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Le Bert N, Samandari T. Silent battles: immune responses in asymptomatic SARS-CoV-2 infection. Cell Mol Immunol 2024; 21:159-170. [PMID: 38221577 PMCID: PMC10805869 DOI: 10.1038/s41423-024-01127-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/03/2024] [Accepted: 01/03/2024] [Indexed: 01/16/2024] Open
Abstract
SARS-CoV-2 infections manifest with a broad spectrum of presentations, ranging from asymptomatic infections to severe pneumonia and fatal outcomes. This review centers on asymptomatic infections, a widely reported phenomenon that has substantially contributed to the rapid spread of the pandemic. In such asymptomatic infections, we focus on the role of innate, humoral, and cellular immunity. Notably, asymptomatic infections are characterized by an early and robust innate immune response, particularly a swift type 1 IFN reaction, alongside a rapid and broad induction of SARS-CoV-2-specific T cells. Often, antibody levels tend to be lower or undetectable after asymptomatic infections, suggesting that the rapid control of viral replication by innate and cellular responses might impede the full triggering of humoral immunity. Even if antibody levels are present in the early convalescent phase, they wane rapidly below serological detection limits, particularly following asymptomatic infection. Consequently, prevalence studies reliant solely on serological assays likely underestimate the extent of community exposure to the virus.
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Affiliation(s)
- Nina Le Bert
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore.
| | - Taraz Samandari
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
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Bansal D, Jaffrey S, Al-Emadi NA, Hassan M, Islam MM, Al-Baker WAA, Radwan E, Hamdani D, Haroun MI, Enan K, Nour M, Coyle PV, Al Marri A, Al-Zeyara AA, Younus NM, Yassine HM, Al Thani AA, Darkhshan F, Khalid M, Marhous H, Tibbo M, Alhosani M, Taha T, Wannous C, Al Hajri M, Bertollini R, Al-Maslamani MA, Al Khal A, Al Romaihi HE, Al Thani SMBHBJ, El Idrissi A, Farag EA. A new One Health Framework in Qatar for future emerging and re-emerging zoonotic diseases preparedness and response. One Health 2023; 16:100487. [PMID: 36683958 PMCID: PMC9851870 DOI: 10.1016/j.onehlt.2023.100487] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
One Health is increasingly recognized as an optimal approach to address the global risk of health threats originating at the human, animal, and ecosystem interface, and their impact. Qatar has successfully practiced One Health approach for investigation and surveillance of zoonotic diseases such as MERS-CoV, and other health threats. However, the current gaps at institution and policy level hinder the sustainment of One Health. In this paper, we have assessed the potential for implementation of One Health Framework to reinforce and sustain One Health capacities in Qatar for 2022-2027. To implement One Health Framework in the country, Qatar Joint External Evaluation (JEE) report, lessons learnt during One Health experiences on zoonotic, vector-borne, and food borne diseases were used to present an outline for multisectoral coordination. In addition, technical capacities of One Health and factors that are required to operationalize it in the country were also assessed in series of meetings and workshops held at Ministry of Public Health on March 2022. Present health care infrastructure and resources were found to be conducive for effective management and response to shared health threats as evident during MERS-CoV, despite being more event based. Regardless, the need for more sustainable capacity development was unanimously emphasized. The consensus between all relevant stakeholders and partners was that there is a need for better communication channels, policies and protocols for data sharing, and the need to invest more resources for better sustainability. The proposed framework is expected to strengthen and facilitate multilateral coordination, enhanced laboratory capacity and network, improve active surveillance and response, risk communication, community engagement, maximize applied research, and build One Health technical work force. This would enable advancement and sustainment of One Health activities to prevent and control health threats shared between humans-animals-ecosystem interface.
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Affiliation(s)
- Devendra Bansal
- Department of Public Health, Ministry of Public Health, Doha, Qatar
| | - Shariq Jaffrey
- Department of Public Health, Ministry of Public Health, Doha, Qatar
| | | | - Mahmoud Hassan
- Department of Animal Resources, Ministry of Municipality, Doha, Qatar
| | | | | | - Eman Radwan
- Health Care Quality Management and Patient Safety, Ministry of Public Health, Doha, Qatar
| | - Dhouha Hamdani
- Health Care Quality Management and Patient Safety, Ministry of Public Health, Doha, Qatar
| | | | - Khalid Enan
- Department of Animal Resources, Ministry of Municipality, Doha, Qatar
| | - Mohammed Nour
- Department of Public Health, Ministry of Public Health, Doha, Qatar
| | | | - Abdulla Al Marri
- Department of Animal Resources, Ministry of Municipality, Doha, Qatar
| | | | - Nidal M. Younus
- Department of Animal Resources, Ministry of Municipality, Doha, Qatar
| | | | | | - Fatima Darkhshan
- Biomedical Sciences and Health, Qatar National Research Fund, Doha, Qatar
| | - Minahil Khalid
- Department of Public Health, Ministry of Public Health, Doha, Qatar
| | - Heba Marhous
- Eastern Mediterranean Office, World Health Organization, Cairo, Egypt
| | - Markos Tibbo
- Food and Agriculture Organization of the United Nations, Subregional Office for the Gulf Cooperation Council States and Yemen, Abu Dhabi, United Arab Emirates
| | - Mohamed Alhosani
- Food and Agriculture Organization of the United Nations, Subregional Office for the Gulf Cooperation Council States and Yemen, Abu Dhabi, United Arab Emirates
| | - Tariq Taha
- One Health, World Organization for Animal Health (OIE) Regional Office for Africa, Nairobi, Kenya
| | - Chadia Wannous
- One Health, World Organization for Animal Health (OIE) Regional Office for Africa, Nairobi, Kenya
| | - Mohamed Al Hajri
- Health Emergency Department, Ministry of Public Health, Doha, Qatar
| | - Roberto Bertollini
- Minister of Public Health Office, Ministry of Public Health, Doha, Qatar
| | | | | | | | | | | | - Elmoubashar Abd Farag
- Department of Public Health, Ministry of Public Health, Doha, Qatar,Corresponding author at: PO Box: 42, Ministry of Public Health, Doha, Qatar.
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Salam SP, Sabo Nok Kia G, Oladayo FO, Ugochukwu ICI. Serosurvey for Middle East respiratory syndrome coronavirus antibody in dromedary camels and human patients at a secondary care hospital, Illela, Northwest Nigeria. COMPARATIVE CLINICAL PATHOLOGY 2022; 31:537-546. [PMID: 35506144 PMCID: PMC9050177 DOI: 10.1007/s00580-022-03351-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
UNLABELLED Middle East respiratory syndrome (MERS) is a serious emerging zoonosis. It is characterized by severe infection of the respiratory tract in humans. Dromedary camels are considered to be the most probable origin of the pathogenic Middle East respiratory syndrome coronavirus (MERS-CoV). This cross-sectional survey was carried out to ascertain the seroprevalence of MERS-CoV in dromedary camels at Illela border and human patients in a secondary care hospital in Illela, Sokoto State, Nigeria from November 2016 to January 2017. Serum samples from 74 camels and 39 human patients were collected while a data form was administered to the camel handlers (40) and human patients to obtain information on zoographic characteristics of dromedary camels, demographic characteristics of camel handlers and human patients and some practices of both groups which are likely to predispose to MERS-CoV infection. The serum samples were analyzed for antibodies against MERS-CoV using the indirect Enzyme-Linked Immuno-Sorbent Assay (ELISA). All the camels sampled were seropositive against MERS-CoV and 74% of the human patients had antibodies against MERS. All handlers treated their camels without consulting veterinarians and there was little or no biosecurity measures undertaken. Age, sex, and occupation were not significant determinants for the presence of MERS-CoV antibody in human patients sampled. This study serves as a baseline for similar researches and due to the high seroprevalence obtained in this study for both camels and humans, there is need for trained personnel, surveillance and diagnostic tools at our border posts and animal markets. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s00580-022-03351-3.
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Affiliation(s)
| | - Grace Sabo Nok Kia
- Department of Veterinary Public Health and Preventive Medicine, Ahmadu Bello University Zaria, Kaduna State, Nigeria
| | - Faleke Olufemi Oladayo
- Department of Veterinary Public Health and Preventive Medicine, Usmanu Danfodiyo University Sokoto, Sokoto State, Nigeria
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Peiris M, Perlman S. Unresolved questions in the zoonotic transmission of MERS. Curr Opin Virol 2022; 52:258-264. [PMID: 34999369 PMCID: PMC8734234 DOI: 10.1016/j.coviro.2021.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 02/08/2023]
Abstract
The Middle East Respiratory Syndrome-coronavirus (MERS-CoV) is the second of three zoonotic coronaviruses to infect humans since 2002, causing severe pneumonia. Unlike SARS-CoV-1 and SARS-CoV-2, the causes of the severe acute respiratory syndrome and Covid-19, respectively, MERS-CoV is enzootic in dromedary camels, a domestic/companion animal present across Africa, the Middle East and Central or South Asia and is sporadically transmitted to humans. However, it does not transmit readily from human to human except in hospital and household settings. Human MERS disease is reported only from the Arabian Peninsula (and only since 2012 even though the virus was detected in camels from at least the early 1990's) and in travelers from this region. Remarkably, no zoonotic MERS disease has been detected in Africa or Asia, even in areas of high density of MERS-CoV infected dromedaries. Here, we review aspects of MERS biology and epidemiology that might contribute to this lack of correlation between sites of camel infection and human zoonotic disease. Since MERS-CoV or MERS-like CoV have pandemic potential, further investigations into this disparity is critical, to forestall pandemics caused by this virus.
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Affiliation(s)
- Malik Peiris
- HKU-Pasteur Research Pole, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, P.R. China; School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong (HKU), Pokfulam, Hong Kong Special Administrative Region, P.R. China.
| | - Stanley Perlman
- Department of Microbiology and Immunology, University of Iowa, Iowa City, IA 52242, United States.
