Knowledge and practices of primary health care physicians regarding updated guidelines of MERS-CoV infection in Abha city

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Abstract

Background:

Human coronaviruses (hCoV) usually cause mild to moderate upper respiratory tract illnesses. The novel coronavirus (nCoV), or Middle East respiratory syndrome coronavirus (MERS-CoV), is a particular strain different from any other known hCoV with the possibility of human and also zoonotic transmissions. The aim of the study to assess primary health care (PHC) physicians’ knowledge and adherence regarding Saudi Ministry of Health guidelines regarding MERS-CoV.

Materials and Methods:

A cross-sectional study design was followed to include 85 PHC physicians in Abha city. An interview questionnaire has been designed by the researcher that was used to assess knowledge and practices of PHC physicians regarding diagnosis and management of MERS-CoV. It includes personal characteristics, the MERS-CoV knowledge assessment questionnaire, and practices related to adherence toward guidelines regarding MERS-CoV.

Results:

PHC physicians’ knowledge gaps regarding MERS-CoV included protected exposure (32.9%), highest seasonal incidence of MERS-CoV in Saudi Arabia (60%), relation between incidence of MERS-CoV and overcrowding (62.4%), case fatality of MERS-CoV cases (63.5%), and collecting specimens from MERS-CoV patients (64.7%). The knowledge of PHC physicians about MERS-CoV was poor among 5.9%, good among 63.5%, and excellent among 30.6%. Personal protective equipment to be used when seeing suspected cases of MERS-CoV infection were mainly the mask (94.1%), gloves (78.8%), the gown (60%), goggles (31.8%), and the cap (22.4%). All participants stated that the most important standard precaution that should be applied when seeing a case of MERS-CoV infection is hand washing, whereas 97.6% stated that the most important respiratory precaution to prevent transmission of respiratory infections in PHC setting when seeing a case of MERS-CoV infection is masking and separation of suspected MERS-CoV patients, and 81.2% stated that upon exit from the room of a MERS-CoV patient, the physician should remove and discard personal protective equipment. PHC physicians’ knowledge about MERS-CoV differed significantly according to their nationality ( P = 0.038), with non-Saudi physicians expressing higher percent of excellent knowledge than Saudi physicians (40% and 20%, respectively). Those who attended continuing medical education (CME) activities had significantly higher percent of excellent knowledge than those who did not attend a CME activity (55.6% and 23.9%, respectively, P = 0.011). PHC physicians’ knowledge did not differ significantly according to their age, gender, qualification, experience in PHC, and practice-related adherence to guidelines. PHC physicians’ practice-related adherence to guidelines about MERS-CoV differed significantly according to their position ( P = 0.035), with specialists having the highest percent of excellent practice (13%).

Conclusions:

There are knowledge gaps among PHC physicians in Abha city, and their practice is suboptimal regarding MERS-CoV infection. Less than one-fourth of PHC physicians attend CME activities about MERS-CoV infection. However, significantly less practice-related adherence to guidelines are associated with Saudi PHC physicians, those who did not attend a related CME activity, and MBBS qualified physicians’ general practitioners. To increase awareness, more CME activities related to MERS-CoV infection management needs to be organized.

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Most cited references 14

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Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study

Abdullah Assiri, Jaffar Al-Tawfiq, Abdullah A Al-Rabeeah … (2013)

Summary Background Middle East respiratory syndrome (MERS) is a new human disease caused by a novel coronavirus (CoV). Clinical data on MERS-CoV infections are scarce. We report epidemiological, demographic, clinical, and laboratory characteristics of 47 cases of MERS-CoV infections, identify knowledge gaps, and define research priorities. Methods We abstracted and analysed epidemiological, demographic, clinical, and laboratory data from confirmed cases of sporadic, household, community, and health-care-associated MERS-CoV infections reported from Saudi Arabia between Sept 1, 2012, and June 15, 2013. Cases were confirmed as having MERS-CoV by real-time RT-PCR. Findings 47 individuals (46 adults, one child) with laboratory-confirmed MERS-CoV disease were identified; 36 (77%) were male (male:female ratio 3·3:1). 28 patients died, a 60% case-fatality rate. The case-fatality rate rose with increasing age. Only two of the 47 cases were previously healthy; most patients (45 [96%]) had underlying comorbid medical disorders, including diabetes (32 [68%]), hypertension (16 [34%]), chronic cardiac disease (13 [28%]), and chronic renal disease (23 [49%]). Common symptoms at presentation were fever (46 [98%]), fever with chills or rigors (41 [87%]), cough (39 [83%]), shortness of breath (34 [72%]), and myalgia (15 [32%]). Gastrointestinal symptoms were also frequent, including diarrhoea (12 [26%]), vomiting (ten [21%]), and abdominal pain (eight [17%]). All patients had abnormal findings on chest radiography, ranging from subtle to extensive unilateral and bilateral abnormalities. Laboratory analyses showed raised concentrations of lactate dehydrogenase (23 [49%]) and aspartate aminotransferase (seven [15%]) and thrombocytopenia (17 [36%]) and lymphopenia (16 [34%]). Interpretation Disease caused by MERS-CoV presents with a wide range of clinical manifestations and is associated with substantial mortality in admitted patients who have medical comorbidities. Major gaps in our knowledge of the epidemiology, community prevalence, and clinical spectrum of infection and disease need urgent definition. Funding None.

