2016 Are Saudi medical students aware of middle east respiratory syndrome coronavirus during an outbreak_

2016·0.35 MB·English

ARTICLE IN PRESS
JIPH-612; No.of Pages8

JournalofInfectionandPublicHealth(2016)xxx,xxx—xxx

Are Saudi medical students aware of

middle east respiratory syndrome

coronavirus during an outbreak?

Ahmad Al-Mohreja,∗, Sajida Aghab

aCollegeofMedicine,KingSaudBinAbdulazizUniversityforHealthSciences,Riyadh,

SaudiArabia
bDepa rtmentofMedicalEducation,CollegeofMedicine,KingSaudbinAbdulaziz

UniversityforHealthSciences,Riyadh,SaudiArabia

Received27February2016;receivedinrevisedform11June2016;accepted24June2016

KEYWORDS Summary Recently,anoutbreakofMERS-CoVoccurredinKingAbdulazizMedical

Coronavirus; City (KAMC), Riyadh. This outbreak contributed to the students at the King Saud

MERS-CoV; bin Abdulaziz University for Health Sciences (KSAU-HS) becoming more involved in

promotinghealthawarenessintheircommunities.
Medicalstudents;

This was a cross-sectional study that evaluated students in the clinical phase of
SaudiArabia;
medical school. The data were collected by an online questionnaire. The mea-
Awareness
surements were obtained using a researcher-administered and a self-reported

questionnaire that had been previously validated. A p-value of less than 0.05 was

consideredstatisticallysignificant.

One hundred and thirty-six students participated and showed good awareness

regarding the clinical aspects of MERS, such as etiology, diagnosis, management,

andprevention.However,76%ofthestudentswerenotawareofthemortalityrate.

Conversely, this study uncovered a low level of awareness in the basic sciences.

Interestingly, fifth year medical students were more familiar with the incubation

periodthanfinalyearstudents(p-value<0.05).Regardinggenderdifferences,more

femalestudentswereknowledgeableabouttheincubationperiodandthepossible

asymptomaticpresentationofthediseasethanmalestudents(p-value<0.05).How-

ever, male students were more aware of the diagnostic tests for MERS than their

femalecounterparts.

MedicalstudentswereknowledgeableabouttheclinicalaspectsofMERSbutwere

lackingbackgroundawarenessinthebasicsciences.

©2016KingSaudBinAbdulazizUniversityforHealthSciences.PublishedbyElsevier

Limited.Allrightsreserved.

∗ Correspondingauthor.

E-mailaddress:[email protected](A.Al-Mohrej).

http://dx.doi.org/10.1016/j.jiph.2016.06.013
1876-0341/©2016KingSaudBinAbdulazizUniversityforHealthSciences.PublishedbyElsevierLimited.Allrightsreserved.

Please cite this article in press as: Al-Mohrej A, Agha S. Are Saudi medical students aware of

middle east respiratory syndrome coronavirus during an outbreak? J Infect Public Health (2016),

http://dx.doi.org/10.1016/j.jiph.2016.06.013
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JIPH-612; No.of Pages8

2 A.Al-Mohrej,S.Agha

Introduction reservoir for MERS-CoV, it is unlikely that they

would be responsible for direct transmission of

Middle East Respiratory Syndrome (MERS) is a viral the infection to humans because it is uncommon

infectionthathasrecentlyemergedinhumansand to have direct or close contact between bats and

causes a severe acute respiratory illness with a humans[13].

mortality rate of 30—40% in average risk patients Recently, there was an outbreak of MERS in

[1]. MERS is caused by a virus named MERS-CoV, Riyadhthatinvolvedoneofits’medicalcities,King

which belongs to a large family of viruses called Abdulaziz Medical City, which had only thirty-one

coronaviruses [2]. It was initially termed human infections from June to August 14th, 2015 [14]. On

(or novel) corona virus but was later changed to August 18th, 2015, there was an announcement of

MERS-CoV [3]. Corona viruses are single-strand, ten new cases; nine of them acquired the virus

positive-sense RNA viruses that measure 120—160 from the hospital [14]. Globally, one of the first

nanometers in diameter and are pleomorphic in large outbreaks that took place outside the Ara-

shape[4].InSeptember2012,thefirstcaseofMERS bian Peninsula was in South Korea, which occurred