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Borrega R, Nelson DKS, Koval AP, Bond NG, Heinrich ML, Rowland MM, Lathigra R, Bush DJ, Aimukanova I, Phinney WN, Koval SA, Hoffmann AR, Smither AR, Bell-Kareem AR, Melnik LI, Genemaras KJ, Chao K, Snarski P, Melton AB, Harrell JE, Smira AA, Elliott DH, Rouelle JA, Sabino-Santos G, Drouin AC, Momoh M, Sandi JD, Goba A, Samuels RJ, Kanneh L, Gbakie M, Branco ZL, Shaffer JG, Schieffelin JS, Robinson JE, Fusco DN, Sabeti PC, Andersen KG, Grant DS, Boisen ML, Branco LM, Garry RF. Cross-Reactive Antibodies to SARS-CoV-2 and MERS-CoV in Pre-COVID-19 Blood Samples from Sierra Leoneans. Viruses 2021; 13:2325. [PMID: 34835131 PMCID: PMC8625389 DOI: 10.3390/v13112325] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/14/2021] [Accepted: 11/17/2021] [Indexed: 12/15/2022] Open
Abstract
Many countries in sub-Saharan Africa have experienced lower COVID-19 caseloads and fewer deaths than countries in other regions worldwide. Under-reporting of cases and a younger population could partly account for these differences, but pre-existing immunity to coronaviruses is another potential factor. Blood samples from Sierra Leonean Lassa fever and Ebola survivors and their contacts collected before the first reported COVID-19 cases were assessed using enzyme-linked immunosorbent assays for the presence of antibodies binding to proteins of coronaviruses that infect humans. Results were compared to COVID-19 subjects and healthy blood donors from the United States. Prior to the pandemic, Sierra Leoneans had more frequent exposures than Americans to coronaviruses with epitopes that cross-react with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), SARS-CoV, and Middle Eastern respiratory syndrome coronavirus (MERS-CoV). The percentage of Sierra Leoneans with antibodies reacting to seasonal coronaviruses was also higher than for American blood donors. Serological responses to coronaviruses by Sierra Leoneans did not differ by age or sex. Approximately a quarter of Sierra Leonian pre-pandemic blood samples had neutralizing antibodies against SARS-CoV-2 pseudovirus, while about a third neutralized MERS-CoV pseudovirus. Prior exposures to coronaviruses that induce cross-protective immunity may contribute to reduced COVID-19 cases and deaths in Sierra Leone.
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Affiliation(s)
- Rodrigo Borrega
- Zalgen Labs, LCC, Germantown, MD 20876, USA; (R.B.); (A.P.K.); (M.L.H.); (M.M.R.); (R.L.); (S.A.K.); (Z.L.B.)
| | - Diana K. S. Nelson
- Zalgen Labs, LCC, Broomfield, CO 80045, USA; (D.K.S.N.); (D.J.B.); (I.A.); (W.N.P.)
| | - Anatoliy P. Koval
- Zalgen Labs, LCC, Germantown, MD 20876, USA; (R.B.); (A.P.K.); (M.L.H.); (M.M.R.); (R.L.); (S.A.K.); (Z.L.B.)
| | - Nell G. Bond
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (N.G.B.); (A.R.H.); (A.R.S.); (A.R.B.-K.); (L.I.M.); (K.J.G.); (K.C.); (J.E.H.)
| | - Megan L. Heinrich
- Zalgen Labs, LCC, Germantown, MD 20876, USA; (R.B.); (A.P.K.); (M.L.H.); (M.M.R.); (R.L.); (S.A.K.); (Z.L.B.)
| | - Megan M. Rowland
- Zalgen Labs, LCC, Germantown, MD 20876, USA; (R.B.); (A.P.K.); (M.L.H.); (M.M.R.); (R.L.); (S.A.K.); (Z.L.B.)
| | - Raju Lathigra
- Zalgen Labs, LCC, Germantown, MD 20876, USA; (R.B.); (A.P.K.); (M.L.H.); (M.M.R.); (R.L.); (S.A.K.); (Z.L.B.)
| | - Duane J. Bush
- Zalgen Labs, LCC, Broomfield, CO 80045, USA; (D.K.S.N.); (D.J.B.); (I.A.); (W.N.P.)
| | - Irina Aimukanova
- Zalgen Labs, LCC, Broomfield, CO 80045, USA; (D.K.S.N.); (D.J.B.); (I.A.); (W.N.P.)
| | - Whitney N. Phinney
- Zalgen Labs, LCC, Broomfield, CO 80045, USA; (D.K.S.N.); (D.J.B.); (I.A.); (W.N.P.)
| | - Sophia A. Koval
- Zalgen Labs, LCC, Germantown, MD 20876, USA; (R.B.); (A.P.K.); (M.L.H.); (M.M.R.); (R.L.); (S.A.K.); (Z.L.B.)
| | - Andrew R. Hoffmann
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (N.G.B.); (A.R.H.); (A.R.S.); (A.R.B.-K.); (L.I.M.); (K.J.G.); (K.C.); (J.E.H.)
| | - Allison R. Smither
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (N.G.B.); (A.R.H.); (A.R.S.); (A.R.B.-K.); (L.I.M.); (K.J.G.); (K.C.); (J.E.H.)
| | - Antoinette R. Bell-Kareem
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (N.G.B.); (A.R.H.); (A.R.S.); (A.R.B.-K.); (L.I.M.); (K.J.G.); (K.C.); (J.E.H.)
| | - Lilia I. Melnik
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (N.G.B.); (A.R.H.); (A.R.S.); (A.R.B.-K.); (L.I.M.); (K.J.G.); (K.C.); (J.E.H.)
| | - Kaylynn J. Genemaras
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (N.G.B.); (A.R.H.); (A.R.S.); (A.R.B.-K.); (L.I.M.); (K.J.G.); (K.C.); (J.E.H.)
- Bioinnovation Program, Tulane University, New Orleans, LA 70118, USA
| | - Karissa Chao
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (N.G.B.); (A.R.H.); (A.R.S.); (A.R.B.-K.); (L.I.M.); (K.J.G.); (K.C.); (J.E.H.)
- Bioinnovation Program, Tulane University, New Orleans, LA 70118, USA
| | - Patricia Snarski
- Heart and Vascular Institute, John W. Deming Department of Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA;
- Department of Physiology, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Alexandra B. Melton
- Department of Microbiology, Tulane National Primate Research Center, Covington, LA 70433, USA;
| | - Jaikin E. Harrell
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (N.G.B.); (A.R.H.); (A.R.S.); (A.R.B.-K.); (L.I.M.); (K.J.G.); (K.C.); (J.E.H.)
| | - Ashley A. Smira
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (A.A.S.); (D.H.E.); (J.A.R.); (J.S.S.); (J.E.R.)
| | - Debra H. Elliott
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (A.A.S.); (D.H.E.); (J.A.R.); (J.S.S.); (J.E.R.)
| | - Julie A. Rouelle
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (A.A.S.); (D.H.E.); (J.A.R.); (J.S.S.); (J.E.R.)
| | - Gilberto Sabino-Santos
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA;
- Centre for Virology Research, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil
| | - Arnaud C. Drouin
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (A.C.D.); (D.N.F.)
| | - Mambu Momoh
- Eastern Polytechnic Institute, Kenema, Sierra Leone;
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone; (J.D.S.); (A.G.); (R.J.S.); (L.K.); (M.G.)
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - John Demby Sandi
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone; (J.D.S.); (A.G.); (R.J.S.); (L.K.); (M.G.)
| | - Augustine Goba
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone; (J.D.S.); (A.G.); (R.J.S.); (L.K.); (M.G.)
| | - Robert J. Samuels
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone; (J.D.S.); (A.G.); (R.J.S.); (L.K.); (M.G.)
| | - Lansana Kanneh
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone; (J.D.S.); (A.G.); (R.J.S.); (L.K.); (M.G.)
| | - Michael Gbakie
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone; (J.D.S.); (A.G.); (R.J.S.); (L.K.); (M.G.)
| | - Zoe L. Branco
- Zalgen Labs, LCC, Germantown, MD 20876, USA; (R.B.); (A.P.K.); (M.L.H.); (M.M.R.); (R.L.); (S.A.K.); (Z.L.B.)
| | - Jeffrey G. Shaffer
- Department of Biostatistics and Data Science, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA;
| | - John S. Schieffelin
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (A.A.S.); (D.H.E.); (J.A.R.); (J.S.S.); (J.E.R.)
- Department of Internal Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - James E. Robinson
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (A.A.S.); (D.H.E.); (J.A.R.); (J.S.S.); (J.E.R.)
| | - Dahlene N. Fusco
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (A.C.D.); (D.N.F.)
| | - Pardis C. Sabeti
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA 02142, USA;
- Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA
- Massachusetts Consortium on Pathogen Readiness, Boston, MA 02115, USA
| | - Kristian G. Andersen
- Department of Immunology and Microbial Science, Scripps Research, La Jolla, CA 92037, USA;
- Scripps Research Translational Institute, La Jolla, CA 92037, USA
| | - Donald S. Grant
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone; (J.D.S.); (A.G.); (R.J.S.); (L.K.); (M.G.)
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Matthew L. Boisen
- Zalgen Labs, LCC, Broomfield, CO 80045, USA; (D.K.S.N.); (D.J.B.); (I.A.); (W.N.P.)
| | - Luis M. Branco
- Zalgen Labs, LCC, Germantown, MD 20876, USA; (R.B.); (A.P.K.); (M.L.H.); (M.M.R.); (R.L.); (S.A.K.); (Z.L.B.)
| | - Robert F. Garry
- Zalgen Labs, LCC, Germantown, MD 20876, USA; (R.B.); (A.P.K.); (M.L.H.); (M.M.R.); (R.L.); (S.A.K.); (Z.L.B.)
- Zalgen Labs, LCC, Broomfield, CO 80045, USA; (D.K.S.N.); (D.J.B.); (I.A.); (W.N.P.)
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA 70112, USA; (N.G.B.); (A.R.H.); (A.R.S.); (A.R.B.-K.); (L.I.M.); (K.J.G.); (K.C.); (J.E.H.)
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Parkhe P, Verma S. Evolution, Interspecies Transmission, and Zoonotic Significance of Animal Coronaviruses. Front Vet Sci 2021; 8:719834. [PMID: 34738021 PMCID: PMC8560429 DOI: 10.3389/fvets.2021.719834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/07/2021] [Indexed: 12/18/2022] Open
Abstract
Coronaviruses are single-stranded RNA viruses that affect humans and a wide variety of animal species, including livestock, wild animals, birds, and pets. These viruses have an affinity for different tissues, such as those of the respiratory and gastrointestinal tract of most mammals and birds and the hepatic and nervous tissues of rodents and porcine. As coronaviruses target different host cell receptors and show divergence in the sequences and motifs of their structural and accessory proteins, they are classified into groups, which may explain the evolutionary relationship between them. The interspecies transmission, zoonotic potential, and ability to mutate at a higher rate and emerge into variants of concern highlight their importance in the medical and veterinary fields. The contribution of various factors that result in their evolution will provide better insight and may help to understand the complexity of coronaviruses in the face of pandemics. In this review, important aspects of coronaviruses infecting livestock, birds, and pets, in particular, their structure and genome organization having a bearing on evolutionary and zoonotic outcomes, have been discussed.
