Mapping immunodominant sites on the MERS-CoV spike glycoprotein targeted by infection-elicited antibodies in humans (preprint)

Middle-East respiratory syndrome coronavirus (MERS-CoV) first emerged in 2012 and causes human infections in endemic regions. Most vaccines and therapeutics in development against MERS-CoV focus on the spike (S) glycoprotein to prevent viral entry into target cells. These efforts, however, are limited by a poor understanding of antibody responses elicited by infection along with their durability, fine specificity and contribution of distinct S antigenic sites to neutralization. To address this knowledge gap, we analyzed S-directed binding and neutralizing antibody titers in plasma collected from individuals infected with MERS-CoV in 2017-2019 (prior to the COVID-19 pandemic). We observed that binding and neutralizing antibodies peak 1 to 6 weeks after symptom onset/hospitalization, persist for at least 6 months, and broadly neutralize human and camel MERS-CoV strains. We show that the MERS-CoV S1 subunit is immunodominant and that antibodies targeting S1, particularly the RBD, account for most plasma neutralizing activity. Antigenic site mapping revealed that polyclonal plasma antibodies frequently target RBD epitopes, particularly a site exposed irrespective of the S trimer conformation, whereas targeting of S2 subunit epitopes is rare, similar to SARS-CoV-2. Our data reveal in unprecedented details the humoral immune responses elicited by MERS-CoV infection, which will guide vaccine and therapeutic design.

Healthcare workers' worries and Monkeypox vaccine advocacy during the first month of the WHO Monkeypox alert: Cross-sectional survey in Saudi Arabia (preprint)

Background: Monkeypox virus re-surged in May 2022 as a new potential global health threat with outbreaks bursting in multiple countries across different continents. This study was conducted during the first month of the WHO announcement to assess the healthcare workers (HCWs) within Saudi Arabia, exploring their perception, worries, and vaccine acceptance for Monkeypox in-line with the resolving COVID-19 pandemic. Methods: A national cross-sectional survey was conducted between May 27 and June 10, 2022, in Saudi Arabia. Data were collected on the sociodemographic and job-related characteristics, COVID-19 infection status, HCWs' worry levels of Monkeypox compared to COVID-19 and its sources, their perceptions, awareness, and HCWs' Monkeypox vaccination advocacy. Results: Among the 1130 HCWs who completed survey, 41.6% already developed COVID-19. Still, 56.5% were more worried from COVID-19 compared to Monkeypox, while the rest were more worried of Monkeypox disease. The main reason for their worry among 68.8% of the participants was development of another worldwide pandemic post COVID-19, followed by their worry of acquiring the infection themselves or their families (49.6%). Most HCWs (60%) rated their self-awareness of Monkeypox disease as moderate to high. Males and those who previously developed COVID-19 were significantly less likely to worry about Monkeypox. The worry about Monkeypox developing into a pandemic and the perception of Monkeypox being a severe disease correlated significantly positively with the odds of high worry from the disease. Regarding participants' advocacy for HCWs' vaccination against Monkeypox disease, those who developed COVID-19 previously and those who supported application of tighter infection control measures compared to the current ones to combat the disease were significantly predicted to agree for vaccination. 74.2% of the surveyed HCWs perceived that they need to read more about the Monkeypox disease after the survey. Conclusion: During the first month of the WHO's Monkeypox international alert, about half of HCWs in this study were more worried about Monkeypox disease as compared to COVID-19, and its possible progression into another pandemic. In addition, the majority were in favor of applying tighter infection prevention measures to combat the disease. The current study highlights areas needed for healthcare administrative about the HCWs' perceptions and readiness for Monkeypox especially in the event of any occurrence of local or international pandemic.

Monkeypox caused less worry than COVID-19 among the general population during the first month of the WHO Monkeypox alert (preprint)

BackgroundMonkeypox re-emerged in May 2022 as another global health threat. This study assessed the publics perception, worries, and vaccine acceptance for Monkeypox and COVID-19 during the first month of WHO announcement. MethodsA national cross-sectional survey was conducted between May 27 and June 5, 2022, in Saudi Arabia. Data were collected on sociodemographic characteristics, previous infection with COVID-19, worry levels regarding Monkeypox compared to COVID-19, awareness, and perceptions of Monkeypox, and vaccine acceptance. ResultsAmong the 1546 participants, most respondents (62%) were more worried about COVID-19 than Monkeypox. Respondents aged 45 years and above and those with a university degree or higher had lower odds of agreement with Monkeypox vaccination (OR .871, p-value .006, OR .719, p-value <0.001), respectively. Respondents with moderate to a high level of self and family commitment to infection control precautionary measures and those who expressed self and family worry of Monkeypox infection had significantly higher odds of vaccination agreement (OR 1.089 p-value=0.047, OR1.395 p-value=0.003) respectively. On the other hand, respondents who previously developed COVID-19 were significantly more worried about the Monkeypox disease (1.30 times more, p-value=0.020). ConclusionWorry levels amongst the public are higher from COVID-19 than Monkeypox. Perception of Monkeypox as a dangerous and virulent disease, worry from contracting the disease, and high commitment to infection precautionary measures were predictors of agreement with Monkeypox vaccination. While advanced age and high education level are predictors of low agreement with vaccination.

SARS-CoV-2 Omicron variant: healthcare workers' perceptions and beliefs of vaccine effectiveness and advocacy: a national survey during the first week of the World Health Organization variant alert (preprint)

Background: As COVID-19 Omicron variant spread in several countries, healthcare workers' (HCWs) perceptions of vaccine effectiveness, booster and worries warrant reassessment. Methods: Online questionnaire among HCWs in Saudi Arabia (KSA) was collected between Dec 1-6, 2021, aiming to assess their Omicron variant's perceptions, worries, and booster-vaccine advocacy. Results: Among the 1285 HCWs participants in the study, two-thirds were females, 41% were nurses,46.4% were physicians, and 50% worked in tertiary care hospitals. Vaccination was perceived to be the most effective way to prevent the spread of Omicron variant and future variants by 66.9%. The respondents perceived social distancing (78%), universal masking (77.8%), and avoiding unnecessary travel (71.4%), slightly superior to vaccination to prevent COVID-19 variants spread. Of the respondents, 99.5% received two doses of COVID-19 vaccine. Regarding the booster dose, 96% either received it or planned to receive it once they are eligible. 57.7% of the respondents agreed that Omicron could cause a new COVID-19 wave worldwide, 45.9% agreed it may cause another COVID-19 wave in Saudi Arabia and 46.1% indicated the possibility of another lockdown. Overall, the HCWs worry level of the Omicron variant correlated significantly and strongly with their perception of the effectiveness of vaccination and preventive measures. Male HCWs had a significant agreement with mandatory vaccination of all eligible adult populations while HCWs who are unwilling to receive the vaccine had a strong disagreement with mandatory vaccination. Conclusions: The current study was conducted in the first week of Omicron variant discovery in KSA and only two-thirds of HCWs felt that vaccination is the best option to prevent the variant spread, indicating the need to further motivation campaigns for vaccination and booster doses education among HCWs. HCWs had a strong belief in non-pharmacologic interventions that should be encouraged and augmented. It is important to further study and enhance coping strategies for HCWs as we move through the third year of the pandemic with more potential variants, to protect HCWs from fatigue and burnout.