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Background The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) infection had been investigated utilizing serology. Materials and methods This community-based sero-survey was carried out in the neighborhoods of three cities in Saudi Arabia. Results Of 5629 participants, 2766 (49.1%) were women; and 2148 (38.1%) were 18–34 years of age, and 3645 (64.7%) were from South East Asia. Positive serology was seen in 2825 (50.2% (95% CI: 48.8–51.5%) for SARS-CoV-2 anti-S1 IgG antibodies by ECLIA. Being in the age category of 18–34 years and being from Eastern Mediterranean Region (country A) were associated with higher COVID-19 seropositivity with estimated odds ratio of 1.3 [95% CI 1.1–1.8] and 2.5 [95% CI 1.1.5–4.2] respectively. Gender, social status, education, nationality, symptoms, presence of comorbidities and activity style were positively associated with increased seropositivity. Factors associated negatively with the rate of seropositivity were higher education and having outdoor activity with estimated OR of 0.92 [95% CI 0.46–0.95] and 0.59 [95% CI 0.47–0.74], respectively. Conclusion The study showed high seroprevalence of SARS-CoV-2 among high density population. Health education campaigns should target middle-aged, those with low education, those living in lower standards and indoor workers.

The prevalence of Middle East respiratory syndrome coronavirus (MERS-CoV) infection during the period of coronavirus disease 2019 (COVID-19) remains uncertain.This study aimed to provide an update on the epidemiology of MERS-CoV in Saudi Arabia from January 2019 to October 2020.Data on all laboratory-confirmed cases of MERS-CoV infection in Saudi Arabia from January 2019 to 20 October 2020 were retrieved from the Health Electronic Surveillance Network of the Ministry of Health of Saudi Arabia. Data collected were: demographic characteristics of cases, clinical course of the infection, related mortality and association with exposure to confirmed cases or camels.In total, 299 cases of MERS-CoV infection were reported in the study period. The mean age of cases was 52.4 years. Most of the cases were males (78.9%) and had comorbidities (72.7%), and 11.9% of cases were health care providers. Of the 299 cases, 83 (27.7%) died. Older age and having comorbidities were associated with higher mortality. Exposure to camels was associated with lower mortality. Health care providers also had a lower mortality rate than non-health care providers. Compared with COVID-19, MERS-CoV infection still has a higher mortality rate but with a more predictable pattern and an anticipated deterioration.MERS-CoV infection remains a public health concern. The percentage of cases that were health care providers (11.9%) is lower than previously reported (19.1-25.0%), possibly due to the various preventive measures put in place to control COVID-19.فيروس كورونا المسبب لمتلازمة الشرق الأوسط التنفسية في حقبة كوفيد-19: تحديث من المملكة العربية السعودية، 2019–2020.أنس خان، شرف الدين بن نفيسه، بندر مزاحم، بخيتة العيد، دالية المطرفي، عبد الله عسيري، هاني جوخدار.ما زال معدل انتشار العدوى بفيروس كورونا المسبب لمتلازمة الشرق الأوسط التنفسية خلال حقبة مرض فيروس كورونا 2019 (كوفيد-19) غير مؤكد.هدفت هذه الدراسة إلى تقديم أحدث المعلومات عن الخصائص الوبائية لفيروس كورونا المسبب لمتلازمة الشرق الأوسط التنفسية في المملكة العربية السعودية في الفترة من يناير / كانون الثاني 2019 وحتى أكتوبر/ تشرين الأول 2020.جُعت بيانات جميع الحالات المؤكدة مختبريًا لعدوى فيروس كورونا المسبب لمتلازمة الشرق الأوسط التنفسية في المملكة العربية السعودية من يناير / كانون الثاني 2019 وحتى أكتوبر/ تشرين الأول 2020 من نظام "حصن" الإلكتروني التابع لوزارة الصحة في المملكة العربية السعودية. وتمثلت البيانات التي جُعت في: الخصائص السكانية للحالات، والمسار السريري للعدوى، والوفيات ذات الصلة وارتباطها بالتعرض للحالات المؤكدة أو الإبل.إجما لً، أُبلِغ بوجود 299 حالة عدوى بفيروس كورونا المسبب لمتلازمة الشرق الأوسط التنفسية أثناء فترة الدراسة. وكان متوسط عمر الحالات 52.4 عامًا. وكانت معظم الحالات من الذكور (78.9٪)، وكانت لديهم اعتلالات مصاحبة (72.7٪)، فيما كان 11.9٪ من الحالات من مقدمي الرعاية الصحية. ومن بين 299 حالة تُوفِّيت 83 (27.7٪). وارتبط التقدم في العمر ووجود اعتلالات مصاحبة بارتفاع معدل الوفيات. وارتبط التعرض للإبل بانخفاض معدل الوفيات. كما كان معدل الوفيات في صفوف مقدمي الرعاية الصحية أقل منه في صفوف غير مقدمي الرعاية الصحية. وبالمقارنة مع كوفيد-19، لا يزال معدل الوفيات الناجمة عن عدوى فيروس كورونا المسبب لمتلازمة الشرق الأوسط التنفسية أكثر ارتفاعًا، ولكنه يسير بنمط أكثر قابلية للتنبؤ به وبتدهور أكثر توقعًا.لا تزال عدوى فيروس كورونا المسبب لمتلازمة الشرق الأوسط التنفسية تسبب قلقًا صحيًا عامًا. وتقل نسبة الحالات التي كانت في صفوف مقدمي خدمات الرعاية الصحية (11.9٪) عما سبق التبليغ به (19.1-25.0٪)، وربما يعود ذلك إلى مختلف التدابير الوقائية التي اتُّذَت لمكافحة كوفيد-19.Le coronavirus du syndrome respiratoire du Moyen-Orient à l'ère de la COVID-19 : le point sur la situation en Arabie saoudite en 2019-2020.La prévalence de l'infection par le coronavirus du syndrome respiratoire du Moyen-Orient (MERS-CoV) pendant la pandémie de maladie à coronavirus 2019 (COVID-19) reste incertaine.La présente étude visait à faire le point sur l'épidémiologie du MERS-CoV en Arabie saoudite entre janvier 2019 et octobre 2020.Les données sur tous les cas d'infection par le MERS-CoV en Arabie saoudite, confirmés en laboratoire, entre janvier 2019 et le 20 octobre 2020 ont été extraites du réseau de surveillance électronique sanitaire du ministère saoudien de la Santé. Les données recueillies étaient les suivantes : caractéristiques démographiques des cas, évolution clinique de l'infection, mortalité associée et lien avec une exposition à des cas confirmés ou à des chameaux.Au total, 299 cas d'infection par le MERS-CoV ont été rapportés pendant la période de l'étude. L'âge moyen des personnes concernées était de 52,4 ans. La plupart des cas étaient de sexe masculin (78,9 %) et présentaient des comorbidités (72,7 %) ; 11,9 % des cas étaient des prestataires de soins de santé. Sur les 299 cas, 83 (27 , 7 %) sont décédés. Un âge avancé et la présence de comorbidités étaient des facteurs associés à une mortalité plus élevée. En revanche, l'exposition à des chameaux était corrélée à une moindre mortalité. Le taux de mortalité des prestataires de soins de santé était également inférieur à celui du reste des sujets. Par rapport à la COVID-19, l'infection par le MERSCoV présente toujours un taux de mortalité plus élevé, mais affiche un schéma plus prévisible et un processus de détérioration de l'état anticipé.L'infection par le MERS-CoV demeure un problème de santé publique. Le pourcentage des cas correspondant à des prestataires de soins de santé (11,9 %) est inférieur aux valeurs rapportées précédemment (19,1-25,0 %), peut-être grâce aux différentes mesures de prévention mises en place pour lutter contre la COVID-19.