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Affiliation(s)
| | - Subhash Verma
- Department of Veterinary Microbiology, DGCN College of Veterinary and Animal Sciences, Chaudhary Sarwan Kumar Himachal Pradesh Krishi Vishvavidyalaya, Palampur, India
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Almatari M, Alghamdi A, Alamri S, Otaibey M, Alghamdi AJ, Alasmari A, Alelyani M. Measuring Awareness of Infection Control Guidelines for Patients with COVID-19 in Radiology Departments in Saudi Arabia. Med Sci (Basel) 2021; 9:medsci9010018. [PMID: 33809671 PMCID: PMC8006024 DOI: 10.3390/medsci9010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/16/2022] Open
Abstract
Due to the contagious nature of the COVID-19 virus, healthcare workers are at a great risk of infection. Since medical imaging plays a significant part in the healthcare system and is often used in the diagnosis of potential COVID-19 patients, the radiology personnel are at a very high risk of becoming infected. Purpose: This study aims to assess the enforcement of infection control guidelines for patients with COVID-19 during medical imaging procedures and raise awareness of infection control in different hospitals in Saudi Arabia. Methods: A total of 128 responses were collected from four hospitals across Saudi Arabia using a new structured questionnaire, which was created for health workers by the WHO specifically for this purpose. Data were collected during the COVID-19 pandemic in April 2020. Results: Most participants correctly followed the guidelines of the WHO and Centers for Disease Control and Prevention (CDC) on infection control in the X-ray and general radiology departments. Guideline awareness was higher among magnetic resonance imaging (MRI) and computerised tomography (CT) radiographers, which reduced the risk of future infections. Out of the total respondents, 98.4% stated that they had received formal training in hand hygiene. Only 40.6% of participants, however, knew that respiratory droplets are the primary mode of transmission of the virus from person to person. Conclusion: The knowledge of healthcare professionals in the radiology department regarding infection control needs to be continually assessed. A focus on educational interventions on infection control is required in order to maintain well-informed medical staff.
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Affiliation(s)
- M. Almatari
- Department of Physics, Faculty of Sciences, Al-Balqa Applied University, Al-Salt 19117, Jordan;
| | - Ali Alghamdi
- Department of Radiological Sciences, Faculty of Applied Medical Sciences, Tabuk University, Tabuk 47713, Saudi Arabia;
| | - Sultan Alamri
- Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, Taif 26521, Saudi Arabia;
- Correspondence:
| | - Mufeed Otaibey
- Department of Nuclear Medicine, King Abdullah Medical City, Makkah 24246, Saudi Arabia;
| | - Ahmad Joman Alghamdi
- Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, Taif 26521, Saudi Arabia;
| | - Azah Alasmari
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha 62529, Saudi Arabia; (A.A.); (M.A.)
| | - Magbool Alelyani
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha 62529, Saudi Arabia; (A.A.); (M.A.)
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8
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Abdelghany TM, Ganash M, Bakri MM, Qanash H, Al-Rajhi AMH, Elhussieny NI. SARS-CoV-2, the other face to SARS-CoV and MERS-CoV: Future predictions. Biomed J 2021; 44:86-93. [PMID: 33602634 PMCID: PMC7603957 DOI: 10.1016/j.bj.2020.10.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/15/2020] [Accepted: 10/26/2020] [Indexed: 12/28/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) outbreak is proving to be an unprecedented disaster that lays its dark shadow on global health, economics and personal freedom. Severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS) epidemics provide scientific data that is useful in better understanding and resolution of COVID-19. Similarities among SARS-CoV, MERS-CoV and SARS-CoV-2 have been investigated in the light of available data. SARS-CoV, MERS-CoV and SARS-CoV-2 evolved in bats and have positive-sense RNA genomes of 27.9 kb, 30.1 kb and 29.9 kb, respectively. Molecular and serological tools used for diagnosis of SARS and MERS patients resemble COVID-19 diagnostic tools. Stability and longevity data of SARS and MERS epidemics contribute in the current pandemic precaution policies. Trials to produce vaccines for SARS-CoV and MERS-CoV failed, therefore different strategies were employed for SARS-CoV2 vaccines production and during the past period antiviral agents, Convalescent plasma and monoclonal antibodies provide potential treatments for sever patients. The mortality rate caused by the SARS-CoV and MERS-CoV reached 15% and 37%, respectively. The first declarations about mortality rate of SARS-CoV-2 was around 2-4% but now this rate differed globally and reached more than 13% in some countries. A realistic COVID-19 outbreak scenario suggest that the pandemic might last for three years with fluctuation in the number of infected cases, unless vaccination process goes faster and/or antiviral drug is discovered.
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Affiliation(s)
- T M Abdelghany
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Cairo, Egypt.
| | - Magdah Ganash
- Biology Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Marwah M Bakri
- University College, Al-Ardah, Jazan University, Jazan, Saudi Arabia
| | - Husam Qanash
- Clinical Laboratory Science Department, College of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia
| | - Aisha M H Al-Rajhi
- Biology Department, Faculty of Science, Princess Nora Bent Abdularahman University, Riyadh, Saudi Arabia
| | - Nadeem I Elhussieny
- Chemistry of Natural and Microbial Products Department, National Research Centre, Cairo, Egypt; Institute of Environmental Biology and Biotechnology, University of Applied Sciences, Bremen, Germany; Life Sciences and Chemistry Department, Jacobs University Bremen GmbH, Bremen, Germany
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9
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Totura A, Livingston V, Frick O, Dyer D, Nichols D, Nalca A. Small Particle Aerosol Exposure of African Green Monkeys to MERS-CoV as a Model for Highly Pathogenic Coronavirus Infection. Emerg Infect Dis 2020; 26:2835-2843. [PMID: 32744989 PMCID: PMC7706928 DOI: 10.3201/eid2612.201664] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Emerging coronaviruses are a global public health threat because of the potential for person-to-person transmission and high mortality rates. Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012, causing lethal respiratory disease in »35% of cases. Primate models of coronavirus disease are needed to support development of therapeutics, but few models exist that recapitulate severe disease. For initial development of a MERS-CoV primate model, 12 African green monkeys were exposed to 103, 104, or 105 PFU target doses of aerosolized MERS-CoV. We observed a dose-dependent increase of respiratory disease signs, although all 12 monkeys survived for the 28-day duration of the study. This study describes dose-dependent effects of MERS-CoV infection of primates and uses a route of infection with potential relevance to MERS-CoV transmission. Aerosol exposure of African green monkeys might provide a platform approach for the development of primate models of novel coronavirus diseases.
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van Tol S, Mögling R, Li W, Godeke GJ, Swart A, Bergmans B, Brandenburg A, Kremer K, Murk JL, van Beek J, Wintermans B, Reimerink J, Bosch BJ, Reusken C. Accurate serology for SARS-CoV-2 and common human coronaviruses using a multiplex approach. Emerg Microbes Infect 2020; 9:1965-1973. [PMID: 32819220 PMCID: PMC8284965 DOI: 10.1080/22221751.2020.1813636] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/19/2020] [Indexed: 01/10/2023]
Abstract
Serology is a crucial part of the public health response to the ongoing SARS-CoV-2 pandemic. Here, we describe the development, validation and clinical evaluation of a protein micro-array as a quantitative multiplex immunoassay that can identify S and N-directed SARS-CoV-2 IgG antibodies with high specificity and sensitivity and distinguish them from all currently circulating human coronaviruses. The method specificity was 100% for SARS-CoV-2 S1 and 96% for N antigen based on extensive syndromic (n=230 cases) and population panel (n=94) testing that also confirmed the high prevalence of seasonal human coronaviruses. To assess its potential role for both SARS-CoV-2 patient diagnostics and population studies, we evaluated a large heterogeneous COVID-19 cohort (n=330) and found an overall sensitivity of 89% (≥ 21 days post onset symptoms (dps)), ranging from 86% to 96% depending on severity of disease. For a subset of these patients longitudinal samples were provided up to 56 dps. Mild cases showed absent or delayed, and lower SARS-CoV-2 antibody responses. Overall, we present the development and extensive clinical validation of a multiplex coronavirus serological assay for syndromic testing, to answer research questions regarding to antibody responses, to support SARS-CoV-2 diagnostics and to evaluate epidemiological developments efficiently and with high-throughput.
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Affiliation(s)
- Sophie van Tol
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Ramona Mögling
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Wentao Li
- Virology Division, Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Gert-Jan Godeke
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Arno Swart
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Barbara Bergmans
- Microvida, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Afke Brandenburg
- Izore Centre for Infectious Diseases Friesland, Leeuwarden, The Netherlands
| | - Kristin Kremer
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jean-Luc Murk
- Microvida, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Josine van Beek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Bas Wintermans
- Department of Medical Microbiology and Immunology, Admiral De Ruyter Hospital, Goes, The Netherlands
- Department of Medical Microbiology, Bravis Hospital, Roosendaal, The Netherlands
| | - Johan Reimerink
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Berend-Jan Bosch
- Virology Division, Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Chantal Reusken
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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11
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Devaux CA, Osman IO, Million M, Raoult D. Coxiella burnetii in Dromedary Camels ( Camelus dromedarius): A Possible Threat for Humans and Livestock in North Africa and the Near and Middle East? Front Vet Sci 2020; 7:558481. [PMID: 33251255 PMCID: PMC7674558 DOI: 10.3389/fvets.2020.558481] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/28/2020] [Indexed: 01/09/2023] Open
Abstract
The "One Health" concept recognizes that human health is connected to animal health and to the ecosystems. Coxiella burnetii-induced human Q fever is one of the most widespread neglected zoonosis. The main animal reservoirs responsible for C. burnetii transmission to humans are domesticated ruminants, primarily goats, sheep, and cattle. Although studies are still too sparse to draw definitive conclusions, the most recent C. burnetii serosurvey studies conducted in herds and farms in Africa, North Africa, Arabian Peninsula, and Asia highlighted that seroprevalence was strikingly higher in dromedary camels (Camelus dromedarius) than in other ruminants. The C. burnetii seroprevalence in camel herds can reach more than 60% in Egypt, Saudi Arabia, and Sudan, and 70 to 80% in Algeria and Chad, respectively. The highest seroprevalence was in female camels with a previous history of abortion. Moreover, C. burnetii infection was reported in ticks of the Hyalomma dromedarii and Hyalomma impeltatum species collected on camels. Even if dromedary camels represent <3% of the domesticated ruminants in the countries of the Mediterranean basin Southern coast, these animals play a major socioeconomic role for millions of people who live in the arid zones of Africa, Middle East, and Asia. In Chad and Somalia, camels account for about 7 and 21% of domesticated ruminants, respectively. To meet the growing consumers demand of camel meat and milk (>5 million tons/year of both raw and pasteurized milk according to the Food and Agriculture Organization) sustained by a rapid increase of population (growth rate: 2.26-3.76 per year in North Africa), dromedary camel breeding tends to increase from the Maghreb to the Arabic countries. Because of possible long-term persistence of C. burnetii in camel hump adipocytes, this pathogen could represent a threat for herds and breeding farms and ultimately for public health. Because this review highlights a hyperendemia of C. burnetii in dromedary camels, a proper screening of herds and breeding farms for C. burnetii is urgently needed in countries where camel breeding is on the rise. Moreover, the risk of C. burnetii transmission from camel to human should be further evaluated.
