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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Middle East respiratory syndrome coronavirus in pediatrics: a report of seven cases from Saudi Arabia</title><author><name sortKey="Alfaraj, Sarah H" sort="Alfaraj, Sarah H" uniqKey="Alfaraj S" first="Sarah H." last="Alfaraj">Sarah H. Alfaraj</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2288 9830</institution-id><institution-id institution-id-type="GRID">grid.17091.3e</institution-id><institution>University of British Columbia,</institution></institution-wrap>Vancouver, V6T 1Z4 Canada</nlm:aff></affiliation><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="GRID">grid.415696.9</institution-id><institution>Corona Center, Infectious Diseases Division, Department of Pediatric, Prince Mohamed Bin Abdulaziz Hospital,</institution><institution>Ministry of Health,</institution></institution-wrap>Riyadh, 11676 Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Al Tawfiq, Jaffar A" sort="Al Tawfiq, Jaffar A" uniqKey="Al Tawfiq J" first="Jaffar A." last="Al-Tawfiq">Jaffar A. Al-Tawfiq</name><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2287 3919</institution-id><institution-id institution-id-type="GRID">grid.257413.6</institution-id><institution>Indiana University School of Medicine,</institution></institution-wrap>Indianapolis, IN 46202 USA</nlm:aff></affiliation><affiliation><nlm:aff id="Aff4"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 9702 165X</institution-id><institution-id institution-id-type="GRID">grid.415305.6</institution-id><institution>Johns Hopkins Aramco Healthcare,</institution></institution-wrap>Dhahran, 31311 Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Altuwaijri, Talal A" sort="Altuwaijri, Talal A" uniqKey="Altuwaijri T" first="Talal A." last="Altuwaijri">Talal A. Altuwaijri</name><affiliation><nlm:aff id="Aff5"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1773 5396</institution-id><institution-id institution-id-type="GRID">grid.56302.32</institution-id><institution>Department of Surgery,</institution><institution>King Saud University,</institution></institution-wrap>Riyadh, 11692 Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Memish, Ziad A" sort="Memish, Ziad A" uniqKey="Memish Z" first="Ziad A." last="Memish">Ziad A. Memish</name><affiliation><nlm:aff id="Aff6"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1758 7207</institution-id><institution-id institution-id-type="GRID">grid.411335.1</institution-id><institution>College of Medicine,</institution><institution>Alfaisal University,</institution></institution-wrap>Riyadh, 11533 Saudi Arabia</nlm:aff></affiliation><affiliation><nlm:aff id="Aff7"><institution-wrap><institution-id institution-id-type="GRID">grid.415696.9</institution-id><institution>Infectious Diseases Division, Department of Medicine, Prince Mohamed Bin Abdulaziz Hospital,</institution><institution>Ministry of Health,</institution></institution-wrap>Riyadh, 11676 Saudi Arabia</nlm:aff></affiliation><affiliation><nlm:aff id="Aff8"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0941 6502</institution-id><institution-id institution-id-type="GRID">grid.189967.8</institution-id><institution>Hubert Department of Global Health, Rollins School of Public Health,</institution><institution>Emory University,</institution></institution-wrap>Atlanta, GA 30322 USA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">29623560</idno><idno type="pmc">7088593</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7088593</idno><idno type="RBID">PMC:7088593</idno><idno type="doi">10.1007/s11684-017-0603-y</idno><date when="2018">2018</date><idno type="wicri:Area/Pmc/Corpus">000169</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000169</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Middle East respiratory syndrome coronavirus in pediatrics: a report of seven cases from Saudi Arabia</title><author><name sortKey="Alfaraj, Sarah H" sort="Alfaraj, Sarah H" uniqKey="Alfaraj S" first="Sarah H." last="Alfaraj">Sarah H. Alfaraj</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2288 9830</institution-id><institution-id institution-id-type="GRID">grid.17091.3e</institution-id><institution>University of British Columbia,</institution></institution-wrap>Vancouver, V6T 1Z4 Canada</nlm:aff></affiliation><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="GRID">grid.415696.9</institution-id><institution>Corona Center, Infectious Diseases Division, Department of Pediatric, Prince Mohamed Bin Abdulaziz Hospital,</institution><institution>Ministry of Health,</institution></institution-wrap>Riyadh, 11676 Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Al Tawfiq, Jaffar A" sort="Al Tawfiq, Jaffar A" uniqKey="Al Tawfiq J" first="Jaffar A." last="Al-Tawfiq">Jaffar A. Al-Tawfiq</name><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2287 3919</institution-id><institution-id institution-id-type="GRID">grid.257413.6</institution-id><institution>Indiana University School of Medicine,</institution></institution-wrap>Indianapolis, IN 46202 USA</nlm:aff></affiliation><affiliation><nlm:aff id="Aff4"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 9702 165X</institution-id><institution-id institution-id-type="GRID">grid.415305.6</institution-id><institution>Johns