Introduction The novel coronavirus (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a single-chain ribonucleic acid (RNA) virus. As of March 25, 2021, the total number of positive cases and fatalities in the Kingdom of Saudi Arabia (KSA) had reached 386,300 and 6624, respectively, with a case fatality rate of 1.71%. The KSA was among the leading nations to heed the advice of WHO officials and put strict precautionary and preventive measures in place to curb the early spread of COVID-19 before it was declared a global pandemic. Methodology This was an uncontrolled before-after study following a mixed-method approach for data collection. National and regional data were extracted from the Health Electronic Surveillance Network (HESN), a centralized public health collection system for quantitative and statistical data. Quantitative and qualitative methods have been utilized in studying data derived from tech media. Results The Saudi authorities utilized different technological tools to aid in managing and combating the COVID-19 pandemic. In the case of Al Madinah Al Mounawarah, after the implementation of several technologies, the most important being Tawakkalna, the number of active daily cases decreased by 61%. Conclusion The use of the Tawakkalna application was proven to be a successful method in fighting the COVID-19 pandemic in the KSA. This vital and essential experience warrants the use of different digital technology that offers a personalized profile displaying the person's status (affected, vaccinated, or no history of infection). This application played and will continue to play a crucial and effective role in pandemic containment in Saudi Arabia.

Objectives:To assess the hospital beds and intensive care unit (ICU) beds with a ventilator surge capacity of the health system in Kingdom of Saudi Arabia (KSA) during the coronavirus disease (COVID-19) pandemic.Methods:This study used relevant data from the National Health Emergency Operation Center to estimate general hospital and ICU bed surge capacity and tipping points under 3 distinct transmission scenarios.Results:The study results reveal that hospitals in the KSA need to be supplied with additional 4372 hospital beds to care for COVID-19 positive cases if the pandemic continues over a 6 months’ period. At the same time, it requires additional 2192 or 1461 hospital beds if the pandemic persists over a 12- or 18-month period, respectively, to manage hospitalized COVID-19 overloads. The health system surge capacity would suffer from a shortage of 1600, 797, and 540 ICU beds under the 3 transmission scenarios to absorb critical and intensive care COVID-19 cases.Conclusion:Our findings highlight the urgent need for additional hospital and ICU beds in the face of critical COVID-19 cases in KSA. The study recommends further assessment measures to the health system surge capacity to keep the Saudi health system prepared during the COVID-19 pandemic.