(the so called index case) was reported in Saudi between May and July 2015, and was followed by

Arabia and presented as symptoms of pneumonia another outbreak in Riyadh in Saudi Arabia [15].

and acute kidney injury [5]. Soon after, another Based upon the recent outbreaks and the role of

patient from Qatar who had visited Saudi Arabia medical students in bringing awareness of MERS

began experiencing acute respiratory symptoms to the community, we aimed to assess the aware-

and renal failure. The symptoms and type of ness of medical students studying in their clinical

viruses reported in these two patients were the years to identify any gaps in their knowledge and

same [6,7]. The age of patients with MERS ranged to recommend any interventions to improve their

from9monthsto94years,andthemedianagewas awarenessforbetterhealtheducation.

48 years [8]. Male patients constituted 64% of the Theaimofthisstudywastoassesstheawareness

total number of cases in non-health care worker and background knowledge of medical students in

patients[8].Conversely,accordingtoBalkhyetal., their clinical years in King Saud Bin Abdulaziz Uni-

the median age of health care workers who got versityforHealthSciencesinRiyadhregardingMERS

MERSduringtheoutbreakfromJunetoAugust2015 duringtheoutbreak.

was 37 years, and female workers constituted 77%

of the total cases [9]. In addition, the mortality Materials and methods
ra te in the in fecte d gen er al populat ion w as higher

and incomparable to the that of health care The study was conducted in the College of

workersbecausetheywereyounger,healthier,and Medicine, King Saud Bin Abdulaziz University for

withfewercomorbidities[9]. Health Sciences (KSAU-COM) in Riyadh, Saudi Ara-

The typical presentation of MERS is a severe bia. The College was established by Royal Decree

acute respiratory illness with a fever, cough, and No.3-B-53278,datedJanuary1,2004.Itislocated

shortnessofbreaththatcanprogresstopneumonia inKingAbdulazizMedicalCity,Riyadh.TheCollege

and kidney failure [10]. The patients with under- providesprogramsforobtainingaMBBSdegreeand

lying conditions before becoming infected were a Master’s in Medical Education. We selected to

morelikelytodiefromMERSthanhealthypatients study students enrolled in one of the above men-

[10]. Conversely, some patients presented with tioned programs because of their exposure to the

atypical symptoms, such as diarrhea, nausea, and recent outbreak of MERS that occurred in the hos-

flu-like symptoms, while some patients remained pitaltheywerestudyingin.

asymptomatic [10]. The treatment for MERS-CoV, This was a cross-sectional study that used con-

as for other coronaviruses, is supportive care secutive samples because all of the male and

because there is currently no curative treatment female medical students in their clinical years

available[10]. (approximately 293) who agreed to participate in

Camels were believed to be the host of MERS- thestudyandcompletedthesurveywereincluded.

CoVbaseduponastudyconductedinSaudiArabia, The data were collected using a fourteen-item

which isolated and identified the genome of the online questionnaire that evaluated the medical

virusesfromasickmanandoneofhiscamels[11]. student’s level of awareness regarding MERS. The

Bats were also believed to play a role in disease questionnaire included three main domains that

transmission according to another study con- covered their knowledge about basic medical sci-

ducted in Saudi Arabia, which isolated coronavirus ences, such as virology, and their knowledge of

sequences by PCR from bats by taking fecal and clinical management and infection prevention and

rectal swabs [12]. Although bats could serve as a control. Some of the questionnaire items were

Please cite this article in press as: Al-Mohrej A, Agha S. Are Saudi medical students aware of

middle east respiratory syndrome coronavirus during an outbreak? J Infect Public Health (2016),

http://dx.doi.org/10.1016/j.jiph.2016.06.013
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AreSaudimedicalstudentsawareofthemiddleeastrespiratorysyndromeduringanoutbreak? 3

Table1 Baselinecharacteristicsoftherespondents.

