Acute Middle East Respiratory Syndrome Coronavirus Infection in Livestock Dromedaries, Dubai, 2014

Wernery, Ulrich; Corman, Victor M.; Wong, Emily Y.; Tsang, Alan K.L.; Muth, Doreen; Lau, Susanna K. P.; Khazanehdari, Kamal; Zirkel, Florian; Ali, Mansoor; Nagy, Peter D.; Juhász, Judit; Wernery, Renate; Joseph, Sunitha; Syriac, G.; Elizabeth, Shyna K.; Patteril, Nissy Annie Georgy; Woo, Patrick C. Y.; Drosten, Christian

doi:10.3201/eid2106.150038

Cited by 91 publications

(119 citation statements)

References 16 publications

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“…More frequent sporadic introductions could be related to an increase in the virus circulation in the zoonotic source. A recent study (Wernery et al, 2015) on MERS-CoV spread among dromedary camels shows that the virus produces acute epidemics in calves, often born in Spring. Such outbreaks may cause an increase in the number of primary cases and increased opportunities for subsequent transmission, multiplying the number of admissions of MERS-CoV cases to hospitals with the possibility of further triggering hospital outbreaks as previously reported (Drosten et al, 2015;Saad et al, 2014;Oboho et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Quantifying spatiotemporal heterogeneity of MERS-CoV transmission in the Middle East region: A combined modelling approach

Poletto¹,

Colizza²,

Boëlle³

2016

Epidemics

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MERS coronavirus cases notified in the Middle East region since the identification of the virus in 2012 have displayed variations in time and across geography. Through a combined modelling approach, we estimate the rates of generation of cases along the zoonotic and human-to-human transmission routes and assess their spatiotemporal heterogeneity. We consider all cases notified to WHO from March 2012 to mid-September 2014. We use a stochastic modelling of the time series of case incidence in the Middle East region to estimate time- and space-dependent zoonotic and human-to-human transmission parameters. The model also accounts for possible lack of identification of secondary transmissions among notified cases. This approach is combined with the analysis of imported cases out of the region to assess the rate of underreporting of cases. Out of a total of 32 possible models, based on different parameterisation and scenario considered, the best-fit model is characterised by a large heterogeneity in time and across space for both zoonotic and human-to-human transmission. The variation in time that occurred during Spring 2014 led to a 17-fold and 3-fold increase in the two transmissions, respectively, bringing the reproductive rate to values above 1 during that period for all regions under study. The model suggests that 75% of MERS-CoV cases are secondary cases (human-to-human transmission), which is substantially higher than the 34% of reported cases with an epidemiological link to another case. Overall, estimated reporting rate is 0.26. Our findings show a higher level of spatial heterogeneity in zoonotic transmission compared to human-to-human, highlighting the strong environmental component of the epidemic. Since sporadic introductions are predicted to be a small proportion of notified cases and are responsible for triggering secondary transmissions, a more comprehensive understanding of zoonotic source and path of transmission could be critical to limit the epidemic spread.

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Section: Discussionmentioning

confidence: 99%

Quantifying spatiotemporal heterogeneity of MERS-CoV transmission in the Middle East region: A combined modelling approach

Poletto¹,

Colizza²,

Boëlle³

2016

Epidemics

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show abstract

“…72,76e81 À Viable MERS-CoV was isolated from nasal and faecal samples from dromedary camels. 76,82 MERS-CoV recovered from dromedary camels is capable of causing ex-vivo infection in human respiratory cells. 83 À Acute infection in dromedary camels has been demonstrated by documented rises in anti-MERS-CoV antibody titres, and by RTePCR in symptomatic animals.…”

Section: Lesson Four: Mers-cov Is Another Zoonotic Infectionmentioning

confidence: 99%

Middle East respiratory syndrome coronavirus (MERS-CoV): what lessons can we learn?

