{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T13:40:50Z","timestamp":1792503650861,"version":"4.5.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Middle East respiratory syndrome (MERS), caused by MERS coronavirus (MERS-CoV), is a severe zoonotic respiratory illness first identified in Saudi Arabia in 2012. Dromedary camels are the recognised reservoir, with human transmission occurring through animal exposure and, less commonly, person-to-person spread, particularly in healthcare settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterise all laboratory-confirmed MERS-CoV cases reported in Saudi Arabia from September 2012 to August 2025, examine trends across four periods defined by suspected-case definitions, and identify factors independently associated with mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed laboratory-confirmed cases in the national surveillance database by period and probable infection source. Case-fatality ratios (CFRs), 95% confidence intervals (CIs), and unadjusted odds ratios were calculated. Multivariable logistic regression assessed independent mortality associations using a prespecified model including period, age, sex, and infection source, and a fuller model additionally considering nationality, comorbidities, and pregnancy. Seasonality of primary cases was assessed using an annual harmonic term.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 2,219 cases, 1,545 (70%) were male, 1,566 (71%) Saudi nationals, and 608 (27%) aged \u226565 years. Overall, 1,211 (55%) were primary cases, including 172 (14%) reporting camel contact; 737 (33%) were healthcare-associated and 271 (12%) household- or community-associated. There were 867 deaths (CFR, 39%; 95% CI, 37%\u201341%). CFR declined from 65% in the earliest period to 32% in the most recent, although changing testing eligibility and ascertainment limit temporal comparisons. Older adults had the highest crude CFR. In the prespecified model, healthcare-associated infection among patients was associated with higher odds of death (aOR, 1.74; 95% CI, 1.15\u20132.65), while odds were lower among healthcare workers (aOR, 0.09; 95% CI, 0.05\u20130.17) and household contacts (aOR, 0.29; 95% CI, 0.18\u20130.48). No consistent seasonality was observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MERS-CoV epidemiology in Saudi Arabia reflects persistent zoonotic spillover, episodic healthcare-associated transmission, and substantial mortality, particularly among older adults. Sustained One Health surveillance, rapid detection, and rigorous infection prevention and control remain essential.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jtm\/taag094","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T11:37:44Z","timestamp":1792496264000},"source":"Crossref","is-referenced-by-count":0,"title":["Epidemiology of MERS-CoV in Saudi Arabia, 2012\u20132025: a nationwide surveillance analysis"],"prefix":"10.1093","author":[{"given":"Amal M","family":"Alshahrani","sequence":"first","affiliation":[{"name":"Public Health Authority , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezzudin A","family":"Okmi","sequence":"additional","affiliation":[{"name":"Public Health Authority , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mutaz","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Public Health Unit, Population Health Department, Johns Hopkins Aramco Healthcare , Dhahran ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osman","family":"Abdalla","sequence":"additional","affiliation":[{"name":"Public Health Authority , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmood","family":"Aldoukhi","sequence":"additional","affiliation":[{"name":"Public Health Authority , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afrah","family":"Alshahrani","sequence":"additional","affiliation":[{"name":"Public Health Authority , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seham F","family":"Basheer","sequence":"additional","affiliation":[{"name":"Ministry of Health , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norah","family":"Alhazir","sequence":"additional","affiliation":[{"name":"Public Health Authority , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanaa A","family":"Alsulaiman","sequence":"additional","affiliation":[{"name":"Public Health Authority , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajar S","family":"Banuqaytah","sequence":"additional","affiliation":[{"name":"Public Health Authority , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lama","family":"Alwalan","sequence":"additional","affiliation":[{"name":"Ministry of Health , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukhtar","family":"Althiyabi","sequence":"additional","affiliation":[{"name":"Public Health Authority , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal M","family":"Alghamdi","sequence":"additional","affiliation":[{"name":"Public Health Authority , Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheena G","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Monash University , Melbourne ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2381-0984","authenticated-orcid":false,"given":"Yusuff Adebayo","family":"Adebisi","sequence":"additional","affiliation":[{"name":"College of Social Sciences, University of Glasgow , 40 Bute Gardens, Glasgow G12 8RT, Scotland ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najim Z","family":"Alshahrani","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, Faculty of Medicine, University of Jeddah , Jeddah ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,20]]},"container-title":["Journal of Travel Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jtm\/advance-article-pdf\/doi\/10.1093\/jtm\/taag094\/72132119\/taag094.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jtm\/advance-article-pdf\/doi\/10.1093\/jtm\/taag094\/72132119\/taag094.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T13:00:47Z","timestamp":1792501247000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jtm\/advance-article\/doi\/10.1093\/jtm\/taag094\/8944027"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,20]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/jtm\/taag094","relation":{},"ISSN":["1195-1982","1708-8305"],"issn-type":[{"value":"1195-1982","type":"print"},{"value":"1708-8305","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,20]]},"article-number":"taag094"}}