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Family Cluster of Middle East Respiratory Syndrome Coronavirus Infections

Ziad A. Memish, Alimuddin I. Zumla, Rafat F. Al-Hakeem … (2013)

A human coronavirus, called the Middle East respiratory syndrome coronavirus (MERS-CoV), was first identified in September 2012 in samples obtained from a Saudi Arabian businessman who died from acute respiratory failure. Since then, 49 cases of infections caused by MERS-CoV (previously called a novel coronavirus) with 26 deaths have been reported to date. In this report, we describe a family case cluster of MERS-CoV infection, including the clinical presentation, treatment outcomes, and household relationships of three young men who became ill with MERS-CoV infection after the hospitalization of an elderly male relative, who died of the disease. Twenty-four other family members living in the same household and 124 attending staff members at the hospitals did not become ill. MERS-CoV infection may cause a spectrum of clinical illness. Although an animal reservoir is suspected, none has been discovered. Meanwhile, global concern rests on the ability of MERS-CoV to cause major illness in close contacts of patients.

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Lack of MERS Coronavirus but Prevalence of Influenza Virus in French Pilgrims after 2013 Hajj

Philippe Gautret, Remi Charrel, Samir Benkouiten … (2014)

To the Editor: Saudi Arabia has reported the highest number of Middle East respiratory syndrome coronavirus (MERS-CoV) cases since the virus first emerged in 2012, with >127 confirmed cases and a case-fatality rate of 42%, as of November 2013 ( 1 ). Global attention has focused on the potential for spread of MERS-CoV after the Hajj pilgrimage during which Muslims from 180 countries converge in Mecca, Saudi Arabia. Such pilgrims have a high risk for respiratory tract infections because of severe overcrowding. The International Health Regulations Emergency Committee advised all countries (particularly those with returning pilgrims) to strengthen their surveillance capacities and ensure robust reporting of any identified cases ( 2 ). We report the results of a prospective cohort study conducted in Saudi Arabia in October 2013. Participants in the survey were adult Hajj pilgrims who traveled together in a group (through 1 travel agency in Marseille, France) from October 3 through October 24, 2013. Pilgrims were included in the study on a voluntary basis and were asked to sign a written consent form. All pilgrims received advice about individual prevention measures against respiratory tract infection before departing, and follow-up was conducted during the journey by a medical doctor who systematically documented travel-associated diseases. Nasal swab specimens were obtained just before the pilgrims left Saudi Arabia, frozen <48 hours after sampling, and processed ( 3 , 4 ). Each sample was tested for MERS-CoV (upE and ORF1a genes) ( 5 , 6 ) and influenza A, B ( 7 ), and A/2009/H1N1 viruses ( 8 ) by real-time reverse transcription PCR. The protocol was approved by our Institutional Review Board (July 23, 2013; reference no. 2013-A00961–44) and by the Saudi Ministry of Health ethics committee. On departure from France, the study comprised 129 pilgrims. Their mean age was 61.7 years (range 34–85 years), and the male/female ratio was 0.7:1. Sixty-eight (52.7%) pilgrims reported having a chronic disease, including hypertension (43 [33.3%]), diabetes (34 [26.4%]), chronic cardiac disease (11 [8.5%]), and chronic respiratory disease (5 [3.9%]). Forty-six (35.7%) pilgrims reported receiving influenza vaccination in 2012; none had been vaccinated in 2013 before the Hajj because the vaccine was not yet available in France. Clinical data were available for 129 persons: 117 (90.7%) had respiratory symptoms while in Saudi Arabia, including cough (112 [86.8%]) and sore throat (107 [82.9%]); 64 (49.6%) reported fever, and 61 (47.3%) had conditions that met the criteria for influenza-like illness (ILI; i.e., the association of cough, sore throat, and subjective fever) (Figure) ( 4 ). One patient was hospitalized during travel (undocumented pneumonia). Nasal swab specimens were obtained from 129 pilgrims on October 23, 2013 (week 43), 1 day before pilgrims left Saudi Arabia for France; 90 (69.8%) pilgrims were still symptomatic. All PCRs were negative for MERS-CoV. Figure Onset of respiratory symptoms by week, reported by 129 Hajj pilgrims from France during their stay in Saudi Arabia, October 2013. Eight pilgrims tested positive for influenza A(H3N2), 1 for influenza A(H1N1), and 1 for influenza B virus. No dual infections were reported. 