Variables Categories N %

Gender Female 55 40.4

Male 81 59.6

Academicyear Fifth 48 35.3

Sixth 88 64.7

Age 20—25 127 93.4

26—30 9 6.6

Heardof(MERS)beforethiscurrent No 16 11.8

outbreak Yes 120 88.2

Sourceofinformation CollegeofMedicine 17 12.5

SocialMedia 75 55.1

Thecommunity 27 19.9

MinistryofHealth 8 5.9

NOTheardofitbefore 9 6.6

adapted from another study with permission from Overall, the majority of the students (88%) had

its’authors[16].However,newitemswereaddedto heard of the disease before the outbreak in their

measure the medical student’s awareness of basic hospital, with social media being the most com-

medicalsciencesregardingthevirus. mon source of obtaining this information (55%).

The questionnaire was reviewed and validated The majority of the students (97.1%) were able

by three experts in the medical education, infec- to state what MERS stands for. Regarding the stu-

tious diseases, and biostatistics fields. After the dents’ knowledge of the new cases in August 2015

pilotstudy,thereliabilitywascalculatedandfound that were diagnosed globally, 50% of the students

tobe0.71. wereunabletoestimatethecorrectnumberofnew

Datamanagementandanalyseswereperformed cases.

using the Statistical Packages for Social Sciences Regardingitemsassessingtheirknowledgeofthe

(SPSS) version 21. Descriptive analyses were per- basicsciences,onlyaminorityofthestudents(14%)

formed by reporting the number and percentages knew the genus to which the virus belonged. Also,

for the different categorical variables. Regarding only a small number of the students (21%) were

the inferential statistics, the associations between aware of the basic structure of the virus. Overall,

knowledgeandthedifferentsubjects’characteris- awarenessinthebasicsciencesrelatedtoMERSwas

ticswereevaluatedusingchi-square,andaP-value belowtheexpectedlevel.

wasreported.Ap-value<0.05wasusedtoindicate Regarding the clinical items, 74% of the stu-

statisticalsignificance. dents were aware that patients with the disease

couldbeasymptomatic.Moreover,75.7%ofthestu-

dents knew the correct incubation period of the

Results virus. Additionally, 75% of the students reported

that camels could be a possible primary host for

AtKSAU-COM,136[male81(60%),female55(40%)] MERS-CoV, while 13% of students thought that bats
stu dents respo nde d to t he quest ionnaire . O ut of were the h ost of the vir us. Regar ding tra nsmi ssion
the respo ndents, 48 (35 .3%) students were in th eir ofdis ease ,97. 1% ofth estud entsbeliev edthatclose
fifth year,whileth er emaind erofthes tuden ts were co ntactwit hillp ati ent swasthe modeof tran smis-
in th eir si xth ye ar. Table 1 sho ws the demogr aphic sion. In addit ion , 96.3% reali zed that c ou gh, fever,
ch aract eristic s of t he res p ondent s. A ll of the par- chills , a nd shortn ess o f breath wer e the t ypical
ticipantswere Sau din ationals. sympto mso ftheinfec tio n.
Medica l stu dents overall awareness of MERS Among the re spondents, 66% of students knew
basedupon theirres ponsesto aquestion nair e that real- time polymerase cha in reaction (PCR)
The ques tionn aire shown in T able 2 was used to testi ngofares piratoryspec imenw asusedt odiag-
measur etheawarene ssofth e studen t sofM ERS. nose M ERS . Also, 61% o f the stud ents succ es sfully
Gener al awareness of medical students answ ered th at su ppor tiv e tre atment w as the only
regarding t he important aspe cts of MER S, such as treatment ava ilable for p atients wi th M ERS . On
knowledge of basic scien ce and v iro logy, th e mo de questionsr egardingp reve ntiveme asures ,allof the
of transmis sio n, dia gnosis, and the treat men t and students k new that hand wash ing with an al coh ol-
pr eventionofME RS. basedha ndsan itize r,cove ringhis/ herm ou thwhen

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middle east respiratory syndrome coronavirus during an outbreak? J Infect Public Health (2016),

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4 A.Al-Mohrej,S.Agha

Table2 Answersofallrespondents.

