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Jamal Ahmadzadeh, Kazhal MobarakiSocial Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, IranCorrespondence: Kazhal MobarakiEpidemiologist in Social Determinants of Health Research Center, Urmia University of Medical Sciences, Resalat Street, Urmia, IranTel +98 918 173 2869Fax +98 443 224 0642Email Mobaraki.k@umsu.ac.irPurpose: This study represents the current epidemiological status of Middle East respiratory syndrome coronavirus (MERS-CoV) worldwide in the first three months of 2019.Patients and methods: Full details of the MERS-CoV cases available and published in the disease outbreak news on the WHO website were retrieved. Related details of laboratory-confirmed MERS-CoV were extracted and analyzed by standard statistical methods.Results: A total of 107 cases of MERS-CoV, including 18 deaths (overall case fatality rate (CFR), 16.8%; male-specific CFR was 17.5% [14/80] and female-specific CFR was 14.8% [4/27]) were reported to WHO from the National International Health Regulation Focal Points of Saudi Arabia and Oman. The overall mean age was 50±17 years and 80 patients (74.8%) were male. The average time from the onset of the symptoms to the first hospitalization was 3±3.3 days; from the first hospitalization to laboratory confirmation was 3.6±6.5 days; from the onset of symptom to death was 17.5±11.7 days; and the mean length of hospitalization forpatients with MERS-CoV was 3.5±3.9 days. Males in comparison to females had a 1.5-fold increased chance (adjusted OR =1.5 [95% CI: 1.3–1.8]) of death related to MERS-CoV infection; 1.05 [95% CI: 1.1–3.3], 1.05 [95% CI: 1.2–2.8] and 1.06 [95% CI: 1.2–2.0] for those who had exposure to camels, camel milk consumption, and close contact with MERS-CoV cases, respectively. Health care workers had 2.4 fold [95% CI: 1.2–3.1] greater odds of death compared to other people.Conclusion: The knowledge obtained from this study can contribute to the development of a prevention program and early system warning against MERS-CoV infection.Keywords: Middle East respiratory syndrome coronavirus, emerging infectious disease, disease outbreaks

Maryam Salamatbakhsh,1 Kazhal Mobaraki,2 Jamal Ahmadzadeh2 1Critical Care Nursing, Urmia University of Medical Sciences, Urmia, Iran; 2Epidemiologist in Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, IranCorrespondence: Jamal AhmadzadehEpidemiologist in Social Determinants of Health Research Center, Urmia University of Medical Sciences, Resalat Street, Urmia, IranTel +98-9143444924Fax +98-4432240642Email ahmadzadeh.j@umsu.ac.irAbstract: This commentary presents a novel outlook for public health authorities in the affected countries to detect and respond quickly to the emerging public health threats such as Middle East respiratory syndrome coronavirus (MERS-CoV). Implementing an innovative electronic surveillance system called syndromic surveillance system is essential for global health security.Keywords: syndromic surveillance system, traditional surveillance system, Middle East respiratory syndrome

This commentary provides a quick overview to 2019 novel coronavirus (COVID-19) and other emerging viruses in recent decades. All the evidence related to emerging infections suggests that we are faced with unknown threats and challenges in the epidemiological and heath transition. The coronaviruses already identified such as severe acute respiratory syndrome coronavirus (SARS-COV), Middle East respiratory syndrome coronavirus (MERS-COV), and nowadays COVID-19, may only be the tips of the icebergs, and probably more novel and severe emerging infections might be revealed in the near future in the humans’ communities.

Background It has been 8 years since the first case of Middle East respiratory syndrome coronavirus (MERS-CoV) was reported in Saudi Arabia and the disease is still being reported in 27 countries; however, there is no international study to estimate the overall burden related of this emerging infectious disease. The present study was conducted to assess the burden of premature mortality due to Middle East respiratory syndrome (MERS) worldwide. Methods In this retrospective analysis, we have utilized publicly available data from the WHO website related to 1789 MERS patients reported between September 23, 2012 and May 17, 2019. To calculate the standard expected years of life lost (SEYLL), life expectancy at birth was set according to the 2000 global burden of disease study on levels 25 and 26 of West model life tables from Coale-Demeny at 82.5 and 80 years for females and males, respectively. Results Overall, the total SEYLL in males and females was 10,702 and 3817.5 years, respectively. The MERS patients within the age range of 30–59 year-olds had the highest SEYLL (8305.5 years) in comparison to the patients within the age groups 0–29 (SEYLL = 3744.5 years) and ≥ 60 years (SEYLL = 2466.5 years). The total SEYLL in all age groups in 2012, 2013, 2014, 2015, 2016, 2017, 2018, and 2019 were 71.5, 2006.5, 3162, 4425.5, 1809.5, 878, 1257.5 and 909 years, respectively. The most SEYLL related to MERS-CoV infection was in the early four years of the onset of the pandemic (2012 to 2015) and in the last four years of the MERS-CoV pandemic (216 to 2019), a significant reduction was observed in the SEYLL related to MERS-CoV infection in the MERS patients. Conclusion We believe that the findings of this study will shed light about the burden of premature mortality due to MERS infection in the world and the results may provide necessary information for policy-makers to prevent, control, and make a quick response to the outbreak of MERS-CoV disease.

Javad Aghazadeh-Attari,1 Iraj Mohebbi,2 Behnam Mansorian,2 Jamal Ahmadzadeh,1 Mohammad Mirza-Aghazadeh-Attari,3 Kazhal Mobaraki,1 Sima Oshnouei1 1Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran; 2Social Determinants of Health Research Center, Occupational Medicine Center, Urmia University of Medical Sciences, Urmia, Iran; 3Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Background: Middle East respiratory syndrome coronavirus (MERS-CoV) is an emerging threat to global health security with high intensity and lethality. This study was conducted to investigate epidemiological factors and patterns related to this disease.Methods: Full details of MERS-CoV cases available on the disease outbreak news section of the World Health Organization official website from January 2013 to November 2016 were retrieved; demographic and clinical information, global distribution status, potential contacts, and probable risk factors for the mortality of laboratory-confirmed MERS-CoV cases were extracted and analyzed by following standard statistical methods.Results: Details of 1,094 laboratory-confirmed cases were recorded, including 421 related deaths. Significant differences were observed in the presentation of the disease from year to year, and all studied parameters differed during the years under study (all P-values

Emerging infections represent a concern especially when their increase is rapid and their mortality is high [1].

Risk factors associated with Middle East respiratory syndrome coronavirus (MERS-CoV) infection outcome were established by analyses of WHO data from September 23, 2012 to 18 June 2018. Of the 2220 reported cases, 1408 cases, including 451 MERS-CoV deaths, were analyzed. The case fatality rate was 32% (95% CI: 29.4–34.5). Compared to MERS patients ≤30 years old, those with >30 years had the adjusted odds ratio estimate for death of 2.38 [95% CI: 1.75–3.22]. This index was 1.43 [95% CI: 1.06–1.92] for Saudi patients in comparison to non-Saudi; 1.76 [95% CI: 1.39–2.22] for patient with comorbidity in comparison to those without comorbidity; 0.58 [95% CI: 0.44–0.75] for those who had close contact to a camel in the past 14 days and 0.42 [95% CI: 0.31–0.57] for patients with >14 days with onset of signs and hospital admission compared to patients with ≤14 days.