none of these five comorbidities.


These risk estimates limit and refine the existing information on risk of MERS. They will better inform preventive and clinical decisions on MERS CoV.