Question Answers N %

InAugustof2015,whatistheestimated Incorrect 68 50.0

numberofNEWcasesreportedglobally? Correct 68 50.0

Inyouropinion,MERSstandsfor? Incorrect 4 2.9

Correct 132 97.1

TowhichgenusdoesMERScoronavirusbelong Incorrect 117 86.0

to? Correct 19 14.0

Structureofcoronavirus Incorrect 108 79.4

Correct 28 20.6

Canapersonbeinfectedwiththevirusand Incorrect 35 25.7

doesnothaveanysymptoms? Correct 101 74.3

TheincubationperiodofMERS-CoVis? Incorrect 33 24.3

Correct 103 75.7

ThepossibleprimaryhostofMERS-CoVcanbe? Incorrect 16 11.8

Correct 120 88.2

MERS-CoVcanbetransmittedby Incorrect 4 2.9

Correct 132 97.1

WhatisatypicalsymptomofMERS? Incorrect 5 3.7

Correct 131 96.3

ThediagnosisofMERScanbeconfirmedby Incorrect 46 33.8

Correct 90 66.2

TreatmentofMERS-CoVis? Incorrect 53 39.0

Correct 83 61.0

PreventionofthespreadofMERS-CoVisby? Incorrect 5 3.7

Correct 131 96.3

Theapproximatemortalityrateinanaverage Incorrect 103 75.7

riskpatientis? Correct 33 24.3

IsthereanavailablevaccineforMERS-corona Incorrect 11 8.1

virus? Correct 125 91.9

coughing or sneezing, and avoiding close personal The awareness of MERS-CoV according to
contact a re the prima ry m easures for pr eventing the respondent ’s year of me dical scho ol

transmission.Also,92%ofthestudentswereaware

that vaccines were unavailable during the out-
The awareness of MERS-CoV according to the

break. However, only 24% of the students could
respondent’s year of medical school is shown in

identify the approximate mortality rate from the
Table 4. Interestingly, the fifth and sixth year

disease.
medical students’ knowledge was only statistically

significantly different regarding their understand-

ingoftheincubationperiodforMERS-CoV(p<0.05),
The awareness of MERS-CoV according
and oddly, the sixth year students had less aware-
to th e gender o f t he respond ents ness . In re lati on to prev ention, d iagn osis , mode

of transmission, and other items, no statistically

The awareness of MERS-CoV according to the gen- significant differences were observed between the

der of the respondents is shown in Table 3. More twogroups.

male students did not know the correct incubation

period of the virus and the possible asymptomatic

presentation of the disease than female students, Discussion

andthedifferencebetweenthegenderswasstatis-

ticallysignificantwithpvaluesof00.01and0.004, The present study attempted to assess medical

respectively. However, male students were more students’ knowledge about MERS, specifically, the

aware of the diagnostic test than female students, management of MERS as wells as infection preven-

whichwasstatisticallysignificantwithapvalueof tionandcontrol.Priorstudiesdemonstratedahigh

0.04. level of awareness in the general Saudi population

No other statistical significant differences were as well as in dental students that was consistent

foundbetweenmaleandfemalestudents. withtheresultsofthepresentstudy[16,17].

Please cite this article in press as: Al-Mohrej A, Agha S. Are Saudi medical students aware of

middle east respiratory syndrome coronavirus during an outbreak? J Infect Public Health (2016),

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AreSaudimedicalstudentsawareofthemiddleeastrespiratorysyndromeduringanoutbreak? 5

Table3 Comparisonoftheanswersbasedonthegenderofrespondents.