Highlights • Among blood donors in May 2020, te overall seroprevalence of anti-SARS-CoV-2 antibodies was 1.4% • Non-citizens had higher prevalence compared to citizens (odds ratio 13.6, p = 0.001). • There was geographic variation in seroprevalence of anti-SARS-CoV-2 antibodies within Saudi Arabia, Background Serologic testing provides better understanding of SARS-CoV-2 prevalence and its transmission. This study is the first investigation of the prevalence of antibodies to SARS-CoV-2 among blood donors in Saudi Arabia. Objective To estimate the seroprevalence of anti-SARS-CoV-2 antibodies among blood donors in Saudi Arabia during the early phase of the current pandemic. Methods Serology results and epidemiological data were analyzed for 837 adult blood donors, with no confirmed SARS-CoV-2 infection, in Saudi Arabia from 20 to 25 May 2020. Seroprevalence was determined using electrochemical immunoassay for detecting anti-SARS-CoV-2 antibodies. Results The overall seroprevalence of anti-SARS-CoV-2 antibodies was 1.4% (12/837). Non-citizens had higher prevalence compared to citizens (odds ratio 13.6, p = 0.001). Having a secondary education as the highest level of education was also significantly associated with high seroprevalence compared to higher education (odds ratio 6.8, p = 0.005). The data showed that the highest seroprevalence was in Makkah (8.1%), Madinah (4.1% with an OR of 0.48 (95% CI: 0.12-1.94), Jeddah (2.3%; OR 0.27; 95%CI: 0.31-2.25), and Qassim (2.9 %, OR: 0.34; 95%CI: 0.04-2.89) and these were not statistically different from the seroprevalence in Makkah region. Conclusions At the early stage of the pandemic in Saudi Arabia, the seroprevalence of antibodies to SARS-CoV-2 among blood donors was low but was higher among non-citizens These findings showed that non-citizens and the less educated may be less attentive to preventive measures. Monitoring seroprevalence trend over time require repeated sampling.

Yasir Almuzaini,1 Abdulaziz Mushi,1 Alhanouf Aburas,1 Yara Yassin,1 Fahad Alamri,1 Ahmed Alahmari,1 Saber Yezli,1 Anas A Khan,1,2 Hani A Jokhdar3 1Global Center for Mass Gatherings Medicine, Ministry of Health, Riyadh, 12341, Saudi Arabia; 2Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, 12372, Saudi Arabia; 3Deputyship of Public Health, Ministry of Health, Riyadh, 11461, Saudi ArabiaCorrespondence: Yasir AlmuzainiGlobal Center for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi ArabiaTel +966567761011Email Almuzaini.Yasir1@gmail.comPurpose: The novel coronavirus (COVID-19), declared a pandemic by WHO in March 2020, is an unprecedented occurrence in our recent history. Effective risk communication by health authorities, through relaying reliable and authoritative information, is imperative in combating the spread of the outbreak. We aimed to measure the effectiveness of risk communication campaign and overall awareness during COVID-19 pandemic among the general population in Saudi Arabia.Patients and Methods: A cross-sectional survey of 5472 individuals in Saudi Arabia was conducted to assess several factors regarding the risk communication messages during the COVID-19 pandemic, including the knowledge and response of the general population toward COVID-19 and MoH efforts. The questionnaire was divided into five main sections: general knowledge of COVID-19, channels and social media platforms used perceived risk and stress or panic toward COVID-19, satisfaction and community perception, most trusted source of information, and type of information received.Results: A total of 5472 individuals participated in the study residing in Saudi Arabia. Overall knowledge of COVID-19 was determined to be above average (0.58 + 0.159). Of the general population, 57.1% perceived that the risk of getting sick with COVID-19 is low, while nearly half of the respondents (45.7%) have a high level of stress and panic toward COVID-19. The majority of responders to the questionnaire reinforced that MoH was their most trusted source of information for the COVID-19 pandemic (91.7%).Conclusion: This study showed that the risk communication campaign by healthcare authorities during the COVID-19 pandemic has improved the awareness among the general population in Saudi Arabia, where the overwhelming majority placed high trust in the MoH as its main reference for COVID-19 information.Keywords: COVID-19, risk communication, awareness, Saudi Arabia

