ABSTRACT
Objectives: Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe respiratory illness. The majority of cases worldwide have been reported by Saudi Arabia. Clinicians and health authorities in Saudi Arabia are required to report all suspected MERS-CoV cases to the Health Electronic Surveillance Network (HESN), a national electronic surveillance platform. We aimed to describe trends in MERS-CoV surveillance and laboratory testing in Saudi Arabia over a three-year period. Method(s): Demographic information and laboratory results were collected for all suspected MERS-CoV cases reported to HESN between 1 March 2016 and 20 March 2019. Demographic and laboratory data of suspected and confirmed cases was analyzed. Data were stratified by local Health Affairs Directorate (HAD) and population estimates obtained from the Ministry of Health. Result(s): During the study period, 200 937 suspected MERS-CoV cases were reported to HESN. MERS-CoV was detected in 698 (0.3%;0.7 per 100 000 population per year). The majority of suspected cases were male (54.3%) and Saudi nationals (72.8%). Among the confirmed cases, 517 (74.1%) were male, 501 (71.8%) were Saudi nationals, and the median age was 54 years (interquartile range: 40 years-65 years). No MERS-CoV cases were identified among Hajj pilgrims. Percent positivity varied by region, with the highest percentage in Hafer Al- Baten HAD (1.2%), followed by Najran HAD (1.1%). Conclusion(s): Saudi Arabia continues to perform extensive surveillance for MERS-CoV, with an average of ~5400 suspected cases identified and tested per month. Continued surveillance is needed to better understand transmission and to monitor testing practices.