Question Answer Gender p-Value

Male Female

N % N %

InAugustof2015,whatistheestimated Incorrect 39 48.1 29 52.7 0.600

numberofNEWcasesreportedglobally? Correct 42 51.9 26 47.3

Inyouropinion,MERSstandsfor? Incorrect 2 2.5 2 3.6 0.693

Correct 79 97.5 53 96.4

TowhichgenusdoesMERScoronavirus Incorrect 70 86.4 47 85.5 0.873

belongto? Correct 11 13.6 8 14.5

Structureofcoronavirus: Incorrect 63 77.8 45 81.8 0.567

Correct 18 22.2 10 18.2

Canapersonbeinfectedwiththevirus Incorrect 28 34.6 7 12.7 0.004

anddoesnothaveanysymptoms? Correct 53 65.4 48 87.3

TheincubationperiodofMERS-CoVis? Incorrect 26 32.1 7 12.7 0.010

Correct 55 67.9 48 87.3

ThepossibleprimaryhostofMERS-CoVcan Incorrect 9 11.1 7 12.7 0.774

be? Correct 72 88.9 48 87.3

MERS-CoVcanbetransmittedby Incorrect 2 2.5 2 3.6 0.693

Correct 79 97.5 53 96.4

WhatisatypicalsymptomofMERS? Incorrect 2 2.5 3 5.5 0.364

Correct 79 97.5 52 94.5

ThediagnosisofMERScanbeconfirmedby Incorrect 22 27.2 24 43.6 0.046

Correct 59 72.8 31 56.4

TreatmentofMERS-CoVis? Incorrect 31 38.3 22 40.0 0.839

Correct 50 61.7 33 60.0

PreventionofthespreadofMERS-CoVis Incorrect 1 1.2 4 7.3 0.066

by? Correct 80 98.8 51 92.7

Theapproximatemortalityrateinaverage Incorrect 60 74.1 43 78.2 0.583

riskpatientinfectedwithMERS-CoVis? Correct 21 25.9 12 21.8

Isthereanavailablevaccinefor Incorrect 5 6.2 6 10.9 0.320

MERS-coronavirus? Correct 76 93.8 49 89.1

Our study revealed that medical students had a about the students’ sources and the availability of

good level of awareness of the clinical aspects of MERS-related information may have had an effect

MERS, such as the diagnosis, treatment, and pre- onthereliabilityoftheresults[18].

vention. Approximately 92% of the students knew The present study showed that 86% of the stu-

that there was no vaccination available, and 97% dents were unaware that MERS-CoV was a beta

of them students were knowledgeable about the Coronaviruse. Also, 80% of the students were not

mode of transmission. This awareness could be awareofthebasicstructureofsingle-strandedRNA

due to their clinical studies during the outbreak viruses. This showed that respondents’ knowledge

and the awareness campaigns in the hospital and of the basic sciences and technical details related

on social media, which were the most common to the virus was relatively lower in comparison

sources of information. Furthermore, the inter- to their knowledge in the clinical sciences, which

net was the most common channel for obtaining couldbeduetoavarietyofdifferentfactors.First,

health awareness regarding MERS for the general a lack of basic science courses in their curriculum

Saudi population [18]. However, their awareness could explain their lack of awareness. Second, a

regarding the number of new cases in August 2015 lackofemphasisonthisinformationintheirclinical

was not as expected. Half of the students could practice could also be another possible explana-

not estimate the correct number of new cases, tion. Moreover, in awareness campaigns directed

which could be due to a lack of interest or a lack to medical students, there was not enough cover-

of resources for the students to keep themselves ageoftheseelements,whichresultedindecreased

updatedandcurrentwithnewevents. awareness.Therefore,decreasedawarenessofthe

Onestudyreportedtheimportanceofthesource technical details of the virus is expected in med-

of the information and that a lack of information ical students due to the abovementioned reasons.

Please cite this article in press as: Al-Mohrej A, Agha S. Are Saudi medical students aware of

middle east respiratory syndrome coronavirus during an outbreak? J Infect Public Health (2016),

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6 A.Al-Mohrej,S.Agha

Table4 Comparisonofanswersbasedontheacademicleveloftherespondents.