The rapid emergence of the novel coronavirus disease 2019 (COVID-19) has resulted in millions of infected patients and hundreds of thousands of deaths worldwide. Health care services delivery is being compromised due to the surge in the number of infected patients during this pandemic.This study aimed to assess the risk factors associated with poor prognosis among COVID-19 patients in Saudi Arabia.This was a multi-centre retrospective cohort study that included all laboratory-confirmed COVID-19 cases with definitive outcomes in Saudi Arabia during March 2020. Demographic, clinical history, comorbidity and outcomes data were retrieved from the National Health Electronic Surveillance Network (HESN) database. We used logistic regression models to calculate crude and adjusted odds ratios (OR) to explore risk factors for critical outcomes (intensive care unit admission or death) among COVID-19 cases.We included 648 COVID-19-positive patients with a median age of 34 years. Of these, 11.9% were in the critical group. Risk factors associated with worse outcomes included males (OR=1.92), age60 years (OR=3.65), cardiac diseases (OR=3.05), chronic respiratory diseases (OR=2.29), and cases with two or more comorbidities (OR=2.57) after adjusting for age and sex; all had significant P-values0.05.Independent risk factors for critical outcomes among COVID-19 cases include old age, males, cardiac patients, chronic respiratory diseases, and the presence of two or more comorbidities. We recommend designing a unique multi-item scale system to prognosticate COVID-19 patients.عوامل الخطر المرتبطة بالنتائج السيئة لمرض كوفيد-19 : دراسة بأثر رجعي في المملكة العربية السعودية.أنس خان، صقر الثنيان، يوسف الصفيان، رائد العتيبي، عبد الله مبارك، محمد عرفات، عبد الله عسيري، هاني جوخدار.أدى الانتشار السريع لفيروس كورونا المستجد 2019 (كوفيد-19) إلى إصابة الملايين من المرضى ووقوع مئات الآلاف من الوفيات في جميع أنحاء العالم. فقد تأثرت خدمات الرعاية الصحية المقدمة سلباً نظراً للازدياد المفاجئ في أعداد المرضى المصابين خلال الجائحة.هدفت هذه الدراسة إلى تقييم عوامل الخطر المرتبطة بالنتائج السيئة لمرضى كوفيد-19 في المملكة العربية السعودية.أجرينا دراسة حشدية رجعية متعددة المراكز شملت جميع حالات كوفيد-19 المؤكدة نتائجهم بالتحاليل المخبرية ولهم نتائج نهائية خلال شهر مارس/آذار في المملكة العربية السعودية. وتم جمع البيانات السكانية والتاريخ الإكلينيكي والأمراض المصاحبة والنتائج من قاعدة بيانات النظام الإلكتروني للترصد الوبائي (حصن). وتم استخدام نماذج الانحدار اللوجيستي لحساب نسب الأرجحية الخام والمعدّلة لاستكشاف عوامل الخطر المصاحبة للنتائج الحرجة لحالات كوفيد-19 (التنويم في وحدة العناية المركزة أو الوفاة).تضمنت الدراسة 648 مريضًا إيجابيًا بكوفيد-19 بمتوسط أعمار 34 عامًا. منهم 11.9٪ في المجموعة الحرجة. وشملت عوامل الخطر المرتبطة بالنتائج السيئة الذكور (نسبة الأرجحية=1.92)، العمر60 عامًا (نسبة الأرجحية=3.65)، أمراض القلب (نسبة الأرجحية=3.05)، الأمراض التنفسية المزمنة (نسبة الأرجحية=2.29)، والحالات المصابة المرتبطة بمرضين مصاحبين أو أكثر (نسبة الأرجحية=2.57) بعد تعديل العمر والجنس؛ وكانت القيمة الاحتمالية لكل منهم ذات أهمية إحصائية0.05.تشمل عوامل الخطر المستقلة المرتبطة بالنتائج الحرجة لمرضى كوفيد-19 : التقدم في السن والذكور ومرضى القلب والأمراض التنفسية المزمنة والحالات المصابة المرتبطة بمرضين مصاحبين أو أكثر. ونوصي بتصميم نظام مقياس فريد متعدد العناصر للتنبؤ بالحالة الصحية لمرضى كوفيد-19.Facteurs de risque associés à une détérioration des résultats pour la COVID-19 : étude rétrospective en Arabie saoudite.L’ émergence rapide de la maladie à nouveau coronavirus 2019 (COVID-19) a entraîné l’infection de millions de patients et des centaines de milliers de décès dans le monde entier. La prestation des services de soins de santé est mise à mal en raison de l’augmentation massive du nombre de patients infectés pendant cette pandémie.La présente étude visait à évaluer les facteurs de risque associés à un mauvais pronostic chez les patients atteints de COVID-19 en Arabie saoudite.Il s’agissait d’une étude de cohorte rétrospective multicentrique qui incluait tous les cas de COVID-19 confirmés en laboratoire, avec des résultats définitifs en Arabie saoudite en mars 2020. Les données démographiques, les antécédents cliniques, la comorbidité et les résultats ont été extraits de la base de données du National Health Electronic Surveillance Network. Nous avons utilisé des modèles de régression logistique pour calculer les odds ratios bruts et ajustés (OR) afin d’étudier les facteurs de risque pour les résultats critiques (admission en unité de soins intensifs ou décès) parmi les cas de COVID-19.Nous avons inclus 648 patients positifs pour la COVID-19, dont l’âge médian était de 34 ans. Parmi eux, 11,9 % appartenaient au groupe critique. Les facteurs de risque associés aux pires résultats comprenaient l’appartenance au sexe masculin (OR = 1,92), un âge supérieur à 60 ans (OR = 3,65), les maladies cardiaques (OR = 3,05), les maladies respiratoires chroniques (OR = 2,29) et les cas présentant deux comorbidités ou plus (OR = 2,57) après ajustement en fonction de l’âge et du sexe ; tous avaient des valeurs p inférieures à 0,05 significatives.Les facteurs de risque indépendants pour les résultats critiques parmi les cas de COVID-19 comprennent la vieillesse, l’appartenance au sexe masculin, les maladies cardiaques, les maladies respiratoires chroniques et la présence de deux comorbidités ou plus. Nous recommandons de mettre au point un système d’échelle unique multi-items pour pronostiquer les patients atteints de COVID-19.