Hopkins Aramco Healthcare,</institution></institution-wrap>Dhahran, 31311 Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Altuwaijri, Talal A" sort="Altuwaijri, Talal A" uniqKey="Altuwaijri T" first="Talal A." last="Altuwaijri">Talal A. Altuwaijri</name><affiliation><nlm:aff id="Aff5"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1773 5396</institution-id><institution-id institution-id-type="GRID">grid.56302.32</institution-id><institution>Department of Surgery,</institution><institution>King Saud University,</institution></institution-wrap>Riyadh, 11692 Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Memish, Ziad A" sort="Memish, Ziad A" uniqKey="Memish Z" first="Ziad A." last="Memish">Ziad A. Memish</name><affiliation><nlm:aff id="Aff6"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1758 7207</institution-id><institution-id institution-id-type="GRID">grid.411335.1</institution-id><institution>College of Medicine,</institution><institution>Alfaisal University,</institution></institution-wrap>Riyadh, 11533 Saudi Arabia</nlm:aff></affiliation><affiliation><nlm:aff id="Aff7"><institution-wrap><institution-id institution-id-type="GRID">grid.415696.9</institution-id><institution>Infectious Diseases Division, Department of Medicine, Prince Mohamed Bin Abdulaziz Hospital,</institution><institution>Ministry of Health,</institution></institution-wrap>Riyadh, 11676 Saudi Arabia</nlm:aff></affiliation><affiliation><nlm:aff id="Aff8"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0941 6502</institution-id><institution-id institution-id-type="GRID">grid.189967.8</institution-id><institution>Hubert Department of Global Health, Rollins School of Public Health,</institution><institution>Emory University,</institution></institution-wrap>Atlanta, GA 30322 USA</nlm:aff></affiliation></author></analytic><series><title level="j">Frontiers of Medicine</title><idno type="ISSN">2095-0217</idno><idno type="eISSN">2095-0225</idno><imprint><date when="2018">2018</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Infection with Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012 as an important respiratory disease with high fatality rates of 40%–60%. Despite the increased number of cases over subsequent years, the number of pediatric cases remained low. A review of studies conducted from June 2012 to April 19, 2016 reported 31 pediatric MERS-CoV cases. In this paper, we present the clinical and laboratory features of seven patients with pediatric MERS. Five patients had no underlying medical illnesses, and three patients were asymptomatic. Of the seven cases, four (57%) patients sought medical advice within 1–7 days from the onset of symptoms. The three other patients (43%) were asymptomatic and were in contact with patients with confirmed diagnosis of MERS-CoV. The most common presenting symptoms were fever (57%), cough (14%), shortness of breath (14%), vomiting (28%), and diarrhea (28%). Two (28.6%) patients had platelet counts of < 150 × 10<sup>9</sup>/L, and one patient had an underlying end-stage renal disease. The remaining patients presented with normal blood count, liver function, and urea and creatinine levels. The documented MERS-CoV Ct values were 32–38 for four of the seven cases. Two patients (28.6%) had abnormal chest radiographic findings of bilateral infiltration. One patient (14.3%) required ventilator support, and two patients (28.6%) required oxygen supplementation. All the seven patients were discharged without complications.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Zaki, Am" uniqKey="Zaki A">AM Zaki</name></author><author><name sortKey="Van Boheemen, S" uniqKey="Van Boheemen S">S van Boheemen</name></author><author><name sortKey="Bestebroer, Tm" uniqKey="Bestebroer T">TM Bestebroer</name></author><author><name sortKey="Osterhaus, Adme" uniqKey="Osterhaus A">ADME Osterhaus</name></author><author><name sortKey="Fouchier, Ram" uniqKey="Fouchier R">RAM Fouchier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Al Tawfiq, Ja" uniqKey="Al Tawfiq J">JA Al-Tawfiq</name></author><author><name sortKey="Memish, Za" uniqKey="Memish Z">ZA Memish</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Assiri, A" uniqKey="Assiri A">A Assiri</name></author><author><name sortKey="Mcgeer, A" uniqKey="Mcgeer A">A 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Front Med</journal-id><journal-id journal-id-type="iso-abbrev">Front Med</journal-id><journal-title-group><journal-title>Frontiers of Medicine</journal-title></journal-title-group><issn pub-type="ppub">2095-0217</issn><issn pub-type="epub">2095-0225</issn><publisher><publisher-name>Higher Education Press</publisher-name><publisher-loc>Beijing</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">29623560</article-id><article-id pub-id-type="pmc">7088593</article-id><article-id pub-id-type="publisher-id">603</article-id><article-id pub-id-type="doi">10.1007/s11684-017-0603-y</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Middle East respiratory syndrome coronavirus in pediatrics: a report of seven cases from Saudi Arabia</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Alfaraj</surname><given-names>Sarah H.</given-names></name><xref ref-type="aff" rid="Aff1">1</xref><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Al-Tawfiq</surname><given-names>Jaffar A.