Question Answer Academicyear p-Value

Fifthyear Sixthyear

N % N %

InAugustof2015,whatistheestimated Incorrect 20 41.7 48 54.5 0.151

numberofNEWcasesreportedglobally? Correct 28 58.3 40 45.5

MERSstandsfor? Incorrect 1 2.1 3 3.4 0.662

Correct 47 97.9 85 96.6

TowhichgenusdoesMERScoronavirus Incorrect 40 83.3 77 87.5 0.503

belongto? Correct 8 16.7 11 12.5

StructureofMERScoronavirusis Incorrect 37 77.1 71 80.7 0.620

Correct 11 22.9 17 19.3

Canapersonbeinfectedwiththevirus Incorrect 9 18.8 26 29.5 0.169

anddoesnothaveanysymptoms? Correct 39 81.3 62 70.5

TheincubationperiodofMERS-CoVis? Incorrect 5 10.4 28 31.8 0.005

Correct 43 89.6 60 68.2

ThepossibleprimaryhostofMERS-CoVcan Incorrect 4 8.3 12 13.6 0.359

be? Correct 44 91.7 76 86.4

Inyouropinion,MERS-CoVcanbe Incorrect 2 4.2 2 2.3 0.532

transmittedby Correct 46 95.8 86 97.7

WhatisatypicalsymptomofMERS? Incorrect 3 6.3 2 2.3 0.239

Correct 45 93.8 86 97.7

ThediagnosisofMERScanbeconfirmedby Incorrect 20 41.7 26 29.5 0.153

Correct 28 58.3 62 70.5

TreatmentofMERS-CoVis? Incorrect 22 45.8 31 35.2 0.226

Correct 26 54.2 57 64.8

PreventionofthespreadofMERS-CoVis Incorrect 3 6.3 2 2.3 0.239

by? Correct 45 93.8 86 97.7

Inyouropinion,theapproximatemortality Incorrect 38 79.2 65 73.9 0.491

rateinaverageriskpatientinfectedwith Correct 10 20.8 23 26.1

IMsEtRhSe-rCeoaVnisa?vailablevaccinefor Incorrect 4 8.3 7 8.0 0.938

MERS-coronavirus? Correct 44 91.7 81 92.0

Because medical students are supposed to play a knowledgeable about the incubation period than

role as health advocates, they should thoroughly sixthyearstudents.Thiscouldbeexplainedbythe

understandnewmedicaleventsandobtainmorein- fact that fifth year students had just studied the

depthknowledgeregardingallaspectsoftheevent, basic medical sciences, including virology, in their

such as virus classification and the basic structure fourthyear,sotheyhadmorerecentlyacquiredthe

ofthevirus,thanthegeneralpopulationtobeable knowledgethansixthyearstudents.Also,fifthyear

toraiseawarenessintheircommunities. students had clinical rotations in infectious dis-

Theresultsofthisstudyrevealedthattherewas eases when they studied Pediatrics and Medicine,

a significant difference in three items when com- whereas sixth year students did not have a similar

paring male and female students. Female students clinicalrotation.Onecouldquestionwhywechose

were more knowledgeable about the incubation to evaluate only fifth and sixth year medical stu-

periodandthepossibilityforthediseasetopresent dents.Wespecificallyevaluatedfifthandsixthyear

asymptomatically.Onecouldarguethatfemalestu- medical students because these students were in

dents are more interested in emerging infectious theclinicalphaseoftheireducationanddirectcon-

diseases,andtherefore,keepmoreup-to-datethan tactwithpatientswaspartoftheirclinicalstudies

theirmalecounterparts. bothbeforeandaftertheoutbreak.

The results of this study also revealed that When we compared our study results with a

there was one statistically significant difference study conducted in dental students in Jeddah,

regarding awareness of the virus’s incubation we observed a similar awareness level regarding

period between fifth and sixth year medical stu- the mode of transmission and treatment of MERS

dents. That is, fifth year students were more [16]. However, medical students had much higher

Please cite this article in press as: Al-Mohrej A, Agha S. Are Saudi medical students aware of

middle east respiratory syndrome coronavirus during an outbreak? J Infect Public Health (2016),

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AreSaudimedicalstudentsawareofthemiddleeastrespiratorysyndromeduringanoutbreak? 7

awareness regarding the signs and symptoms and Thisstudywasconductedduringanoutbreakfor

the incubation period of the disease [16], which several reasons. First, our medical students were

could be due to their background and proximity to raising awareness in their communities regarding

the outbreak at the teaching hospital. Also, there MERS because it was a very common and relevant

wereawarenesscampaignsandactivitiesthatcould topic in the media and the community. There-

havepositivelyaffectedtheirawareness. fore,researcherswantedtoassesswhethermedical

