Background: Emerging infectious diseases, especially those that have potential to create pandemics, are one of the largest risks to global public health. Outbreaks represent unique opportunities to collect data on clinical characterisation, treatment, and validation of new diagnostics to inform rapid public health response. The World Health Organization Research and Development Blueprint has identified a list of priority diseases for accelerated research based on their potential to cause a public health emergency. Among these diseases are severe acute respiratory syndrome-coronavirus (SARS-CoV) and Middle East respiratory syndrome-coronavirus (MERS-CoV). To facilitate a rapid research response during an outbreak, standardised research protocols should be designed in between outbreaks. The first step in designing the research protocols is identifying the key clinical research questions. The aim of this systematic review is to identify the most common clinical research questions asked during outbreaks of SARS-CoV and MERS-CoV.
Methods and materials: Medline, Embase, and Global Health bibliographic databases were searched to identify clinical studies published on SARS-CoV and MERS-CoV in the outbreak setting. Studies were grouped thematically according to the clinical research question addressed. Descriptive statistics were calculated to determine prevailing study designs and publication timelines. This is a narrative systematic review, and no meta-analysis was conducted.
Results: From the research questions and objectives, eleven themes in the literature were identified: clinical characterisation, prognosis, diagnosis, clinical management, viral pathogenesis, epidemiological characterisation, infection prevention and control, transmission, susceptibility, psychosocial, and aetiology. Case series made up the highest proportion of study designs, while clinical trials made up the lowest proportion. Retrospective cohort studies had the longest median time from data collection to publication. 83% of SARS-CoV studies were published after the end of the epidemic.
Conclusion: The thematic analysis was used to identify the key clinical research questions asked during outbreaks of SARS-CoV and MERS-CoV and study designs were recommended to answer these questions. By defining the key clinical research questions, this study provides the first step in creating standardised clinical research protocols and defining core data variables to be collected during future outbreaks of SARS-CoV and MERS-CoV.