70 (54.3%) pilgrims were seen 3–5 weeks after they returned to France, and the remaining were lost to follow-up. Fifty-five (78.6%) had experienced respiratory symptoms since their return, including cough (50 [71.4%]) and sore throat (14 [20.0%]); 12 (17.1%) reported fever, and illness in 5 (7.1%) pilgrims met the criteria for ILI. The 10 pilgrims who had positive test results for influenza virus on return had cleared their infection; only 1 additional sample was positive (for influenza A[H1N1]). Our results support data obtained from a similar cohort in 2012 that showed a lack of nasal carriage of MERS-CoV among Hajj pilgrims from France ( 3 ). However, a higher prevalence of influenza virus (7.8%) was observed in nasal swab specimens in 2013 than in 2012 when 2 (3.2%) cases of influenza B virus infection were detected and no case of influenza A virus infection was detected among 162 pilgrims returning from the Hajj ( 4 ). The estimated incidence of ILI in France during week 43 was 27 per 100,000 inhabitants, far below the epidemic threshold (126/100,000) with few sporadic cases of influenza A virus infection reported in some regions in France (www.grog.org/bullhebdo_pdf/bull_grog_43-2013.pdf). No case was reported in the Marseille area (http://websenti.u707.jussieu.fr/sentiweb). The high prevalence of respiratory symptoms in our cohort probably reflects the close surveillance performed and is consistent with 2012 results ( 3 , 4 ). In Marseille, all patients with suspected MERS-CoV infection are referred to the Institut Hospitalo-Universitaire Méditerranée Infection. As of November 8, 2013, of the 14 first returning patients hospitalized for respiratory symptoms and screened for MERS-CoV and other pathogens, including influenza, 4 were infected with influenza A(H3N2), 4 with influenza A(H1N1), and 1 with influenza B virus. All samples tested negative for MERS-CoV. Our preliminary results indicate that pilgrims from France returning from the 2013 Hajj were free of MERS-CoV but that a proportion were infected with influenza viruses and may represent a potential for early introduction of influenza in southern France. This proportion may have been underestimated because screening was performed at the end of the study period when some infections had cleared. Influenza vaccination should be a priority for pilgrims attending the Hajj ( 9 , 10 ).

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Author and article information

Journal

Journal ID (nlm-ta): J Family Med Prim Care

Journal ID (iso-abbrev): J Family Med Prim Care

Journal ID (publisher-id): JFMPC

Title: Journal of Family Medicine and Primary Care

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 2249-4863

ISSN (Electronic): 2278-7135

Publication date (Print): February 2019

Volume: 8

Issue: 2

Pages: 455-461

Affiliations

[1 ] Department of Family Medicine, Ministry of Health, Abha, KSA

[2 ] Department of Family and Community Medicine, College of Medicine, KingKhalid University, Abha, Kingdom of Saudi Arabia

[3 ] Department of Anatomy, College of Medicine, KingKhalid University, Abha, Kingdom of Saudi Arabia

Author notes

Address for correspondence: Dr. Saad Al-Amri, Family Medicine Specialist, King Khalid University, Abha, Saudi Arabia. E-mail: Al3mri.sa@ 123456hotmail.com

Article

Publisher ID: JFMPC-8-455

DOI: 10.4103/jfmpc.jfmpc_336_18

PMC ID: 6436268

PubMed ID: 30984654

SO-VID: 9f2fbe8a-32fd-44a4-a613-75b32424c72b

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This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Knowledge and practices of primary health care physicians regarding updated guidelines of MERS-CoV infection in Abha city

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Novel Coronavirus Disease COVID-19

Most cited references 14

Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study

Family Cluster of Middle East Respiratory Syndrome Coronavirus Infections

Lack of MERS Coronavirus but Prevalence of Influenza Virus in French Pilgrims after 2013 Hajj

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