Abstract
Nearly 4 years after the first report of the emergence of Middle-East respiratory syndrome Coronavirus (MERS-CoV) and nearly 1800 human cases later, the ecology of MERS-CoV, its epidemiology, and more than risk factors of MERS-CoV transmission between camels are poorly understood. Knowledge about the pathways and mechanisms of transmission from animals to humans is limited; as of yet, transmission risks have not been quantified. Moreover the divergent sanitary situations and exposures to animals among populations in the Arabian Peninsula, where human primary cases appear to dominate, vs. other regions in the Middle East and Africa, with no reported human clinical cases and where the virus has been detected only in dromedaries, represents huge scientific and health challenges. Here, we have used expert-opinion elicitation in order to obtain ideas on relative importance of MERS-CoV risk factors and estimates of transmission risks from various types of contact between humans and dromedaries. Fourteen experts with diverse and extensive experience in MERS-CoV relevant fields were enrolled and completed an online questionnaire that examined pathways based on several scenarios, e.g., camels–camels, camels–human, bats/other species to camels/humans, and the role of diverse biological substances (milk, urine, etc.) and potential fomites. Experts believed that dromedary camels play the largest role in MERS-CoV infection of other dromedaries; however, they also indicated a significant influence of the season (i.e. calving or weaning periods) on transmission risk. All experts thought that MERS-CoV-infected dromedaries and asymptomatic humans play the most important role in infection of humans, with bats and other species presenting a possible, but yet undefined, risk. Direct and indirect contact of humans with dromedary camels were identified as the most risky types of contact, when compared to consumption of various camel products, with estimated “most likely” incidence risks of at least 22 and 13% for direct and indirect contact, respectively. The results of our study are consistent with available, yet very limited, published data regarding the potential pathways of transmission of MERS-CoV at the animal–human interface. These results identify key knowledge gaps and highlight the need for more comprehensive, yet focused research to be conducted to better understand transmission between dromedaries and humans.
Highlights
4 years after the first report of the emergence of MiddleEast respiratory syndrome Coronavirus (MERS-CoV) in humans and more than 1800 human cases later [1], mainly in Saudi Arabia (~75% of cases and almost all of the primary cases), the ecology of MERS-CoV and its epidemiology remain poorly understood [2]
When data are scarce and knowledge gaps are highly prevalent, such as with the recently identified MERS-CoV, too many transmission pathways would have been presented for the risk analysis. This is why we proposed, as a preliminary step, to call upon experts using expertopinion elicitation (EOE), to explore scenarios and hypotheses of transmission among animal(s), fomites, and humans
Despite a lack of quantitative data, our results are supported by growing evidence from research published from MERS-CoV affected countries
Summary
4 years after the first report of the emergence of MiddleEast respiratory syndrome Coronavirus (MERS-CoV) in humans and more than 1800 human cases later [1], mainly in Saudi Arabia (~75% of cases and almost all of the primary cases), the ecology of MERS-CoV and its epidemiology remain poorly understood [2]. Many studies have identified dromedary camels (Camelus dromedarius; dromedaries) as a natural host for MERS-CoV, and there appears to be ample evidence of widespread infection (either past or present) in dromedaries in the Middle East [7,8,9,10]. High levels of MERS-CoV specific seroprevalence have been observed in dromedaries, ranging from 0% in Central Asia to as much as 100% in Africa and the Arabian Peninsula [7,8,9,10,11,12,13,14,15,16,17] (see Figure 1). MERS-CoV strains isolated from dromedaries are genetically and phenotypically very similar or identical to those infecting humans [18, 19]
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