Middle East respiratory syndrome coronavirus disease is rare in children: An update from Saudi Arabia

Al-Tawfiq, Jaffar A; Kattan, Rana F; Memish, Ziad A

Middle East respiratory syndrome-coronavirus (MERS-CoV) was first isolated in 2012 from a patient in the Kingdom of Saudi Arabia (KSA) [1] . As more cases were reported, the case fatality rate changed to 40% from 60% [2] [3] [4] [5] . In addition, initially there was a predominance of males; later this ratio decreased [2, 6] . MERS-CoV is characterized by three different patterns of disease: Sporadic cases, intra-familial transmission [7] [8] [9] and health care associated infection [2, 3, [10] [11] [12] [13] [14] [15] [16] . Despite the increased number overtime and the multiple health care associated outbreaks [17] , the number of pediatric cases remained low during the study period [18] . The initial description of 47 cases included only a 14-year-old child [4] . The first pediatric case was a 2-year-old child reported from Jeddah, KSA on June 28, 2013 [19] . Later an additional three asymptomatic children were reported [4] . The largest report of childhood MERS-CoV cases included eleven, of which two patients were symptomatic and nine were asymptomatic [18] . The exact reason for this low prevalence of the disease in children is not known. In this study, we summarize the reported MERS-CoV cases and the associated clinical presentation and the outcome.