Estimating the Severity and Subclinical Burden of Middle East Respiratory Syndrome Coronavirus Infection in the Kingdom of Saudi Arabia.
Lessler, Justin; Salje, Henrik; Van Kerkhove, Maria D.; Ferguson, Neil M.; Cauchemez, Simon; Rodriquez-Barraquer, Isabel; Hakeem, Rafat; Jombart, Thibaut; Aguas, Ricardo; Al-Barrak, Ali; Cummings, Derek A. T.; for the MERS-CoV Scenario and Modeling Working Group; Algarni, Homud; AlHarbi, Khalid; Clapham, Hannah; Collins, Caitlin; Cori, Anne; Donnelly, Christl; Fraser, Christophe; Garske, Tini; Grabowski, M. Kate; Mills, Harriet; Moore, Sean M.; Nouvellet, Pierre; Riley, Steven; Truelove, Shaun; Turkistani, Abdulhafiz
[Article] American Journal of Epidemiology. 183(7):657-663, April 01, 2016.

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Not all persons infected with Middle East respiratory syndrome coronavirus (MERS-CoV) develop severe symptoms, which likely leads to an underestimation of the number of people infected and an overestimation of the severity. To estimate the number of MERS-CoV infections that have occurred in the Kingdom of Saudi Arabia, we applied a statistical model to a line list describing 721 MERS-CoV infections detected between June 7, 2012, and July 25, 2014. We estimated that 1,528 (95% confidence interval (CI): 1,327, 1,883) MERS-CoV infections occurred in this interval, which is 2.1 (95% CI: 1.8, 2.6) times the number reported. The probability of developing symptoms ranged from 11% (95% CI: 4, 25) in persons under 10 years of age to 88% (95% CI: 72, 97) in those 70 years of age or older. An estimated 22% (95% CI: 18, 25) of those infected with MERS-CoV died. MERS-CoV is deadly, but this work shows that its clinical severity differs markedly between groups and that many cases likely go undiagnosed.

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