Alkhamis M A, Fernández-Fontelo A, VanderWaal K, Abuhadida S, Puig P, Alba-Casals A
Department of Epidemiology and Biostatistics, Faculty of Public Health, Health Sciences Center, Kuwait University Kuwait, Khaldiya, Kuwait.
Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, USA.
Epidemiol Infect. 2018 Oct 8;147:e21. doi: 10.1017/S0950268818002728.
Middle East respiratory syndrome coronavirus (MERS-CoV) remains a notable disease and poses a significant threat to global public health. The Arabian Peninsula is considered a major global epicentre for the disease and the virus has crossed regional and continental boundaries since 2012. In this study, we focused on exploring the temporal dynamics of MERS-CoV in human populations in the Arabian Peninsula between 2012 and 2017, using publicly available data on case counts and combining two analytical methods. Disease progression was assessed by quantifying the time-dependent reproductive number (TD-Rs), while case series temporal pattern was modelled using the AutoRegressive Integrated Moving Average (ARIMA). We accounted for geographical variability between three major affected regions in Saudi Arabia including Eastern Province, Riyadh and Makkah. In Saudi Arabia, the epidemic size was large with TD-Rs >1, indicating significant spread until 2017. In both Makkah and Riyadh regions, the epidemic progression reached its peak in April 2014 (TD-Rs > 7), during the highest incidence period of MERS-CoV cases. In Eastern Province, one unique super-spreading event (TD-R > 10) was identified in May 2013, which comprised of the most notable cases of human-to-human transmission. Best-fitting ARIMA model inferred statistically significant biannual seasonality in Riyadh region, a region characterised by heavy seasonal camel-related activities. However, no statistical evidence of seasonality was identified in Eastern Province and Makkah. Instead, both areas were marked by an endemic pattern of cases with sporadic outbreaks. Our study suggested new insights into the epidemiology of the virus, including inferences about epidemic progression and evidence for seasonality. Despite the inherent limitations of the available data, our conclusions provide further guidance to currently implement risk-based surveillance in high-risk populations and, subsequently, improve related interventions strategies against the epidemic at country and regional levels.
中东呼吸综合征冠状病毒（MERS-CoV）仍然是一种值得关注的疾病，对全球公共卫生构成重大威胁。阿拉伯半岛被认为是该疾病的一个主要全球中心，自2012年以来，该病毒已跨越区域和大陆边界。在本研究中，我们利用公开的病例数数据，并结合两种分析方法，重点探索2012年至2017年阿拉伯半岛人群中MERS-CoV的时间动态。通过量化时间依赖性繁殖数（TD-Rs）评估疾病进展，同时使用自回归积分移动平均（ARIMA）对病例系列的时间模式进行建模。我们考虑了沙特阿拉伯三个主要受影响地区（包括东部省、利雅得和麦加）之间的地理差异。在沙特阿拉伯，疫情规模较大，TD-Rs>1，表明在2017年之前疫情有显著传播。在麦加和利雅得地区，疫情进展在2014年4月达到峰值（TD-Rs>7），这是MERS-CoV病例发病率最高的时期。在东部省，2013年5月发现了一次独特的超级传播事件（TD-R>10），其中包括最显著的人传人病例。最佳拟合ARIMA模型推断利雅得地区存在具有统计学意义的双年度季节性，该地区以与骆驼相关的季节性活动频繁为特征。然而，在东部省和麦加未发现季节性的统计证据。相反，这两个地区的病例呈现地方病模式，偶有暴发。我们的研究为该病毒的流行病学提供了新的见解，包括对疫情进展的推断和季节性证据。尽管现有数据存在固有局限性，但我们的结论为当前在高危人群中实施基于风险的监测提供了进一步指导，并随后在国家和地区层面改进针对该疫情的相关干预策略。