The medical students’ levels of awareness students were well informed about MERS and pre-

regardingtheprimarysourceofinfection,causative paredtoplaytheirroleashealthadvocatesintheir

organism, treatment, and lack of a vaccine was communities. Second, the researchers wanted to

muchhigherthanthegeneralSaudipopulation[17]. identifyareasthatneedtobeaddressedinorderto

This could be due to the role of medical students improvethestudent’sknowledge,whichwillleadto

as health advocates during the outbreak, which bettereducationofthegeneralpopulation.Finally,

made them more informed and prepared to raise by conducting the study during an outbreak, we

awarenessintheircommunities.However,boththe uncovered how new emerging infectious diseases

medical students and general population had good triggered the student’s curiosity and their ability

awareness of the signs and symptoms of the dis- toreadandreacttosurroundingevents.

ease, the mode of transmission, and protective Our study had several limitations. First, there is

measures[17],whichcouldbeduetotheawareness no comparable study involving Saudi medical stu-

efforts by the Ministry of Health and other health dents in other colleges to compare with our study.

institutions that were shedding light on the symp- A comparison group consisting of randomly sam-

tomsofthediseaseandtheprotectivemeasures. pledmedicalstudentsmightbeneededinthestudy

The World Health Organization (WHO) and the designtobetterunderstandthefindings.Also,due

Centers for Disease Control and Prevention (CDC) therelativelysmallnumberofthestudentsintheir

have issued recommendations for the prevention clinical years and the low response rate despite

and control of MERS infection in healthcare sett- sending multiple reminders, our sample size might

ings [19]. The prevention of MERS includes hand notbeidealtorepresenttheawarenesslevelofall

hygiene, wearing personal protective equipment, medical students. Therefore, future studies with a

and patient placement [19]. One study reported largersamplesizeaddressingthosepointsarewarr-

the role of overcrowding of patients in emergency anted.

departments as a possible trigger that could initi- Therefore, we conclude that medical students

ate outbreaks along with poor compliance to the haveasimilarknowledgeabouttheclinicalaspects

infection control measures [20]. Courses on new ofMERSastheSaudigeneralpopulationanddental

emergingdiseases,fieldepidemiology,andtropical students.However,theirawarenessofthebasicsci-

medicineshouldbeintroducedtomedicalstudents enceswasfoundtobelowerthanourexpectations

to prepare them for dealing with these types of duetotheabovementionedfactors.

healthemergencies[21].InlightoftherecentMERS

outbreaks,werecommendadditional,newcourses
for medica l st udents in or der to impr ove the stu- Funding

dents’knowledgeofrecentinfectiontrendsandto

ensurethatstandardinfectioncontrolmeasuresare NofundingSources.

beingappropriatelyused.

The key to preventing acute viral respiratory
tractin fect ion includeswe aringa mask andgloves, Competing interests

avoiding close contact with patients, eye protec-

tion, etc. [19]. However, according to Al-Mohrej Nonedeclared.

et al. the efficacy of the facemasks has not been

fully established [17,22]. All of the respondents
(100% ) were awa re of the abo ve men tioned meas- Ethical approval

ures for protection, and we think this awareness

was due to the activities focusing on disease Notrequired.

preventionandcontrolinthehospital.Wealsorec-

ommend that the students educate themselves by
readingt hem ater ialsprepa redbyth eCDC&WH O, Acknowledgements

which cover the various aspects of the disease and

shedlightontheimportantelementsofprevention The study would not have been possible without

andearlyrecognitionofthedisease[1,2]. the constructive help of Dr. Omar A. Al-Mohrej,

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middle east respiratory syndrome coronavirus during an outbreak? J Infect Public Health (2016),

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ARTICLE IN PRESS
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8 A.Al-Mohrej,S.Agha

who offered all possible support to this study. The [11] Azhar EI, El-Kafrawy SA, Farraj SA, Hassan AM, Al-

authorsalsowouldliketothankDr.AmirOmairfor Saeed MS, Hashem AM, et al. Evidence for camel-to-
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Please cite this article in press as: Al-Mohrej A, Agha S. Are Saudi medical students aware of

middle east respiratory syndrome coronavirus during an outbreak? J Infect Public Health (2016),

http://dx.doi.org/10.1016/j.jiph.2016.06.013