</given-names></name><xref ref-type="aff" rid="Aff3">3</xref><xref ref-type="aff" rid="Aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Altuwaijri</surname><given-names>Talal A.</given-names></name><xref ref-type="aff" rid="Aff5">5</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Memish</surname><given-names>Ziad A.</given-names></name><address><email>zmemish@yahoo.com</email></address><xref ref-type="aff" rid="Aff6">6</xref><xref ref-type="aff" rid="Aff7">7</xref><xref ref-type="aff" rid="Aff8">8</xref></contrib><aff id="Aff1"><label>1</label><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2288 9830</institution-id><institution-id institution-id-type="GRID">grid.17091.3e</institution-id><institution>University of British Columbia,</institution></institution-wrap>Vancouver, V6T 1Z4 Canada</aff><aff id="Aff2"><label>2</label><institution-wrap><institution-id institution-id-type="GRID">grid.415696.9</institution-id><institution>Corona Center, Infectious Diseases Division, Department of Pediatric, Prince Mohamed Bin Abdulaziz Hospital,</institution><institution>Ministry of Health,</institution></institution-wrap>Riyadh, 11676 Saudi Arabia</aff><aff id="Aff3"><label>3</label><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2287 3919</institution-id><institution-id institution-id-type="GRID">grid.257413.6</institution-id><institution>Indiana University School of Medicine,</institution></institution-wrap>Indianapolis, IN 46202 USA</aff><aff id="Aff4"><label>4</label><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 9702 165X</institution-id><institution-id institution-id-type="GRID">grid.415305.6</institution-id><institution>Johns Hopkins Aramco Healthcare,</institution></institution-wrap>Dhahran, 31311 Saudi Arabia</aff><aff id="Aff5"><label>5</label><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1773 5396</institution-id><institution-id institution-id-type="GRID">grid.56302.32</institution-id><institution>Department of Surgery,</institution><institution>King Saud University,</institution></institution-wrap>Riyadh, 11692 Saudi Arabia</aff><aff id="Aff6"><label>6</label><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1758 7207</institution-id><institution-id institution-id-type="GRID">grid.411335.1</institution-id><institution>College of Medicine,</institution><institution>Alfaisal University,</institution></institution-wrap>Riyadh, 11533 Saudi Arabia</aff><aff id="Aff7"><label>7</label><institution-wrap><institution-id institution-id-type="GRID">grid.415696.9</institution-id><institution>Infectious Diseases Division, Department of Medicine, Prince Mohamed Bin Abdulaziz Hospital,</institution><institution>Ministry of Health,</institution></institution-wrap>Riyadh, 11676 Saudi Arabia</aff><aff id="Aff8"><label>8</label><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0941 6502</institution-id><institution-id institution-id-type="GRID">grid.189967.8</institution-id><institution>Hubert Department of Global Health, Rollins School of Public Health,</institution><institution>Emory University,</institution></institution-wrap>Atlanta, GA 30322 USA</aff></contrib-group><pub-date pub-type="epub"><day>6</day><month>4</month><year>2018</year></pub-date><pub-date pub-type="ppub"><year>2019</year></pub-date><volume>13</volume><issue>1</issue><fpage>126</fpage><lpage>130</lpage><history><date date-type="received"><day>19</day><month>6</month><year>2017</year></date><date date-type="accepted"><day>23</day><month>10</month><year>2017</year></date></history><permissions><copyright-statement>© Higher Education Press and Springer-Verlag GmbH Germany, part of Springer Nature 2018</copyright-statement><license><license-p>This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.</license-p></license></permissions><abstract id="Abs1"><p>Infection with Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012 as an important respiratory disease with high fatality rates of 40%–60%. Despite the increased number of cases over subsequent years, the number of pediatric cases remained low. A review of studies conducted from June 2012 to April 19, 2016 reported 31 pediatric MERS-CoV cases. In this paper, we present the clinical and laboratory features of seven patients with pediatric MERS. Five patients had no underlying medical illnesses, and three patients were asymptomatic. Of the seven cases, four (57%) patients sought medical advice within 1–7 days from the onset of symptoms. The three other patients (43%) were asymptomatic and were in contact with patients with confirmed diagnosis of MERS-CoV. The most common presenting symptoms were fever (57%), cough (14%), shortness of breath (14%), vomiting (28%), and diarrhea (28%). Two (28.6%) patients had platelet counts of < 150 × 10<sup>9</sup>/L, and one patient had an underlying end-stage renal disease. The remaining patients presented with normal blood count, liver function, and urea and creatinine levels. The documented MERS-CoV Ct values were 32–38 for four of the seven cases. Two patients (28.6%) had abnormal chest radiographic findings of bilateral infiltration. One patient (14.3%) required ventilator support, and two patients (28.6%) required oxygen supplementation. 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