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Affiliation(s)
- Christian A. Devaux
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
- CNRS, Marseille, France
| | - Ikram Omar Osman
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
- Faculty of Sciences Ben-Ben-M'Sik, University Hassan II, Casablanca, Morocco
| | - Matthieu Million
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Didier Raoult
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
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12
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Mok CKP, Zhu A, Zhao J, Lau EHY, Wang J, Chen Z, Zhuang Z, Wang Y, Alshukairi AN, Baharoon SA, Wang W, Tan W, Liang W, Oladipo JO, Perera RAPM, Kuranga SA, Peiris M, Zhao J. T-cell responses to MERS coronavirus infection in people with occupational exposure to dromedary camels in Nigeria: an observational cohort study. THE LANCET. INFECTIOUS DISEASES 2020; 21:385-395. [PMID: 33035474 PMCID: PMC7538089 DOI: 10.1016/s1473-3099(20)30599-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 06/09/2020] [Accepted: 06/19/2020] [Indexed: 12/14/2022]
Abstract
Background Middle East respiratory syndrome (MERS) remains of global public health concern. Dromedary camels are the source of zoonotic infection. Over 70% of MERS coronavirus (MERS-CoV)-infected dromedaries are found in Africa but no zoonotic disease has been reported in Africa. We aimed to understand whether individuals with exposure to dromedaries in Africa had been infected by MERS-CoV. Methods Workers slaughtering dromedaries in an abattoir in Kano, Nigeria, were compared with abattoir workers without direct dromedary contact, non-abattoir workers from Kano, and controls from Guangzhou, China. Exposure to dromedaries was ascertained using a questionnaire. Serum and peripheral blood mononuclear cells (PBMCs) were tested for MERS-CoV specific neutralising antibody and T-cell responses. Findings None of the participants from Nigeria or Guangdong were MERS-CoV seropositive. 18 (30%) of 61 abattoir workers with exposure to dromedaries, but none of 20 abattoir workers without exposure (p=0·0042), ten non-abattoir workers or 24 controls from Guangzhou (p=0·0002) had evidence of MERS-CoV-specific CD4+ or CD8+ T cells in PBMC. T-cell responses to other endemic human coronaviruses (229E, OC43, HKU-1, and NL-63) were observed in all groups with no association with dromedary exposure. Drinking both unpasteurised camel milk and camel urine was significantly and negatively associated with T-cell positivity (odds ratio 0·07, 95% CI 0·01–0·54). Interpretation Zoonotic infection of dromedary-exposed individuals is taking place in Nigeria and suggests that the extent of MERS-CoV infections in Africa is underestimated. MERS-CoV could therefore adapt to human transmission in Africa rather than the Arabian Peninsula, where attention is currently focused. Funding The National Science and Technology Major Project, National Institutes of Health.
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Affiliation(s)
- Chris Ka Pun Mok
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; HKU-Pasteur Research Pole, The University of Hong Kong, Hong Kong Special Administrative Region, China; School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Airu Zhu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Nanshan Medicine Innovation Institute of Guangdong Province Guangzhou, Guangdong, China
| | - Jingxian Zhao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Eric H Y Lau
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Junxiang Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhao Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhen Zhuang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanqun Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Abeer N Alshukairi
- King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Salim A Baharoon
- King Saud bin Abdulaziz for Health Sciences University, Riyadh, Saudi Arabia
| | - Wenling Wang
- National Health Commission Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Wenjie Tan
- National Health Commission Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Weiwen Liang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jamiu O Oladipo
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ranawaka A P M Perera
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sulyman A Kuranga
- Department of Surgery, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
| | - Malik Peiris
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; HKU-Pasteur Research Pole, The University of Hong Kong, Hong Kong Special Administrative Region, China; School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Jincun Zhao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Eighth People's Hospital of Guangzhou Medical University, Guangzhou, China.
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13
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Abbad A, Perera RA, Anga L, Faouzi A, Minh NNT, Malik SMMR, Iounes N, Maaroufi A, Van Kerkhove MD, Peiris M, Nourlil J. Middle East respiratory syndrome coronavirus (MERS-CoV) neutralising antibodies in a high-risk human population, Morocco, November 2017 to January 2018. ACTA ACUST UNITED AC 2020; 24. [PMID: 31796154 PMCID: PMC6891945 DOI: 10.2807/1560-7917.es.2019.24.48.1900244] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BackgroundMiddle East respiratory syndrome coronavirus (MERS-CoV) remains a major concern for global public health. Dromedaries are the source of human zoonotic infection. MERS-CoV is enzootic among dromedaries on the Arabian Peninsula, the Middle East and in Africa. Over 70% of infected dromedaries are found in Africa. However, all known zoonotic cases of MERS have occurred in the Arabian Peninsula with none being reported in Africa.AimWe aimed to investigate serological evidence of MERS-CoV infection in humans living in camel-herding areas in Morocco to provide insights on whether zoonotic transmission is taking place.MethodsWe carried out a cross sectional seroprevalence study from November 2017 through January 2018. We adapted a generic World Health Organization MERS-CoV questionnaire and protocol to assess demographic and risk factors of infection among a presumed high-risk population. ELISA, MERS-CoV spike pseudoparticle neutralisation tests (ppNT) and plaque neutralisation tests (PRNT) were used to assess MERS-CoV seropositivity.ResultsSerum samples were collected from camel slaughterhouse workers (n = 137), camel herders (n = 156) and individuals of the general population without occupational contact with camels but living in camel herding areas (n = 186). MERS-CoV neutralising antibodies with ≥ 90% reduction of plaque numbers were detected in two (1.5%) slaughterhouse workers, none of the camel herders and one individual from the general population (0.5%).ConclusionsThis study provides evidence of zoonotic transmission of MERS-CoV in Morocco in people who have direct or indirect exposure to dromedary camels.
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Affiliation(s)
- Anass Abbad
- These authors contributed equally to this work.,Laboratoire d'Ecologie et d'Environnement, Faculté des Sciences Ben M'Sik, Université Hassan II, Casablanca, Morocco.,Medical Virology and BSL-3 Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Ranawaka Apm Perera
- These authors contributed equally to this work.,School of Public Health, University of Hong-Kong, Hong Kong SAR, China
| | - Latifa Anga
- Medical Virology and BSL-3 Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Abdellah Faouzi
- Medical Virology and BSL-3 Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Nhu Nguyen Tran Minh
- Health Emergencies Programme, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Sk Md Mamunur Rahman Malik
- Health Emergencies Programme, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Nadia Iounes
- Laboratoire d'Ecologie et d'Environnement, Faculté des Sciences Ben M'Sik, Université Hassan II, Casablanca, Morocco
| | - Abderrahmane Maaroufi
- Medical Virology and BSL-3 Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
| | | | - Malik Peiris
- HKU-Pasteur Research Pole, University of Hong Kong, Hong Kong SAR, China.,School of Public Health, University of Hong-Kong, Hong Kong SAR, China
| | - Jalal Nourlil
- Medical Virology and BSL-3 Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
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14
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Grant R, Malik MR, Elkholy A, Van Kerkhove MD. A Review of Asymptomatic and Subclinical Middle East Respiratory Syndrome Coronavirus Infections. Epidemiol Rev 2020; 41:69-81. [PMID: 31781765 PMCID: PMC7108493 DOI: 10.1093/epirev/mxz009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/02/2019] [Accepted: 09/09/2019] [Indexed: 12/14/2022] Open
Abstract
The epidemiology of Middle East respiratory syndrome coronavirus (MERS-CoV) since 2012 has been largely characterized by recurrent zoonotic spillover from dromedary camels followed by limited human-to-human transmission, predominantly in health-care settings. The full extent of infection of MERS-CoV is not clear, nor is the extent and/or role of asymptomatic infections in transmission. We conducted a review of molecular and serological investigations through PubMed and EMBASE from September 2012 to November 15, 2018, to measure subclinical or asymptomatic MERS-CoV infection within and outside of health-care settings. We performed retrospective analysis of laboratory-confirmed MERS-CoV infections reported to the World Health Organization to November 27, 2018, to summarize what is known about asymptomatic infections identified through national surveillance systems. We identified 23 studies reporting evidence of MERS-CoV infection outside of health-care settings, mainly of camel workers, with seroprevalence ranges of 0%–67% depending on the study location. We identified 20 studies in health-care settings of health-care worker (HCW) and family contacts, of which 11 documented molecular evidence of MERS-CoV infection among asymptomatic contacts. Since 2012, 298 laboratory-confirmed cases were reported as asymptomatic to the World Health Organization, 164 of whom were HCWs. The potential to transmit MERS-CoV to others has been demonstrated in viral-shedding studies of asymptomatic MERS infections. Our results highlight the possibility for onward transmission of MERS-CoV from asymptomatic individuals. Screening of HCW contacts of patients with confirmed MERS-CoV is currently recommended, but systematic screening of non-HCW contacts outside of health-care facilities should be encouraged.
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Affiliation(s)
| | | | | | - Maria D Van Kerkhove
- Correspondence to Maria D. Van Kerkhove, PhD, Department of Infectious Hazards Management, Health Emergencies Program, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland (e-mail: )
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15
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Mostafa A, Kandeil A, Shehata M, El Shesheny R, Samy AM, Kayali G, Ali MA. Middle East Respiratory Syndrome Coronavirus (MERS-CoV): State of the Science. Microorganisms 2020; 8:microorganisms8070991. [PMID: 32630780 PMCID: PMC7409282 DOI: 10.3390/microorganisms8070991] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 02/07/2023] Open
Abstract
Coronaviruses belong to a large family of viruses that can cause disease outbreaks ranging from the common cold to acute respiratory syndrome. Since 2003, three zoonotic members of this family evolved to cross species barriers infecting humans and resulting in relatively high case fatality rates (CFR). Compared to Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV, CFR = 10%) and pandemic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2, CFR = 6%), the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) has scored the highest CFR (approximately 35%). In this review, we systematically summarize the current state of scientific knowledge about MERS-CoV, including virology and origin, epidemiology, zoonotic mode of transmission, and potential therapeutic or prophylactic intervention modalities.
