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Surveillance and Testing for Middle East Respiratory Syndrome-Coronavirus, Saudi Arabia, March 2016 - March 2019


On March 2019, a team from United Stated, Centers for Disease Control and Prevention in collaboration with Saudi Field Epidemiology Training program. Initiated an assessment for MERS-CoV surveillance system in Saudi Arabia as the suspected case definition has been changed during 2018.


We conducted a cross-sectional study, surveillance system-based. We included all suspected and confirmed cases of MERS-CoV as identified by HESN database based on the 2015 and the updated 2018 definition criteria of suspected cases of MERS-CoV by the Saudi Ministry of Health. We estimated the number of suspected cases of MERS-CoV in Saudi Arabia as well as the prevalence of confirmed cases between March 2016- March 2019 based on the updated case definition of MERS-CoV.


A total of 200,936 suspected MERS-CoV cases were tested and reported. The majority of confirmed cases were males, aged 50-65 years, of Saudi nationality. Overall, and both before and after the definition change, the average monthly percentage of suspected cases testing positive was 0.3%. Peaks in positivity occurred in June 2016 (1.0%), June 2017 (0.9%), and February 2019 (0.9%). The highest positivity rate per population was reported in Al-Jouf city with 2.5 confirmed cases per 100,000 population per year. The highest proportion of suspected case-patients testing positive was in Hafr Al-Baten (1.2%) and the lowest in Makkah (0.06%). Additionally, the study period encompassed three Hajj pilgrimage seasons; during these periods, a total of 2,738 pilgrims were tested for MERS-CoV, and none tested positive. Lastly, A total of 5.6% of included participants were healthcare personnel, and the positive rate of MERS-CoV was higher among healthcare personnel (0.7%) compared to non-healthcare personnel (0.3%).


Our study provides valuable evidence regarding the trends of MERS-CoV in Saudi Arabia. Our findings highlighted that only a minority of suspected cases were actually diagnosed with MERS-CoV during the period of 2016 to 2019, meaning that the diagnostic procedures that have been implemented were seemingly highly sensitive and not highly specific.