Middle East respiratory syndrome (MERS) is a viral respiratory illness first reported in Saudi Arabia in September 2012 caused by the human coronavirus (CoV), MERS-CoV. Using full-genome sequencing and phylogenetic analysis, scientists have identified three clades and multiple lineages of MERS-CoV in humans and the zoonotic host, dromedary camels. In this study, we have characterized eight MERS-CoV isolates collected from patients in Saudi Arabia in 2015. We have performed full-genome sequencing on the viral isolates, and compared them to the corresponding clinical specimens. All isolates were clade B, lineages 4 and 5. Three of the isolates carry deletions located on three independent regions of the genome in the 5'UTR, ORF1a and ORF3. All novel MERS-CoV strains replicated efficiently in Vero and Huh7 cells. Viruses with deletions in the 5'UTR and ORF1a exhibited impaired viral release in Vero cells. These data emphasize the plasticity of the MERS-CoV genome during human infection.

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARSCoV- 2) emerged in Wuhan City, China. The SARS-CoV-2 crossed borders and quickly transformed into a "Public health emergency of international concern". Countries around the globe are in the race to achieve herd immunity. We describe the steps taken by Saudi Arabia to achieve this goal.

Background The aim of this study is to describe the clinical and demographic characteristics of COVID-19 patients, and the risk factors associated with death in Saudi Arabia to serve as a reference to further understand this pandemic and to help in the future decisions and control of this global crisis. Methods This multicenter, retrospective, observational, cross-sectional study was conducted on 240,474 patients with confirmed COVID-19 in Saudi Arabia. Data was collected retrospectively through the Health Electronic Surveillance Network at the Ministry of Health. Patients were classified based on their outcome as recovered, dead, or active with no definite outcome. We must specify the date period. Results As of 20th of June 2020, 79.7% of COVID-19 cases were young and middle-aged, ranging between 20–59 years. There was evidently a difference in the sex ratio, where males constituted 71.7% of cases. The majority were non-Saudi nationals, representing 54.7% of cases. Furthermore, the contraction of COVID-19 was travel-related in 45.1% of cases. Signs and symptoms were reported in 63% of cases, the most common of which were fever; 85.2%, and cough; 85%. Deaths occurred more frequently in patients 40−49 years, 50−59 years, and 60−69 years, representing 19.2%, 27.9%, and 21.3% of deaths, respectively. Additionally, the case fatality rate (CFR) was higher in older age-groups, reaching 10.1% in those ≥80 years. Moreover, the CFR of males was higher than that of females, with 0.95% and 0.62%, respectively. As for nationality, Saudis had a CFR of 0.46% versus 1.19% in non-Saudis. Conclusion The total number of positive COVID-19 cases detected constitute 0.7% of the Saudi population to date. Older age, non-Saudi nationalities, being male, travelling outside Saudi Arabia, and the presence of symptoms, as opposed to being asymptomatic were considered risk factors and found to be significantly more associated with death in patients with COVID-19.

The Hajj pilgrimage, held in the Kingdom of Saudi Arabia, is among the largest mass gatherings in the world. More than 2.5 million Muslim pilgrims assemble from over 180 countries worldwide to perform Hajj. The Saudi government recognized the potential risks associated with this event since the first novel coronavirus disease 2019 (COVID-19) case was detected in the country on March 2, 2020. The return of possibly infected pilgrims to their countries after this huge mass gathering event could have turned Hajj into a superspreading event during the global COVID-19 pandemic. A multidisciplinary Saudi team from governmental sectors, including the Global Center for Mass Gatherings Medicine, shared in the assessment, planning, execution, and success of this holy event to prevent the spread of disease. The World Health Organization welcomed the Saudi government's decision to protect the wellbeing and safety of pilgrims and strengthen regional and global health security. A total of 1,000 pilgrims from 160 different countries were randomly selected to perform the rituals. Of all the pilgrims, healthcare personnel, and nonmedical employees facilitating the rituals, no confirmed cases of COVID-19 were identified during or after Hajj. This article highlights the success of the risk mitigation plan in place during the Hajj pilgrimage in 2020 (1441 Hijri year) during the COVID-19 pandemic and the efforts of the Saudi government to prevent associated outbreaks.

