Abstract
Middle East Respiratory Syndrome Coronavirus (MERS-CoV) causes severe acute respiratory illness with a case fatality rate (CFR) of 35,5%. The highest number of MERS-CoV cases are from Saudi-Arabia, the major worldwide hotspot for this disease. In the absence of neither effective treatment nor a ready-to-use vaccine and with yet an incomplete understanding of its epidemiological cycle, prevention and containment measures can be derived from mathematical models of disease epidemiology. We constructed 2-strain models to predict past outbreaks in the interval 2012–2016 and derive key epidemiological information for Macca, Madina and Riyadh. We approached variability in infection through three different disease incidence functions capturing social behavior in response to an epidemic (e.g. Bilinear, BL; Non-monotone, NM; and Saturated, SAT models). The best model combination successfully anticipated the total number of MERS-CoV clinical cases for the 2015–2016 season and accurately predicted both the number of cases at the peak of seasonal incidence and the overall shape of the epidemic cycle. The evolution in the basic reproduction number (R0) warns that MERS-CoV may easily take an epidemic form. The best model correctly captures this feature, indicating a high epidemic risk (1≤R0≤2,5) in Riyadh and Macca and confirming the alleged co-circulation of more than one strain. Accurate predictions of the future MERS-CoV peak week, as well as the number of cases at the peak are now possible. These results indicate public health agencies should be aware that measures for strict containment are urgently needed before new epidemics take off in the region.
Highlights
The first case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection was identified in Saudi Arabia in 2012[1,2,3,4,5]
We considered the case when two strains of MERS-CoV may be co-circulating in the human population in Saudi Arabia
We simulated the situation when one strain is assumed to be more active with a higher transmission rate, whilst the other is much less transmissible among individuals in the different provinces of Saudi-Arabia[37]. we have considered two strains circulating in the community setting, we do not distinguish among strains in hospital premises
Summary
The first case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection was identified in Saudi Arabia in 2012[1,2,3,4,5]. Since the country suffers from repeated outbreaks of MERS-CoV in different provinces (Fig 1A and 1B)[2]. It is suspected that dromedary camels are the source of human infections[1] but the transmission route of MERS-CoV to humans is yet not well understood (Fig 1C). Potential propagation to nearby and more distant regions is a high-risk possibility as an outbreak of MERS-CoV is likely to emerge in areas such as nearby countries in the Middle East and eastern Africa where the camel trade connects the different regions (Fig 1). As for MERS-CoV vaccines are only at the preclinical phase[10], increasing our understanding of its epidemic potential and knowledge on the drivers of MERS-CoV variability might help to achieve better preparedness ahead of forthcoming epidemics
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