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

In adults with MERS-CoV infections, three patterns of transmissions were observed: Sporadic (primary) cases presumed to be due to animal exposure (mainly camels), household contacts or health care associated infections [32] . In KSA, the majority (45%) of cases were health care-associated infections, 38% were primary cases, and 13% were household contacts [32] . In contrast, in the majority of pediatric cases that reported source of acquisition (66.7% of the 15 with reported source), the disease was acquired through household contact. This pattern indicates a low exposure of children to animals and a higher rate of health care associated infections in adult wards. The male to female ratio (2.8:1 and 3.3:1) was initially high [3, 4] . This apparent male predominance could be explained by the nature of hospital outbreaks [2] . Eventually the male to female ratio was reduced to 1.3:1 to 1.8:1 [5, 6] . Consistent with these studies, the male to female ratio in children with MERS-CoV was 1.7:1 and may indicate similar exposure of children to index cases in the household settings and differential host factors.