BACKGROUNDCurrently, there is no proven effective therapy nor vaccine for the treatment of SARS-CoV-2. Evidence regarding the potential benefit of early administration of hydroxychloroquine (HCQ) therapy in symptomatic patients with Coronavirus Disease (COVID-19) is not clear.METHODSThis observational prospective cohort study took place in 238 ambulatory fever clinics in Saudi Arabia, which followed the Ministry of Health (MOH) COVID-19 treatment guideline. This guideline included multiple treatment options for COVID-19 based on the best available evidence at the time, among which was Hydroxychloroquine (HCQ). Patients with confirmed COVD-19 (by reverse transcriptase polymerase chain reaction (PCR) test) who presented to these clinics with mild to moderate symptoms during the period from 5-26 June 2020 were included in this study. Our study looked at those who received HCQ-based therapy along with supportive care (SC) and compared them to patients who received SC alone. The primary outcome was hospital admission within 28-days of presentation. The secondary outcome was a composite of intensive care admission (ICU) and/or mortality during the follow-up period. Outcome data were assessed through a follow-up telephonic questionnaire at day 28 and were further verified with national hospitalisation and mortality registries. Multiple logistic regression model was used to control for prespecified confounders.RESULTSOf the 7,892 symptomatic PCR-confirmed COVID-19 patients who visited the ambulatory fever clinics during the study period, 5,541 had verified clinical outcomes at day 28 (1,817 patients in the HCQ group vs 3,724 in the SC group). At baseline, patients who received HCQ therapy were more likely to be males who did not have hypertension or chronic lung disease compared to the SC group. No major differences were noted regarding other comorbid conditions. All patients were presenting with active complaints; however, the HCQ groups had higher rates of symptoms compared to the SC group (fever: 84% vs 66.3, headache: 49.8 vs 37.4, cough: 44.5 vs 35.6, respectively). Early HCQ-based therapy was associated with a lower hospital admission within 28-days compared to SC alone (9.4% compared to 16.6%, RRR 43%,p-valuep-value0.001). Adjusting for age, gender, and major comorbid conditions, a multivariate logistic regression model showed a decrease in the odds of hospitalisation in patients who received HCQ compared to SC alone (adjusted OR 0.57 [95% CI 0.47-0.69],p-value ). The composite outcome of ICU admission and/or mortality was also lower for the HCQ group compared to the SC group controlling for potential confounders (adjusted OR 0.55 [95% CI 0.34-0.91],p-value0.019).CONCLUSIONEarly intervention with HCQ-based therapy in patients with mild to moderate symptoms at presentation is associated with lower adverse clinical outcomes among COVID-19 patients, including hospital admissions, ICU admission, and/or death.

During March 2016–March 2019, a total of 200,936 suspected cases of Middle East respiratory syndrome coronavirus infection were identified in Saudi Arabia; infections were confirmed in 698 cases (0.3% [0.7/100,000 population per year]). Continued surveillance is necessary for early case detection and timely infection control response.

During the 2019 Hajj, the Ministry of Health in Saudi Arabia implemented for the first time a health early warning system for rapid detection and response to health threats.This study aimed to describe the early warning findings at the Hajj to highlight the pattern of health risks and the potential benefits of the disease surveillance system.Using syndromic surveillance and event-based surveillance data, the health early warning system generated automated alarms for public health events, triggered alerts for rapid epidemiological investigations and facilitated the monitoring of health events.During the deployment period (4 July-31 August 2019), a total of 121 automated alarms were generated, of which 2 events (heat-related illnesses and injuries/trauma) were confirmed by the response teams.The surveillance system potentially improved the timeliness and situational awareness for health events, including non-infectious threats. In the context of the current COVID-19 pandemic, a health early warning system could enhance case detection and facilitate monitoring of the disease geographical spread and the effectiveness of control measures.تنفيذ نظام الإنذار الصحي المبكر القائم على ترصّد المتلازمات والأحداث في موسم الحج لعام 2019.كينجسلي لزور بيه، أنس خان، صابر يزلي، أحمد الجنايني، ساري عسيري، بدرية العتيبي، سجود غلاب، أمجد الخولي، عبدي-ناصر أبو بكر، هاني جوخضار.نَفّذت، لأول مرة، وزارة الصحة في المملكة العربية السعودية، خلال موسم الحج لعام 2019، نظامًا للإنذار المبكر للكشف السريع عن الأخطار الصحية والاستجابة لها.هدفت هذه الدراسة إلى وصف نتائج الإنذار المبكر في موسم الحج لتسليط الضوء على نمط المخاطر الصحية والفوائد المحتملة لنظام ترصّد الأمراض.أصدر نظام الإنذار الصحي المبكر، باستخدام بيانات ترصّد المتلازمات والأحداث، إنذارات آلية لأحداث صحية عامة، وأطلق تنبيهات لإجراء استقصاءات وبائية سريعة، ويسّ رصد الأحداث الصحية.خلال فترة النشر (4 يوليو/تموز – 31 أغسطس/آب 2019)، صدر ما مجموعه 121 إنذارًا آليًا، وأكدت فرق الاستجابة حدثين منها (أمراض مرتبطة بالحرارة وإصابات/ورضوح).يُتَمَل أن يحسّن نظام الترصّد التوقيت والوعي بأوضاع الأحداث الصحية، ومن ضمنها التهديدات غير المعدية. وفي سياق جائحة كوفيد 19 – الحالية، يمكن لنظام الإنذار الصحي المبكر أن يعزز اكتشاف الحالات وييسّ رصد الانتشار الجغرافي للأمراض وفعالية تدابير المكافحة.Mise en œuvre du système d'alerte sanitaire précoce basé sur la surveillance syndromique et fondée sur les événements lors du Hadj de l’année 2019.Au cours du Hadj de l’année 2019, le Ministère de la Santé d'Arabie saoudite a mis en place pour la première fois un système d'alerte précoce en matière de santé pour une détection des menaces sanitaires et une riposte rapides face à celles-ci.La présente étude avait pour objectif de présenter les résultats de l'alerte précoce lors du Hadj afin de mettre en évidence le schéma des risques sanitaires et les avantages potentiels du système de surveillance des maladies.À l’aide de la surveillance syndromique et des données de surveillance basée sur les événements, le système d'alerte sanitaire précoce a généré des alarmes automatisées pour les événements de santé publique, a déclenché des alertes en vue d’enquêtes épidémiologiques rapides et a facilité le suivi des événements de santé.Au cours de la période de déploiement (4 juillet-31 août 2019), un total de 121 alarmes automatiques ont été générées, dont deux événements (maladies et blessures/traumatismes liés à la chaleur) ont été confirmés par les équipes d’intervention.Le système de surveillance a potentiellement amélioré la notification en temps voulu des événements de santé et la connaissance des situations concernant ces événements, y compris les menaces non infectieuses. Dans le contexte de la pandémie actuelle de COVID-19, un système d'alerte précoce permettrait d’améliorer la détection des cas et de faciliter le suivi de la propagation géographique de la maladie ainsi que l'efficacité des mesures de lutte.

