One-health approach to MERS-COV, 2012-2017: Experience from Qatar

Objectives: The emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012 was accompanied by uncertainty about its epidemiological and clinical characteristics. Once camelus dromedarius was found to be the natural reservoir of the virus public health systems across the Arabian Peninsula came under unprecedented pressure to control its transmission. This study describes how a One Health approach was used in Qatar to manage the MERS-CoV outbreak between 2012 and 2017. Method(s): The One Health approach adopted brought together professionals working in the health, animal welfare, and environmental sectors. To manage the MERS outbreak the Qatar National Outbreak Control Taskforce (OCT) was reactivated in November 2012 and experts from the animal health sector were invited to join. Later, technical expertise was requested from the WHO, FAO, CDC, Erasmus University (EMC), and Public Health England (PHE). A One Health roadmap was subsequently delivered addressing surveillance and investigation, epidemiological studies and increased local diagnostic capacity. Result(s): The joint OCT, once trained, was allocated resources and had access to high risk areas to gather evidence on the potential source of the virus and investigate all cases within 24-48 hours of reporting. Lack of sufficient technical guidance on veterinary surveillance and poor risk perception among vulnerable populations constituted major obstacles to maintaining systematic One Health performance. Conclusion(s): A One Health approach is essential for generating evidence and implementing control measures to restrain MERS-CoV and other zoonotic diseases.

Evidence of zoonotic MERS-COV infection among a high-risk population in Morocco

Objectives: There have been recurrent spillovers from dromedaries into the human population since the emergence of Middle East respiratory syndrome coronavirus (MERS-CoV). All known zoonotic MERS disease had hitherto occurred in the Arabian Peninsula, with none reported in Africa. This study assesses zoonotic MERS-CoV infection in high-risk groups in Morocco. Method(s): The study adapted a World Health Organization (WHO) MERS-CoV protocol to assess the seroprevalence of MERS-CoV and the risk factors of infection among high-risk populations in three study sites in the south of Morocco with high-densities of dromedaries. Demographic and camel exposure data was obtained using a questionnaire for three set study groups - members of the general population, slaughterhouse workers, and camel herders. Human sera samples were tested for MERS-CoV IgG antibodies through ELISA, pseudoparticule neutralisation, and plaque reduction neutralisation assay. Result(s): Blood samples from 479 participants enrolled in the study were collected between November 2017 and January 2018. The results produced the first evidence in Africa of human primary cases of MERS-CoV infection with documented direct exposure to dromedaries. Three out of 137 slaughterhouse workers and one of 186 from the general population group showed the neutralizing MERS-CoV antibody. Conclusion(s): This is the first time MERS-CoV transmission risk factors have been examined in Morocco through a seroprevalence study among high-risk populations. It provided evidence of zoonotic transmission, underlining the need for exhaustive investigations of human ARI in likely areas for evidence of MERS circulation.

Middle East respiratory syndrome [Review]

The Middle East respiratory syndrome coronavirus (MERS-CoV) is a lethal zoonotic pathogen that was first identified in humans in Saudi Arabia and Jordan in 2012. Intermittent sporadic cases, community clusters, and nosocomial outbreaks of MERS-CoV continue to occur. Between April 2012 and December 2019, 2499 laboratory-confirmed cases of MERS-CoV infection, including 858 deaths (34.3% mortality) were reported from 27 countries to WHO, the majority of which were reported by Saudi Arabia (2106 cases, 780 deaths). Large outbreaks of human-to-human transmission have occurred, the largest in Riyadh and Jeddah in 2014 and in South Korea in 2015. MERS-CoV remains a high-threat pathogen identified by WHO as a priority pathogen because it causes severe disease that has a high mortality rate, epidemic potential, and no medical countermeasures. This Seminar provides an update on the current knowledge and perspectives on MERS epidemiology, virology, mode of transmission, pathogenesis, diagnosis, clinical features, management, infection control, development of new therapeutics and vaccines, and highlights unanswered questions and priorities for research, improved management, and prevention.