Omrani

Shalhoub

2015

Journal of Hospital Infection

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The Middle East Respiratory Coronavirus (MERS-CoV) was first isolated from a patient who died with severe pneumonia in June 2012. As of 19 June 2015, a total of 1,338 MERS-CoV infections have been notified to the World Health Organization (WHO). Clinical illness associated with MERS-CoV ranges from mild upper respiratory symptoms to rapidly progressive pneumonia and multi-organ failure. A significant proportion of patients present with non-respiratory symptoms such as headache, myalgia, vomiting and diarrhoea. A few potential therapeutic agents have been identified but none have been conclusively shown to be clinically effective. Human to human transmission is well documented, but the epidemic potential of MERS-CoV remains limited at present. Healthcare-associated clusters of MERS-CoV have been responsible for the majority of reported cases. The largest outbreaks have been driven by delayed diagnosis, overcrowding and poor infection control practices. However, chains of MERS-CoV transmission can be readily interrupted with implementation of appropriate control measures. As with any emerging infectious disease, guidelines for MERS-CoV case identification and surveillance evolved as new data became available. Sound clinical judgment is required to identify unusual presentations and trigger appropriate control precautions. Evidence from multiple sources implicates dromedary camels as natural hosts of MERS-CoV. Camel to human transmission has been demonstrated, but the exact mechanism of infection remains uncertain. The ubiquitously available social media have facilitated communication and networking amongst healthcare professionals and eventually proved to be important channels for presenting the public with factual material, timely updates and relevant advice.

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“…However, camels are believed to be an intermediate with speculation that bats could be the primary host . Dromedary camels were 80% to 90% seropositive, from samples dated back to as early as 1983, in African countries, Arabian Peninsula countries, and the Spanish Canary Islands, but 0% in Australian dromedary camels or Bactrian camels, and several groups reported viral shedding from infected camels . Nevertheless, despite the impressive and quick elucidation of many issues about MERS‐CoV, there are gaps in our understanding of this emerging virus, such as the precise route of transmission of camel‐to‐human infections, the risk factors for contracting the virus, and the protective level of neutralizing antibodies (nAb).…”

Section: Introductionmentioning

confidence: 99%

Vaccines against Middle East respiratory syndrome coronavirus for humans and camels

Alharbi

2016

Reviews in Medical Virology

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Middle East respiratory syndrome coronavirus (MERS-CoV) is caused by a novel betacoronavirus that was isolated in late 2012 in Saudi Arabia. The viral infections have been reported in more than 1700 humans, ranging from asymptomatic or mild cases to severe pneumonia with a mortality rate of 40%. It is well documented now that dromedary camels contract the infection and shed the virus without notable symptoms, and such animals had been infected by at least the early 1980s. The mechanism of camel to human transmission is still not clear, but several primary cases have been associated with camel contact. There is no approved antiviral drug or vaccine against MERS-CoV despite the active research in this area. Vaccine candidates have been developed using various platforms and regimens and have been tested in several animal models. Here, this article reviews the published studies on MERS-CoV vaccines with more focus on vaccines tested in large animals, including camels. It is foreseeable that the 1-health approach could be the best way of tackling the MERS-CoV endemic in the Arabian Peninsula, by using the mass vaccination of camels in the affected areas to block camel to human transmission. Camel vaccines can be developed in a faster time with fewer regulations and lower costs and could clear this virus from the Arabian Peninsula if accompanied by efficient public health measures.

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Acute Middle East Respiratory Syndrome Coronavirus Infection in Livestock Dromedaries, Dubai, 2014

Cited by 91 publications

References 16 publications

Quantifying spatiotemporal heterogeneity of MERS-CoV transmission in the Middle East region: A combined modelling approach

Quantifying spatiotemporal heterogeneity of MERS-CoV transmission in the Middle East region: A combined modelling approach

Middle East respiratory syndrome coronavirus (MERS-CoV): what lessons can we learn?

Vaccines against Middle East respiratory syndrome coronavirus for humans and camels

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