The Phylogeography of MERS-CoV in Hospital Outbreak-Associated Cases Compared to Sporadic Cases in Saudi Arabia

Epidemiology and evolution of Middle East respiratory syndrome coronavirus, 2012-2020

BACKGROUND

The ongoing transmission of the Middle East respiratory syndrome coronavirus (MERS-CoV) in the Middle East and its expansion to other regions are raising concerns of a potential pandemic. An in-depth analysis about both population and molecular epidemiology of this pathogen is needed.

METHODS

MERS cases reported globally as of June 2020 were collected mainly from World Health Organization official reports, supplemented by other reliable sources. Determinants for case fatality and spatial diffusion of MERS were assessed with Logistic regressions and Cox proportional hazard models, respectively. Phylogenetic and phylogeographic analyses were performed to examine the evolution and migration history of MERS-CoV.

RESULTS

A total of 2562 confirmed MERS cases with 150 case clusters were reported with a case fatality rate of 32.7% (95% CI: 30.9‒34.6%). Saudi Arabia accounted for 83.6% of the cases. Age of ≥ 65 years old, underlying conditions and ≥ 5 days delay in diagnosis were independent risk factors for death. However, a history of animal contact was associated with a higher risk (adjusted OR = 2.97, 95% CI: 1.10-7.98) among female cases < 65 years but with a lower risk (adjusted OR = 0.31, 95% CI: 0.18-0.51) among male cases ≥ 65 years old. Diffusion of the disease was fastest from its origin in Saudi Arabia to the east, and was primarily driven by the transportation network. The most recent sub-clade C5.1 (since 2013) was associated with non-synonymous mutations and a higher mortality rate. Phylogeographic analyses pointed to Riyadh of Saudi Arabia and Abu Dhabi of the United Arab Emirates as the hubs for both local and international spread of MERS-CoV.

CONCLUSIONS

MERS-CoV remains primarily locally transmitted in the Middle East, with opportunistic exportation to other continents and a potential of causing transmission clusters of human cases. Animal contact is associated with a higher risk of death, but the association differs by age and sex. Transportation network is the leading driver for the spatial diffusion of the disease. These findings how this pathogen spread are helpful for targeting public health surveillance and interventions to control endemics and to prevent a potential pandemic.

The quality of Internet information relating to 2019-nCov transmission control in dental practice

Background

To date, the quality of the Internet information regarding the control and management of 2019-nCov virus transmission in dental clinics has not been evaluated. The aim of this study was to evaluate the quality of Internet information about the control of 2019-nCov transmission in dental practice.

Material and Methods

Internet websites were identified daily using two search engines: Google and Yahoo! during the week from 20-06-2020 to 26-06-2020, applying the search term "2019-nCov transmission control in dental practice." The first 100 consecutive sites identified in each search were visited and classified. The quality of information contained in each website was analyzed using the Journal of the American Medical Association (JAMA) benchmarks, whether the website had been granted the Health on the Net Foundation Code of Conduct (HONcode), and a new tool for evaluating the quality of Internet websites providing information relating to 2019-nCov transmission control in dental practice, which awards a score of 0-40 points (8-13: poor; 14-26: medium; and 27-40 high).

Results

After the exclusion of duplicates, non-functioning websites, books/journals, irrelevant websites, or websites not in English, a total of 30 websites were evaluated. Only 6.66% fulfilled all four JAMA benchmarks, none had been granted the HONcode, and only 10% presented high quality information.

Conclusions

The quality of Internet information about 2019-nCov transmission control in dental practice is poor. This study points to the need to improve the quality of information available on the Internet relating to 2019-nCov transmission control in dental practice. Key words:2019-nCov, COVID-19, transmission control in dental practice, Internet, quality of information.