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Affiliation(s)
- Ahmed Mostafa
- Center of Scientific Excellence for Influenza Viruses, Environmental Research Division, National Research Centre (NRC), Cairo 12622, Egypt; (A.M.); (A.K.); (M.S.); (R.E.S.)
| | - Ahmed Kandeil
- Center of Scientific Excellence for Influenza Viruses, Environmental Research Division, National Research Centre (NRC), Cairo 12622, Egypt; (A.M.); (A.K.); (M.S.); (R.E.S.)
| | - Mahmoud Shehata
- Center of Scientific Excellence for Influenza Viruses, Environmental Research Division, National Research Centre (NRC), Cairo 12622, Egypt; (A.M.); (A.K.); (M.S.); (R.E.S.)
| | - Rabeh El Shesheny
- Center of Scientific Excellence for Influenza Viruses, Environmental Research Division, National Research Centre (NRC), Cairo 12622, Egypt; (A.M.); (A.K.); (M.S.); (R.E.S.)
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Abdallah M. Samy
- Entomology Department, Faculty of Science, Ain Shams University, Abbassia, Cairo 11566, Egypt;
| | - Ghazi Kayali
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas, Houston, TX 77030, USA
- Human Link, Baabda 1109, Lebanon
- Correspondence: (G.K.); (M.A.A.); Tel.: +20-237481483 (M.A.A.)
| | - Mohamed A. Ali
- Center of Scientific Excellence for Influenza Viruses, Environmental Research Division, National Research Centre (NRC), Cairo 12622, Egypt; (A.M.); (A.K.); (M.S.); (R.E.S.)
- Correspondence: (G.K.); (M.A.A.); Tel.: +20-237481483 (M.A.A.)
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16
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Tolah AM, AL Masaudi SB, El-Kafrawy SA, Mirza AA, Harakeh SM, Hassan AM, Alsaadi MA, Alzahrani AA, Alsaaidi GA, Amor NMS, Alagaili AN, Hashem AM, Azhar EI. Cross-sectional prevalence study of MERS-CoV in local and imported dromedary camels in Saudi Arabia, 2016-2018. PLoS One 2020; 15:e0232790. [PMID: 32453746 PMCID: PMC7250453 DOI: 10.1371/journal.pone.0232790] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/21/2020] [Indexed: 12/03/2022] Open
Abstract
The Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) is an endemic virus in dromedaries. Annually, Saudi Arabia imports thousands of camels from the Horn of Africa, yet the epidemiology of MERS-CoV in these animals is largely unknown. Here, MERS-CoV prevalence was compared in imported African camels and their local counterparts. A total of 1399 paired sera and nasal swabs were collected from camels between 2016 and 2018. Imported animals from Sudan (n = 829) and Djibouti (n = 328) were sampled on incoming ships at Jeddah Islamic seaport before unloading, and local camels were sampled from Jeddah (n = 242). Samples were screened for neutralizing antibodies (nAbs) and MERS-CoV viral RNA. The overall seroprevalence was 92.7% and RNA detection rate was 17.2%. Imported camels had higher seroprevalence compared to resident herds (93.8% vs 87.6%, p <0.01) in contrast to RNA detection (13.3% vs 35.5%, p <0.0001). Seroprevalence significantly increased with age (p<0.0001) and viral RNA detection rate was ~2-folds higher in camels <2-year-old compared to older animals. RNA detection was higher in males verses females (24.3% vs 12.6%, p<0.0001) but seroprevalence was similar. Concurrent positivity for viral RNA and nAbs was found in >87% of the RNA positive animals, increased with age and was sex-dependent. Importantly, reduced viral RNA load was positively correlated with nAb titers. Our data confirm the widespread of MERS-CoV in imported and domestic camels in Saudi Arabia and highlight the need for continuous active surveillance and better prevention measures. Further studies are also warranted to understand camels correlates of protection for proper vaccine development.
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Affiliation(s)
- Ahmed M. Tolah
- King Fahd Medical Research Center, Special Infectious Agents Unit, King Abdulaziz University, Jeddah, Saudi Arabia
- Division of Microbiology, Department of Biological Science, Faculty of science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Saad B. AL Masaudi
- Division of Microbiology, Department of Biological Science, Faculty of science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sherif A. El-Kafrawy
- King Fahd Medical Research Center, Special Infectious Agents Unit, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A. Mirza
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Steve M. Harakeh
- King Fahd Medical Research Center, Special Infectious Agents Unit, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed M. Hassan
- King Fahd Medical Research Center, Special Infectious Agents Unit, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed A. Alsaadi
- King Fahd Medical Research Center, Special Infectious Agents Unit, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulrahman A. Alzahrani
- Directorate of Agriculture, Ministry of Environment Water and Agriculture, Makkah Region, Saudi Arabia
| | - Ghaleb A. Alsaaidi
- Directorate of Agriculture, Ministry of Environment Water and Agriculture, Makkah Region, Saudi Arabia
| | - Nabil M. S. Amor
- KSU Mammals Research Chair, Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz N. Alagaili
- KSU Mammals Research Chair, Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Anwar M. Hashem
- King Fahd Medical Research Center, Vaccines and Immunotherapy Unit, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- * E-mail: (AH); (EA)
| | - Esam I. Azhar
- King Fahd Medical Research Center, Special Infectious Agents Unit, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- * E-mail: (AH); (EA)
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17
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Kiyong’a AN, Cook EAJ, Okba NMA, Kivali V, Reusken C, Haagmans BL, Fèvre EM. Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Seropositive Camel Handlers in Kenya. Viruses 2020; 12:E396. [PMID: 32260186 PMCID: PMC7232417 DOI: 10.3390/v12040396] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 01/05/2023] Open
Abstract
Middle East respiratory syndrome (MERS) is a respiratory disease caused by a zoonotic coronavirus (MERS-CoV). Camel handlers, including slaughterhouse workers and herders, are at risk of acquiring MERS-CoV infections. However, there is limited evidence of infections among camel handlers in Africa. The purpose of this study was to determine the presence of antibodies to MERS-CoV in high-risk groups in Kenya. Sera collected from 93 camel handlers, 58 slaughterhouse workers and 35 camel herders, were screened for MERS-CoV antibodies using ELISA and PRNT. We found four seropositive slaughterhouse workers by PRNT. Risk factors amongst the slaughterhouse workers included being the slaughterman (the person who cuts the throat of the camel) and drinking camel blood. Further research is required to understand the epidemiology of MERS-CoV in Africa in relation to occupational risk, with a need for additional studies on the transmission of MERS-CoV from dromedary camels to humans, seroprevalence and associated risk factors.
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Affiliation(s)
- Alice N. Kiyong’a
- International Livestock Research Institute, Old Naivasha Road, PO Box 30709, Nairobi 00100, Kenya (E.A.J.C.); (V.K.)
| | - Elizabeth A. J. Cook
- International Livestock Research Institute, Old Naivasha Road, PO Box 30709, Nairobi 00100, Kenya (E.A.J.C.); (V.K.)
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston CH64 7TE, UK
| | - Nisreen M. A. Okba
- Viroscience Department, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.A.O.); (C.R.); (B.L.H.)
| | - Velma Kivali
- International Livestock Research Institute, Old Naivasha Road, PO Box 30709, Nairobi 00100, Kenya (E.A.J.C.); (V.K.)
| | - Chantal Reusken
- Viroscience Department, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.A.O.); (C.R.); (B.L.H.)
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands
| | - Bart L. Haagmans
- Viroscience Department, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.A.O.); (C.R.); (B.L.H.)
| | - Eric M. Fèvre
- International Livestock Research Institute, Old Naivasha Road, PO Box 30709, Nairobi 00100, Kenya (E.A.J.C.); (V.K.)
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston CH64 7TE, UK
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18
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Degnah AA, Al-Amri SS, Hassan AM, Almasoud AS, Mousa M, Almahboub SA, Alhabbab RY, Mirza AA, Hindawi SI, Alharbi NK, Azhar EI, Hashem AM. Seroprevalence of MERS-CoV in healthy adults in western Saudi Arabia, 2011-2016. J Infect Public Health 2020; 13:697-703. [PMID: 32005618 PMCID: PMC7104088 DOI: 10.1016/j.jiph.2020.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/04/2019] [Accepted: 01/15/2020] [Indexed: 12/17/2022] Open
Abstract
Background The Middle East respiratory syndrome coronavirus (MERS-CoV) is a newly recognized zoonotic coronavirus. Current evidence confirms the role of dromedaries in primary human infections but does not explain the sporadic community cases. However, asymptomatic or subclinical cases could represent a possible source of infection in the community. Methods Archived human sera (7461) collected between 2011 and 2016 from healthy adult blood donors from 50 different nationalities in the western part of Saudi Arabia were obtained for MERS-CoV seroprevalence investigation. Samples were tested for MERS-CoV S1-specific antibodies (Abs) by ELISA and confirmed by testing for neutralizing Abs (nAbs) using both pseudotyped and live virus neutralization assays. Results Out of 7461 samples, 174 sera from individuals with 18 different nationalities were ELISA positive (2.3%, 95% CI 2.0–2.7). Presence of nAbs was confirmed in 17 samples (0.23%, 95% CI 0.1–0.4) of which one sample exhibited positivity in both neutralization assays. Confirmed seropositivity was identified in young (15–44 years) men and women from Saudi Arabia, Egypt, Yemen, Pakistan, Palestine, Sudan, and India without significant preference. Conclusions An increasing trend of MERS-CoV seroprevalence was observed in the general population in western Saudi Arabia, suggesting that asymptomatic or mild infections might exist and act as an unrecognized source of infection. Seropositivity of individuals from different nationalities underscores the potential MERS exportation outside of the Arabian Peninsula. Thus, enhanced and continuous surveillance is highly warranted.
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Affiliation(s)
- Afnan A Degnah
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sawsan S Al-Amri
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed M Hassan
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulrahman S Almasoud
- Department of Infectious Disease Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Manar Mousa
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sarah A Almahboub
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rowa Y Alhabbab
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A Mirza
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Salwa I Hindawi
- Department of Hematology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Naif Khalaf Alharbi
- Department of Infectious Disease Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Esam I Azhar
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Anwar M Hashem
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
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19
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The Middle East Respiratory Syndrome Coronavirus: An Emerging Virus of Global Threat. EMERGING AND REEMERGING VIRAL PATHOGENS 2020. [PMCID: PMC7148737 DOI: 10.1016/b978-0-12-819400-3.00008-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Middle East respiratory syndrome (MERS) is a viral respiratory illness caused by a coronavirus (CoV), first identified in Saudi Arabia in 2012. Since then, almost 2000 cases have been reported from 27 countries, with Saudi Arabia being the epicenter. This newly emerging virus is highly pathogenic and has a case mortality rate of 35%. It is similar to the CoV causing severe acute respiratory syndrome CoV (SARS-CoV) in that both belong to the genus beta CoVs that are of zoonotic origin and cause lower respiratory infection. The natural reservoir for MERS-CoV remains unknown. Serological studies indicate that most dromedary camels in the Middle East have been infected with this virus, and they maybe the potential intermediate host. However, the mode of transmission from camels to humans is poorly understood. The majority of confirmed human cases have resulted from human-to-human transmission, most probably via respiratory route. Patients most at risk of developing severe MERS-CoV infection appear to be those with underlying conditions such as diabetes, hypertension, obesity, cardiac diseases, chronic respiratory diseases, and cancer. Unlike SARS-CoV, MERS-CoV is considered an ongoing public health problem, particularly for the Middle East region. In this chapter, we outline the prevailing information regarding the emergence and epidemiology of this virus, its mode of transmission and pathogenicity, its clinical features, and the potential strategies for prevention.
