Abstract
Detection of human cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection internationally is a global public health concern. Rigorous risk assessment is particularly challenging in a context where surveillance may be subject to under-ascertainment and a selection bias towards more severe cases. We would like to assess whether the virus is capable of causing widespread human epidemics, and whether self-sustaining transmission is already under way. Here we review possible transmission scenarios for MERS-CoV and their implications for risk assessment and control. We discuss how existing data, future investigations and analyses may help in reducing uncertainty and refining the public health risk assessment and present analytical approaches that allow robust assessment of epidemiological characteristics, even from partial and biased surveillance data. Finally, we urge that adequate data be collected on future cases to permit rigorous assessment of the transmission characteristics and severity of MERS-CoV, and the public health threat it may pose. Going beyond minimal case reporting, open international collaboration, under the guidance of the World Health Organization and the International Health Regulations, will impact on how this potential epidemic unfolds and prospects for control.
Highlights
Detection of human cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection internationally is a global public health concern
How feasible is it that most of the severe MERS-CoV cases detected to date were infected via human-to-human transmission and that the epidemic is already self-sustaining in human populations (Figure 1B)? Under this transmission scenario, substantial numbers of human infections may have already occurred, with only a small proportion of them being detected
If none of the MERS-CoV cases detected by routine surveillance had exposure to the reservoir(s), this would clearly indicate that an epidemic in humans is already self-sustaining [26]
Summary
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