Mass gatherings health is a recently formalized scientific discipline that deals with all aspects of health at mass gatherings (1). The latter are occasions that attract a sufficient number of people to strain the planning and response capabilities of the organizing hosts. Saudi Arabia, with its extensive and prolonged experience in hosting the Hajj mass gathering, was a leader in advancing the global mass gatherings health agenda and the establishment of the mass gatherings health discipline (2). Starting by hosting the 1st International Conference on Mass Gatherings Medicine, entitled “Global Forum on Mass Gathering Medicine”, organized by the Saudi Ministry of Health and the Lancet Infectious Diseases journal (3). The conference took place in Jeddah in 2010 where the “Jeddah Declaration” was adopted at the end of the event. The declaration proposed steps for the formalization of the new discipline of mass gatherings health and called for the establishment of the Global Centre for Mass Gatherings Medicine (GCMGM) in Saudi Arabia, as well as the hosting of regular international conferences on mass gatherings medicine (4).

ObjectiveTo investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.DesignOutbreak investigation.SettingCases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.MethodsContact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.ResultsIn total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.ConclusionsWe describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.

We characterized exposures and demographics of Middle East respiratory syndrome coronavirus cases reported to the Saudi Arabia Ministry of Health during July 1–October 31, 2017, and June 1–September 16, 2018. Molecular characterization of available specimens showed that circulating viruses during these periods continued to cluster within lineage 5.

Diabetes mellitus and hypertension are recognized risk factors for severe clinical outcomes, including death, associated with Middle East respiratory syndrome coronavirus infection. Among 32 virus-infected patients in Saudi Arabia, severity of illness and frequency of death corresponded closely with presence of multiple and more severe underlying conditions.

Middle East respiratory syndrome coronavirus (MERS-CoV) is a novel zoonotic coronavirus that was identified in 2012. MERS-CoV infection in humans can result in an acute, severe respiratory disease and in some cases multi-organ failure; the global mortality rate is approximately 35 %. The MERS-CoV spike (S) protein is a major target for neutralizing antibodies in infected patients. The MERS-CoV microneutralization test (MNt) is the gold standard method for demonstrating prior infection. However, this method requires the use of live MERS-CoV in biosafety level 3 (BSL-3) containment. The present work describes the generation and validation of S protein-bearing vesicular stomatitis virus (VSV) pseudotype particles (VSV-MERS-CoV-S) in which the VSV glycoprotein G gene has been replaced by the luciferase reporter gene, followed by the establishment of a pseudoparticle-based neutralization test to detect MERS-CoV neutralizing antibodies under BSL-2 conditions. Using a panel of human sera from confirmed MERS-CoV patients, the VSV-MERS-CoV particle neutralization assay produced results that were highly comparable to those of the microneutralization test using live MERS-CoV. The results suggest that the VSV-MERS-CoV-S pseudotype neutralization assay offers a highly specific, sensitive and safer alternative method to detect MERS-CoV neutralizing antibodies in human sera.