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20
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Ramshaw RE, Letourneau ID, Hong AY, Hon J, Morgan JD, Osborne JCP, Shirude S, Van Kerkhove MD, Hay SI, Pigott DM. A database of geopositioned Middle East Respiratory Syndrome Coronavirus occurrences. Sci Data 2019; 6:318. [PMID: 31836720 PMCID: PMC6911100 DOI: 10.1038/s41597-019-0330-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/15/2019] [Indexed: 12/21/2022] Open
Abstract
As a World Health Organization Research and Development Blueprint priority pathogen, there is a need to better understand the geographic distribution of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and its potential to infect mammals and humans. This database documents cases of MERS-CoV globally, with specific attention paid to zoonotic transmission. An initial literature search was conducted in PubMed, Web of Science, and Scopus; after screening articles according to the inclusion/exclusion criteria, a total of 208 sources were selected for extraction and geo-positioning. Each MERS-CoV occurrence was assigned one of the following classifications based upon published contextual information: index, unspecified, secondary, mammal, environmental, or imported. In total, this database is comprised of 861 unique geo-positioned MERS-CoV occurrences. The purpose of this article is to share a collated MERS-CoV database and extraction protocol that can be utilized in future mapping efforts for both MERS-CoV and other infectious diseases. More broadly, it may also provide useful data for the development of targeted MERS-CoV surveillance, which would prove invaluable in preventing future zoonotic spillover. Measurement(s) | Middle East Respiratory Syndrome • geographic location | Technology Type(s) | digital curation | Factor Type(s) | geographic distribution of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) • year | Sample Characteristic - Organism | Middle East respiratory syndrome-related coronavirus | Sample Characteristic - Location | Earth (planet) |
Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.11108801
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Affiliation(s)
- Rebecca E Ramshaw
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States
| | - Ian D Letourneau
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States
| | - Amy Y Hong
- Bloomberg School of Public Health, Johns Hopkins University, 615N Wolfe St, Baltimore, MD, 21205, United States
| | - Julia Hon
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States
| | - Julia D Morgan
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States
| | - Joshua C P Osborne
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States
| | - Shreya Shirude
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States
| | - Maria D Van Kerkhove
- Department of Infectious Hazards Management, Health Emergencies Programme, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States.,Department of Health Metrics Sciences, School of Medicine, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States
| | - David M Pigott
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States. .,Department of Health Metrics Sciences, School of Medicine, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States.
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21
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Okba NMA, Raj VS, Widjaja I, GeurtsvanKessel CH, de Bruin E, Chandler FD, Park WB, Kim NJ, Farag EABA, Al-Hajri M, Bosch BJ, Oh MD, Koopmans MPG, Reusken CBEM, Haagmans BL. Sensitive and Specific Detection of Low-Level Antibody Responses in Mild Middle East Respiratory Syndrome Coronavirus Infections. Emerg Infect Dis 2019; 25:1868-1877. [PMID: 31423970 PMCID: PMC6759241 DOI: 10.3201/eid2510.190051] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) infections in humans can cause asymptomatic to fatal lower respiratory lung disease. Despite posing a probable risk for virus transmission, asymptomatic to mild infections can go unnoticed; a lack of seroconversion among some PCR-confirmed cases has been reported. We found that a MERS-CoV spike S1 protein–based ELISA, routinely used in surveillance studies, showed low sensitivity in detecting infections among PCR-confirmed patients with mild clinical symptoms and cross-reactivity of human coronavirus OC43–positive serum samples. Using in-house S1 ELISA and protein microarray, we demonstrate that most PCR-confirmed MERS-CoV case-patients with mild infections seroconverted; nonetheless, some of these samples did not have detectable levels of virus-neutralizing antibodies. The use of a sensitive and specific serologic S1-based assay can be instrumental in the accurate estimation of MERS-CoV prevalence.
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22
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So RT, Perera RA, Oladipo JO, Chu DK, Kuranga SA, Chan KH, Lau EH, Cheng SM, Poon LL, Webby RJ, Peiris M. Lack of serological evidence of Middle East respiratory syndrome coronavirus infection in virus exposed camel abattoir workers in Nigeria, 2016. ACTA ACUST UNITED AC 2019; 23. [PMID: 30107872 PMCID: PMC6092911 DOI: 10.2807/1560-7917.es.2018.23.32.1800175] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic threat of global public health concern and dromedary camels are the source of zoonotic infection. Although MERS-CoV is enzootic in dromedaries in Africa as well as the Middle East, zoonotic disease has not been reported in Africa. Methods: In an abattoir in Kano, Nigeria, we tested nasal swabs from camels and investigated 261 humans with repeated occupational exposure to camels, many of whom also reported drinking fresh camel milk (n = 138) or urine (n = 94) or using camel urine for medicinal purposes (n = 96). Results: Weekly MERS-CoV RNA detection in January–February 2016 ranged from 0–8.4% of camels sampled. None of the abattoir workers with exposure to camels had evidence of neutralising antibody to MERS-CoV. Conclusion: There is a need for more studies to investigate whether or not zoonotic transmission of MERS-CoV does take place in Africa.
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Affiliation(s)
- Ray Ty So
- These authors contributed equally to this work.,School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ranawaka Apm Perera
- These authors contributed equally to this work.,School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jamiu O Oladipo
- Faculty of Clinical Sciences, Department of Surgery, Old Jebba Road, University of Ilorin, Ilorin, Nigeria.,These authors contributed equally to this work.,School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Daniel Kw Chu
- These authors contributed equally to this work.,School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sulyman A Kuranga
- Faculty of Clinical Sciences, Department of Surgery, Old Jebba Road, University of Ilorin, Ilorin, Nigeria
| | - Kin-Ho Chan
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eric Hy Lau
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Samuel Ms Cheng
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Leo Lm Poon
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Richard J Webby
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, United States
| | - Malik Peiris
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
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23
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Some One Health based control strategies for the Middle East respiratory syndrome coronavirus. One Health 2019; 8:100102. [PMID: 31485476 PMCID: PMC6715958 DOI: 10.1016/j.onehlt.2019.100102] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 02/08/2023] Open
Abstract
The Middle East respiratory syndrome coronavirus (MERS-CoV) presents an ideal example for developing One Health concepts. Dromedary camels are the principal reservoir for the virus. Infected camels shed the virus in body secretions, particularly nasal discharges. MERS-CoV has the potential to remain active in the environment for some time under optimum conditions of temperature and humidity. This shedding sustains the virus in endemic communities and thus contact with camels is considered a major risk factor for human infection. Reducing virus shedding from camels will have a great positive impact on reducing the human risk of infection. Our main objective is to highlight the potential aspects of reducing virus shedding from camels to the environment, thereby reducing the possibility of human infection. We will focus on the potential roles of camel markets, camel shows, importation, transportation and grazing in the amplification and shedding of the virus, providing some novel concepts for the control approaches for the MERS-CoV.
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Zhu S, Zimmerman D, Deem SL. A Review of Zoonotic Pathogens of Dromedary Camels. ECOHEALTH 2019; 16:356-377. [PMID: 31140075 PMCID: PMC7087575 DOI: 10.1007/s10393-019-01413-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 06/09/2023]
Abstract
Dromedary, or one-humped, camels Camelus dromedarius are an almost exclusively domesticated species that are common in arid areas as both beasts of burden and production animals for meat and milk. Currently, there are approximately 30 million dromedary camels, with highest numbers in Africa and the Middle East. The hardiness of camels in arid regions has made humans more dependent on them, especially as a stable protein source. Camels also carry and may transmit disease-causing agents to humans and other animals. The ability for camels to act as a point source or vector for disease is a concern due to increasing human demands for meat, lack of biosafety and biosecurity protocols in many regions, and a growth in the interface with wildlife as camel herds become sympatric with non-domestic species. We conducted a literature review of camel-borne zoonotic diseases and found that the majority of publications (65%) focused on Middle East respiratory syndrome (MERS), brucellosis, Echinococcus granulosus, and Rift Valley fever. The high fatality from MERS outbreaks during 2012-2016 elicited an immediate response from the research community as demonstrated by a surge of MERS-related publications. However, we contend that other camel-borne diseases such as Yersinia pestis, Coxiella burnetii, and Crimean-Congo hemorrhagic fever are just as important to include in surveillance efforts. Camel populations, particularly in sub-Saharan Africa, are increasing exponentially in response to prolonged droughts, and thus, the risk of zoonoses increases as well. In this review, we provide an overview of the major zoonotic diseases present in dromedary camels, their risk to humans, and recommendations to minimize spillover events.
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Affiliation(s)
- Sophie Zhu
- Graduate Group in Epidemiology, University of California, Davis, CA, 95616, USA.
| | - Dawn Zimmerman
- Global Health Program, Smithsonian Conservation Biology Institute, Washington, DC, 20008, USA
| | - Sharon L Deem
- Institute for Conservation Medicine, Saint Louis Zoo, Saint Louis, MO, 63110, USA
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25
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Khudhair A, Killerby ME, Al Mulla M, Abou Elkheir K, Ternanni W, Bandar Z, Weber S, Khoury M, Donnelly G, Al Muhairi S, Khalafalla AI, Trivedi S, Tamin A, Thornburg NJ, Watson JT, Gerber SI, Al Hosani F, Hall AJ. Risk Factors for MERS-CoV Seropositivity among Animal Market and Slaughterhouse Workers, Abu Dhabi, United Arab Emirates, 2014-2017. Emerg Infect Dis 2019; 25:927-935. [PMID: 31002068 PMCID: PMC6478233 DOI: 10.3201/eid2505.181728] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Camel contact is a recognized risk factor for Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Because specific camel exposures associated with MERS-CoV seropositivity are not fully understood, we investigated worker-camel interactions and MERS-CoV seroprevalence. We assessed worker seroprevalence in 2 slaughterhouses and 1 live-animal market in Abu Dhabi, United Arab Emirates, during 2014-2017 and administered an epidemiologic survey in 2016 and 2017. Across 3 sampling rounds during 2014-2017, we sampled 100-235 workers, and 6%-19% were seropositive for MERS-CoV at each sampling round. One (1.4%) of 70 seronegative workers tested at multiple rounds seroconverted. On multivariable analyses, working as a camel salesman, handling live camels or their waste, and having diabetes were associated with seropositivity among all workers, whereas handling live camels and either administering medications or cleaning equipment was associated with seropositivity among market workers. Characterization of high-risk exposures is critical for implementation of preventive measures.
