Middle East Respiratory Syndrome Coronavirus, Saudi Arabia, 2017–2018

Middle East respiratory syndrome (MERS) coronavirus (MERS-CoV) epidemiology in Saudi Arabia is characterized by healthcare-associated outbreaks (1,2), occasional household-contact transmission (3), and sporadic cases without apparent links to other known cases (4,5). Since 2015, healthcare-associated transmission has decreased as infection prevention and control practices have improved (6); however, sporadic cases continue to be reported, often associated with contact with dromedaries (4,7). Surveillance and routine investigation of recent MERS cases are critical to monitor the epidemiology of this emerging pathogen. We characterized exposures and demographics of MERS cases reported to the Saudi Arabia Ministry of Health during July 1–October 31, 2017, and June 1–September 16, 2018, and performed molecular characterization of available specimens to describe circulating viruses during these periods.

We summarized demographics and exposures using Ministry of Health investigation data. To further characterize exposures among sporadic cases (no known epidemiologic link to a hospital outbreak or known case) reported during July 1–October 31, 2017, we conducted telephone interviews using a standardized questionnaire addressing demographics and activities during the 14 days before symptom onset (exposure period). For deceased or unavailable patients, we interviewed proxies. We did not conduct interviews for cases reported during June 1–September 16, 2018; this period was selected because of specimen availability. Cases were confirmed by testing respiratory specimens with MERS-CoV real-time reverse transcription PCR assays (8). We shipped 20 specimens to the US Centers for Disease Control and Prevention for genome sequence analysis (9).

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