Table 1.

Risk factors for MERS-CoV infection and outbreaks.

•Contact with camels and bats or their excreta, saliva and other products •Exposure to or contact with MERS-CoV-infected patients in the community or hospitals •Late diagnosis of MERS •Delayed implementation of infection control measures •Contaminated hospital environment: a risk to other patients, HCWs and visitors to contaminated and overcrowded healthcare facilities especially Emergency Departments, Inpatient wards and dialyses units •Poor compliance with MERS-specific infection control guidelines •Poor compliance with appropriate Personal Protective Equipment when assessing patients with febrile respiratory illness •Aerosol-generating procedures or invasive procedures on MERS patients (e.g., nebulisers, resuscitation, intubation and ventilation) •Lack of proper isolation room facilities, or bed distance < 1 m •Friends and family members staying as caregivers in overcrowded healthcare facilities

Adopted from Assiri A, Al-Tawfiq JA, Al-Rabeeah AA, et al (2013a) Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East Respiratory Syndrome Coronavirus disease from Saudi Arabia: A descriptive study. The Lancet Infectious Diseases 13: 752–761; Assiri A, McGeer A, Perl TM, et al (2013b) Hospital outbreak of Middle East Respiratory Syndrome Coronavirus. The New England Journal of Medicine 2013b 369(5): 407–416; Al-Abdallat MM, Payne DC, Alqasrawi S, et al (2014) Hospital-associated outbreak of Middle East Respiratory Syndrome Coronavirus: A serologic, epidemiologic, and clinical description. Clinical Infectious Diseases 59(9): 1225–1233; Oboho IK, Tomczyk SM, Al-Asmari AM, et al (2015) 2014 MERS-CoV outbreak in Jeddah—A link to health care facilities. The New England Journal of Medicine 372(9): 846–854; Hui DS, Perlman S, Zumla A. Spread of MERS to South Korea and China. The Lancet Respiratory Medicine 3(7): 509–510; Zumla A, Hui DS, Perlman S (2015a) Middle East Respiratory Syndrome. Lancet 386 (9997): 995–1007; Zumla A, Rustomjee R, Ntoumi F, Mwaba P, Bates M, Maeurer M, Hui DS, Petersen E.(2015b) Middle East Respiratory Syndrome—Need for increased vigilance and watchful surveillance for MERS-CoV in sub-Saharan Africa. International Journal of Infectious Diseases 37: 77–79; Alenazi TH, Al Arbash H, El-Saed A, et al (2017) Identified transmission dynamics of Middle East Respiratory Syndrome Coronavirus infection during an outbreak: Implications of an Overcrowded Emergency Department. Clinical Infectious Diseases 65(4): 675–679; Nam HS, Park JW, Ki M, Yeon MY, Kim J, Kim SW (2017) High fatality rates and associated factors in two hospital outbreaks of MERS in Daejeon, the Republic of Korea. International Journal of Infectious Diseases 58: 37–42.