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26
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Qatar experience on One Health approach for middle-east respiratory syndrome coronavirus, 2012-2017: A viewpoint. One Health 2019; 7:100090. [PMID: 31011617 PMCID: PMC6462540 DOI: 10.1016/j.onehlt.2019.100090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 11/20/2022] Open
Abstract
The emergence of the Middle East Respiratory Syndrome Corona Virus (MERS-CoV) in the Middle East in 2012 was associated with an overwhelming uncertainty about its epidemiological and clinical characteristics. Once dromedary camels (Camelus dromedarius) was found to be the natural reservoir of the virus, the public health systems across the Arabian Peninsula encountered an unprecedented pressure to control its transmission. This view point describes how the One Health approach was used in Qatar to manage the MERS-CoV outbreak during the period 2012–2017. One Health focuses on the association between the human, animals and environment sectors for total health and wellbeing of these three sectors. To manage the MERS outbreak in Qatar through a One Health approach, the Qatar National Outbreak Control Taskforce (OCT) was reactivated in November 2012. The animal health sector was invited to join the OCT. Later on, technical expertise was requested from the WHO, FAO, CDC, EMC, and PHE. Subsequently, a comprehensive One Health roadmap was delivered through leadership and coordination; surveillance and investigation; epidemiological studies and increase of local diagnostic capacity. The joint OCT, once trained had easy access to allocated resources and high risk areas to provide more evidence on the potential source of the virus and to investigate all reported cases within 24–48 h. Lack of sufficient technical guidance on veterinary surveillance and poor risk perception among the vulnerable population constituted major obstacles to maintain systematic One Health performance.
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Efficacy of an Adjuvanted Middle East Respiratory Syndrome Coronavirus Spike Protein Vaccine in Dromedary Camels and Alpacas. Viruses 2019; 11:v11030212. [PMID: 30832356 PMCID: PMC6466352 DOI: 10.3390/v11030212] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/23/2019] [Accepted: 02/28/2019] [Indexed: 01/08/2023] Open
Abstract
MERS-CoV is present in dromedary camels throughout the Middle East and Africa. Dromedary camels are the primary zoonotic reservoir for human infections. Interruption of the zoonotic transmission chain from camels to humans, therefore, may be an effective strategy to control the ongoing MERS-CoV outbreak. Here we show that vaccination with an adjuvanted MERS-CoV Spike protein subunit vaccine confers complete protection from MERS-CoV disease in alpaca and results in reduced and delayed viral shedding in the upper airways of dromedary camels. Protection in alpaca correlates with high serum neutralizing antibody titers. Lower titers of serum neutralizing antibodies correlate with delayed and significantly reduced shedding in the nasal turbinates of dromedary camels. Together, these data indicate that induction of robust neutralizing humoral immune responses by vaccination of naïve animals reduces shedding that potentially could diminish the risk of zoonotic transmission.
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Comparative Serological Study for the Prevalence of Anti-MERS Coronavirus Antibodies in High- and Low-Risk Groups in Qatar. J Immunol Res 2019; 2019:1386740. [PMID: 30906787 PMCID: PMC6398027 DOI: 10.1155/2019/1386740] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/29/2018] [Accepted: 12/27/2018] [Indexed: 11/18/2022] Open
Abstract
Infection with Middle East respiratory syndrome coronavirus (MERS-CoV) could be asymptomatic or cause mild influenza-like illness. Therefore, the prevalence of MERS-CoV infections in the general population could be underestimated, which necessitates active surveillance to determine the epidemiological importance of asymptomatic cases. The aim of this study is to evaluate the performance of various serological assays and to estimate the seroprevalence of anti-MERS-CoV antibodies in high- and low-risk groups in Qatar. A total of 4858 samples were screened, including 4719 samples collected from healthy blood donors (BD) over a period of five years (2012-2016), 135 samples from baseline case contacts (CC) collected from individuals in close contact with three positive PCR-confirmed patients (CP), and four samples from MERS-CoV CP. Initial screening using anti-MERS-CoV IgG (IgG rS1-ELISA kit) revealed ten reactive samples from BD (10/4719, 0.21%), one from CC (1/135, 0.74%), and three from CP (3/4, 75%). Samples from CP but not from BD were also reactive by whole-virus anti-MERS-CoV IgG (n = 3/4) and IgM (n = 1/4) indirect immunefluorescent tests (IIFT) and pseudoparticle neutralization test (ppNT). The reactive sample from CC was also confirmed by ppNT. Surprisingly, one out of thirteen (7.7%) randomly selected IgG rS1-ELISA-negative BD samples from the initial screening was reactive by the IgM-IIFT (but not by the IgG-IIFT) and was subsequently confirmed by ppNT. All IgG rS1-ELISA-reactive samples from BD exhibited considerable reactivity to the four circulating human coronaviruses (HKU1, OC43, 229E, and NL63). Cross-reactivity with SARS was only reported for samples from CP using IgG and IgM-IIFT. In conclusion, we report a low prevalence of anti-MERS antibodies in the general population, which coincides with the low number of all reported cases by the time of our study (2017) in Qatar (n = 21). The false-positive results and the observed cross-reactivity between MERS-CoV and other circulating human coronavirus necessitate more detailed evaluation of available serological assays.
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Kelly-Cirino C, Mazzola LT, Chua A, Oxenford CJ, Van Kerkhove MD. An updated roadmap for MERS-CoV research and product development: focus on diagnostics. BMJ Glob Health 2019; 4:e001105. [PMID: 30815285 PMCID: PMC6361340 DOI: 10.1136/bmjgh-2018-001105] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/13/2018] [Accepted: 10/23/2018] [Indexed: 01/12/2023] Open
Abstract
Diagnostics play a central role in the early detection and control of outbreaks and can enable a more nuanced understanding of the disease kinetics and risk factors for the Middle East respiratory syndrome-coronavirus (MERS-CoV), one of the high-priority pathogens identified by the WHO. In this review we identified sources for molecular and serological diagnostic tests used in MERS-CoV detection, case management and outbreak investigations, as well as surveillance for humans and animals (camels), and summarised the performance of currently available tests, diagnostic needs, and associated challenges for diagnostic test development and implementation. A more detailed understanding of the kinetics of infection of MERS-CoV is needed in order to optimise the use of existing assays. Notably, MERS-CoV point-of-care tests are needed in order to optimise supportive care and to minimise transmission risk. However, for new test development, sourcing clinical material continues to be a major challenge to achieving assay validation. Harmonisation and standardisation of laboratory methods are essential for surveillance and for a rapid and effective international response to emerging diseases. Routine external quality assessment, along with well-characterised and up-to-date proficiency panels, would provide insight into MERS-CoV diagnostic performance worldwide. A defined set of Target Product Profiles for diagnostic technologies will be developed by WHO to address these gaps in MERS-CoV outbreak management.
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Affiliation(s)
| | | | - Arlene Chua
- Department of Information, Evidence and Research, WHO, Geneva, Switzerland.,Medecins Sans Frontières, Geneva, Switzerland
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30
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Abstract
The Middle East respiratory syndrome (MERS) is a coronavirus (CoV)-mediated respiratory disease. Virus transmission occurs within health care settings, but cases also appear sporadically in the community. Camels are believed to be the source for community-acquired cases, but most patients do not have camel exposure. Here, we assessed whether camel workers (CWs) with high rates of exposure to camel nasal and oral secretions had evidence of MERS-CoV infection. The results indicate that a high percentage of CWs were positive for virus-specific immune responses but had no history of significant respiratory disease. Thus, a possible explanation for repeated MERS outbreaks is that CWs develop mild or subclinical disease. These CWs then transmit the virus to uninfected individuals, some of whom are highly susceptible, develop severe disease, and are detected as primary MERS cases in the community. Middle East respiratory syndrome (MERS), a highly lethal respiratory disease caused by a novel coronavirus (MERS-CoV), is an emerging disease with high potential for epidemic spread. It has been listed by the WHO and the Coalition for Epidemic Preparedness Innovations (CEPI) as an important target for vaccine development. While initially the majority of MERS cases were hospital acquired, continued emergence of MERS is attributed to community acquisition, with camels likely being the direct or indirect source. However, the majority of patients do not describe camel exposure, making the route of transmission unclear. Here, using sensitive immunological assays and a cohort of camel workers (CWs) with well-documented camel exposure, we show that approximately 50% of camel workers (CWs) in the Kingdom of Saudi Arabia (KSA) and 0% of controls were previously infected. We obtained blood samples from 30 camel herders, truck drivers, and handlers with well-documented camel exposure and from healthy donors, and measured MERS-CoV-specific enzyme-linked immunosorbent assay (ELISA), immunofluorescence assay (IFA), and neutralizing antibody titers, as well as T cell responses. Totals of 16/30 CWs and 0/30 healthy control donors were seropositive by MERS-CoV-specific ELISA and/or neutralizing antibody titer, and an additional four CWs were seronegative but contained virus-specific T cells in their blood. Although virus transmission from CWs has not been formally demonstrated, a possible explanation for repeated MERS outbreaks is that CWs develop mild disease and then transmit the virus to uninfected individuals. Infection of some of these individuals, such as those with comorbidities, results in severe disease and in the episodic appearance of patients with MERS.
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31
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Dudas G, Carvalho LM, Rambaut A, Bedford T. MERS-CoV spillover at the camel-human interface. eLife 2018; 7:e31257. [PMID: 29336306 PMCID: PMC5777824 DOI: 10.7554/elife.31257] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/19/2017] [Indexed: 12/17/2022] Open
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic virus from camels causing significant mortality and morbidity in humans in the Arabian Peninsula. The epidemiology of the virus remains poorly understood, and while case-based and seroepidemiological studies have been employed extensively throughout the epidemic, viral sequence data have not been utilised to their full potential. Here, we use existing MERS-CoV sequence data to explore its phylodynamics in two of its known major hosts, humans and camels. We employ structured coalescent models to show that long-term MERS-CoV evolution occurs exclusively in camels, whereas humans act as a transient, and ultimately terminal host. By analysing the distribution of human outbreak cluster sizes and zoonotic introduction times, we show that human outbreaks in the Arabian peninsula are driven by seasonally varying zoonotic transfer of viruses from camels. Without heretofore unseen evolution of host tropism, MERS-CoV is unlikely to become endemic in humans.