Healthcare workers (HCWs) stand at the frontline for fighting coronavirus disease 2019 (COVID-19) pandemic. This puts them at higher risk of acquiring the infection than other individuals in the community. Defining immunity status among health care workers is therefore of interest since it helps to mitigate the exposure risk. This study was conducted between May 20th and 30th, 2020. Eighty-five hospitals across Kingdom of Saudi Arabia were divided into 2 groups: COVID-19 referral hospitals are those to which RT-PCR-confirmed COVID-19 patients were admitted or referred for management (Case-hospitals). COVID-19 nonaffected hospitals where no COVID-19 patients had been admitted or managed and no HCW outbreak (Control hospitals). Next, seroprevalence of severe acute respiratory syndrome coronavirus 2 among HCWs was evaluated; there were 12,621 HCWs from the 85 hospitals. There were 61 case-hospitals with 9379 (74.3%) observations, and 24 control-hospitals with 3242 (25.7%) observations. The overall positivity rate by the immunoassay was 299 (2.36%) with a significant difference between the case-hospital (2.9%) and the control-group (0.8%) (P value

Abstract The MIRACLE trial (MERS-CoV Infection tReated with A Combination of Lopinavir/ritonavir and intErferon-β1b) investigates the efficacy of a combination therapy of lopinavir/ritonavir and recombinant interferon-β1b provided with standard supportive care, compared to placebo provided with standard supportive care, in hospitalized patients with laboratory-confirmed MERS. The MIRACLE trial is designed as a recursive, two-stage, group sequential, multicenter, placebo-controlled, double-blind randomized controlled trial. The aim of this article is to describe the statistical analysis plan for the MIRACLE trial. The primary outcome is 90-day mortality. The primary analysis will follow the intention-to-treat principle. The MIRACLE trial is the first randomized controlled trial for MERS treatment. Trial registration ClinicalTrials.gov, NCT02845843. Registered on 27 July 2016.

[No Abstract Available] Saudi Med J 2018; Vol. 39 (5): 524-525 doi: 10.15537/smj.2018.5.21801 How to cite this article: Assiri AM, Asiri SI, Banassir T, Baljoon MJ, Jokhdar H. Burden of influenza-related severe acute respiratory infections during Hajj season 1438 (2017). Lessons and future directions. Saudi Med J . 2018 May;39(5):524-525. doi: 10.15537/smj.2018.5.21801.

Objective.To compare findings as observed on enhanced magnetic resonance imaging (MRI) of the knee joints, in oligoarticular-undifferentiated arthritis (UA) in those with established rheumatoid arthritis (RA) and spondyloarthropathy (SpA).Methods.A total of 55 patients with knee arthritis were consecutively recruited for the study, including 25 with undifferentiated oligoarthritis of the knee joint(s), 15 fulfilling the American College of Rheumatology criteria for RA and 15 with SpA. Laboratory investigations included erythrocyte sedimentation rate, C-reactive protein, complete blood count, aspartate aminotransferase, alanine aminotransferase, serum creatinine, and urine analysis. In all patients in the UA and in the RA group, rheumatoid factor and anti-CCP2 antibody (ELISA) were tested. All patients underwent enhanced MRI of the more symptomatic knee. All groups were compared in terms of demographics, laboratory investigations, and MRI findings.Results.Synovial thickness differed significantly in the RA group compared to UA and SpA groups (p < 0.001). The RA group showed a higher rate of bony and cartilaginous erosions and bone marrow edema compared to UA and SpA groups (p < 0.001). Enthesitis was found in all patients in the SpA group (100%) and differed from RA and UA groups (p < 0.001).Conclusion.Patients with RA showed more destructive changes in terms of synovial thickening, bone marrow edema, cartilaginous and bone erosions compared to UA and SpA groups. Enthesitis is a common feature on MRI in SpA, while absent in the RA and UA groups. This latter finding may have important clinical implications for classification purposes, and can help to determine the evolving pattern of patients with UA of the knee joint.

In Saudi Arabia, vaccination with the meningococcal A/C polysaccharide (MACP) vaccine is advised every 3 years. A clinical outcome study was performed to test the effect of repeat vaccination with the MACP vaccine on the immune responses among Saudi nationals who live in the Makkah and Jeddah areas. Subjects ( n = 230) aged 10 to 29 years were selected: 113 subjects with two or more prior vaccinations with the MACP vaccine, 79 subjects with one prior vaccination with the MACP vaccine, and 38 subjects naïve to vaccination with the MACP vaccine. All subjects received the MACP vaccine in 2002, and serum bactericidal antibody (SBA) titers were measured before and 1 month after vaccination with the MACP vaccine. For serogroup C, geometric mean SBA titers 1 month following vaccination with the MACP vaccine were 708.6 (95% confidence interval [CI], 217.5 to 2,308.9) for those naïve to prior vaccination with the MACP vaccine, and they were significantly higher ( P < 0.0001) than 25.0 (95% CI, 12.4 to 50.2) for those who had received one prior vaccination with the MACP vaccine and 32.4 (95% CI, 18.7 to 56.4) for those who had received two or more doses of the MACP vaccine. For serogroup A, the geometric mean SBA titer 1 month after receipt of the MACP vaccine was 1,649.3 (95% CI, 835.2 to 3,256.9) for those naïve to prior vaccination, and the titers were lower ( P = 0.67) than 2,185.7 (95% CI, 1,489.4 to 3,207.7) for those who had received one prior dose of the MACP vaccine and significantly lower ( P = 0.042) than 3,540.8 (95% CI, 2,705.2 to 4,634.5) for those who had received two or more doses of the MACP vaccine. For serogroup C, the proportions of nonresponders (SBA titers