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Affiliation(s)
- Gytis Dudas
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleUnited States
| | - Luiz Max Carvalho
- Institute of Evolutionary BiologyUniversity of EdinburghEdinburghUnited Kingdom
| | - Andrew Rambaut
- Institute of Evolutionary BiologyUniversity of EdinburghEdinburghUnited Kingdom
- Fogarty International CenterNational Institutes of HealthBethesdaUnited States
| | - Trevor Bedford
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleUnited States
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32
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An Opportunistic Pathogen Afforded Ample Opportunities: Middle East Respiratory Syndrome Coronavirus. Viruses 2017; 9:v9120369. [PMID: 29207494 PMCID: PMC5744144 DOI: 10.3390/v9120369] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 11/28/2017] [Accepted: 12/01/2017] [Indexed: 01/10/2023] Open
Abstract
The human coronaviruses (CoV) include HCoV-229E, HCoV-OC43, HCoV-NL63, and HCoV-HKU1, some of which have been known for decades. The severe acute respiratory syndrome (SARS) CoV briefly emerged into the human population but was controlled. In 2012, another novel severely human pathogenic CoV—the Middle East Respiratory Syndrome (MERS)-CoV—was identified in the Kingdom of Saudi Arabia; 80% of over 2000 human cases have been recorded over five years. Targeted research remains key to developing control strategies for MERS-CoV, a cause of mild illness in its camel reservoir. A new therapeutic toolbox being developed in response to MERS is also teaching us more about how CoVs cause disease. Travel-related cases continue to challenge the world’s surveillance and response capabilities, and more data are needed to understand unexplained primary transmission. Signs of genetic change have been recorded, but it remains unclear whether there is any impact on clinical disease. How camels came to carry the virus remains academic to the control of MERS. To date, human-to-human transmission has been inefficient, but virus surveillance, characterisation, and reporting are key to responding to any future change. MERS-CoV is not currently a pandemic threat; it is spread mainly with the aid of human habit and error.
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Sikkema RS, Farag EABA, Himatt S, Ibrahim AK, Al-Romaihi H, Al-Marri SA, Al-Thani M, El-Sayed AM, Al-Hajri M, Haagmans BL, Koopmans MPG, Reusken CBEM. Risk Factors for Primary Middle East Respiratory Syndrome Coronavirus Infection in Camel Workers in Qatar During 2013-2014: A Case-Control Study. J Infect Dis 2017; 215:1702-1705. [PMID: 28387845 PMCID: PMC7107360 DOI: 10.1093/infdis/jix174] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/04/2017] [Indexed: 01/05/2023] Open
Abstract
The transmission routes and risk factors for zoonotic Middle East respiratory syndrome coronavirus (MERS-CoV) infections are still unknown. We used the World Health Organization questionnaire for MERS-CoV case-control studies to assess risk factors for human MERS-CoV seropositivity at a farm complex in Qatar. Nine camel workers with MERS-CoV antibodies and 43 workers without antibodies were included. Some camel-related activities may pose a higher risk of MERS-CoV infection, as may cross-border movements of camels, poor hand hygiene, and overnight hospital stays with respiratory complaints. The risk factors identified in this study can be used to develop infection prevention and control measures for human MERS-CoV infections.
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Affiliation(s)
- Reina S Sikkema
- Department of Viroscience, Erasmus Medical Center,Rotterdam, the Netherlands
| | | | | | | | | | | | | | | | | | - Bart L Haagmans
- Department of Viroscience, Erasmus Medical Center,Rotterdam, the Netherlands
| | - Marion P G Koopmans
- Department of Viroscience, Erasmus Medical Center,Rotterdam, the Netherlands
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Chen Z, Bao L, Chen C, Zou T, Xue Y, Li F, Lv Q, Gu S, Gao X, Cui S, Wang J, Qin C, Jin Q. Human Neutralizing Monoclonal Antibody Inhibition of Middle East Respiratory Syndrome Coronavirus Replication in the Common Marmoset. J Infect Dis 2017; 215:1807-1815. [PMID: 28472421 PMCID: PMC7107363 DOI: 10.1093/infdis/jix209] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/28/2017] [Indexed: 12/20/2022] Open
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) infection in humans is highly lethal, with a fatality rate of 35%. New prophylactic and therapeutic strategies to combat human infections are urgently needed. We isolated a fully human neutralizing antibody, MCA1, from a human survivor. The antibody recognizes the receptor-binding domain of MERS-CoV S glycoprotein and interferes with the interaction between viral S and the human cellular receptor human dipeptidyl peptidase 4 (DPP4). To our knowledge, this study is the first to report a human neutralizing monoclonal antibody that completely inhibits MERS-CoV replication in common marmosets. Monotherapy with MCA1 represents a potential alternative treatment for human infections with MERS-CoV worthy of evaluation in clinical settings.
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Affiliation(s)
- Zhe Chen
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Linlin Bao
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Beijing Key Laboratory for Animal Models of Emerging and Remerging Infectious Diseases
| | - Cong Chen
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Tingting Zou
- College of Life Sciences and Technology, Huazhong Agricultural University, Wuhan
| | - Ying Xue
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Fengdi Li
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Beijing Key Laboratory for Animal Models of Emerging and Remerging Infectious Diseases
| | - Qi Lv
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Beijing Key Laboratory for Animal Models of Emerging and Remerging Infectious Diseases
| | - Songzhi Gu
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Beijing Key Laboratory for Animal Models of Emerging and Remerging Infectious Diseases
| | - Xiaopan Gao
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Sheng Cui
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Jianmin Wang
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Chuan Qin
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Beijing Key Laboratory for Animal Models of Emerging and Remerging Infectious Diseases
| | - Qi Jin
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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35
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Goldstein SA, Weiss SR. Origins and pathogenesis of Middle East respiratory syndrome-associated coronavirus: recent advances. F1000Res 2017; 6:1628. [PMID: 29026532 PMCID: PMC5583735 DOI: 10.12688/f1000research.11827.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2017] [Indexed: 12/20/2022] Open
Abstract
Middle East respiratory syndrome-associated coronavirus (MERS-CoV) has been a significant research focus since its discovery in 2012. Since 2012, 2,040 cases and 712 deaths have been recorded (as of August 11, 2017), representing a strikingly high case fatality rate of 36%. Over the last several years, MERS-CoV research has progressed in several parallel and complementary directions. This review will focus on three particular areas: the origins and evolution of MERS-CoV, the challenges and achievements in the development of MERS-CoV animal models, and our understanding of how novel proteins unique to MERS-CoV counter the host immune response. The origins of MERS-CoV, likely in African bats, are increasingly clear, although important questions remain about the establishment of dromedary camels as a reservoir seeding human outbreaks. Likewise, there have been important advances in the development of animal models, and both non-human primate and mouse models that seem to recapitulate human disease are now available. How MERS-CoV evades and inhibits the host innate immune response remains less clear. Although several studies have identified MERS-CoV proteins as innate immune antagonists, little of this work has been conducted using live virus under conditions of actual infection, but rather with ectopically expressed proteins. Accordingly, considerable space remains for major contributions to understanding unique ways in which MERS-CoV interacts with and modulates the host response. Collectively, these areas have seen significant advances over the last several years but continue to offer exciting opportunities for discovery.
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Affiliation(s)
- Stephen A Goldstein
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan R Weiss
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Abstract
INTRODUCTION In the past five years, there have been 1,936 laboratory-confirmed cases of Middle East Respiratory Syndrome coronavirus (MERS-CoV) in 27 countries, with a mortality rate of 35.6%. Most cases have arisen in the Middle East, particularly the Kingdom of Saudi Arabia, however there was a large hospital-associated outbreak in the Republic of Korea in 2015. Exposure to dromedary camels has been recognized by the World Health Organization (WHO) as a risk factor in primary cases, but the exact mechanisms of transmission are not clear. Rigorous application of nationally defined infection prevention and control measures has reduced the levels of healthcare facility-associated outbreaks. There is currently no approved specific therapy or vaccine available. Areas covered: This review presents an overview of MERS-CoV within the last five years, with a particular emphasis on the key areas of transmission, infection control and prevention, and therapies and vaccines. Expert commentary: MERS-CoV remains a significant threat to public health as transmission mechanisms are still not completely understood. There is the potential for mutations that could increase viral transmission and/or virulence, and zoonotic host range. The high mortality rate highlights the need to expedite well-designed randomized clinical trials for direct, effective therapies and vaccines.
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Affiliation(s)
- Ali A Rabaan
- a Molecular Diagnostic Laboratory , Johns Hopkins Aramco Healthcare , Dhahran , Saudi Arabia
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37
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Abstract
Since the identification of the first patients with Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, over 1,600 cases have been reported as of February 2016. Most cases have occurred in Saudi Arabia or in other countries on or near the Arabian Peninsula, but travel-associated cases have also been seen in countries outside the Arabian Peninsula. MERS-CoV causes a severe respiratory illness in many patients, with a case fatality rate as high as 40%, although when contacts are investigated, a significant proportion of patients are asymptomatic or only have mild symptoms. At this time, no vaccines or treatments are available. Epidemiological and other data suggest that the source of most primary cases is exposure to camels. Person-to-person transmission occurs in household and health care settings, although sustained and efficient person-to-person transmission has not been observed. Strict adherence to infection control recommendations has been associated with control of previous outbreaks. Vigilance is needed because genomic changes in MERS-CoV could result in increased transmissibility, similar to what was seen in severe acute respiratory syndrome coronavirus (SARS-CoV).
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Chen X, Chughtai AA, Dyda A, MacIntyre CR. Comparative epidemiology of Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia and South Korea. Emerg Microbes Infect 2017; 6:e51. [PMID: 28588290 PMCID: PMC5520315 DOI: 10.1038/emi.2017.40] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 01/17/2017] [Accepted: 03/26/2017] [Indexed: 01/27/2023]
Abstract
MERS-CoV infection emerged in the Kingdom of Saudi Arabia (KSA) in 2012 and has spread to 26 countries. However, 80% of all cases have occurred in KSA. The largest outbreak outside KSA occurred in South Korea (SK) in 2015. In this report, we describe an epidemiological comparison of the two outbreaks. Data from 1299 cases in KSA (2012-2015) and 186 cases in SK (2015) were collected from publicly available resources, including FluTrackers, the World Health Organization (WHO) outbreak news and the Saudi MOH (MOH). Descriptive analysis, t-tests, Chi-square tests and binary logistic regression were conducted to compare demographic and other characteristics (comorbidity, contact history) of cases by nationality. Epidemic curves of the outbreaks were generated. The mean age of cases was 51 years in KSA and 54 years in SK. Older males (⩾70 years) were more likely to be infected or to die from MERS-CoV infection, and males exhibited increased rates of comorbidity in both countries. The epidemic pattern in KSA was more complex, with animal-to-human, human-to-human, nosocomial and unknown exposure, whereas the outbreak in SK was more clearly nosocomial. Of the 1186 MERS cases in KSA with reported risk factors, 158 (13.3%) cases were hospital associated compared with 175 (94.1%) in SK, and an increased proportion of cases with unknown exposure risk was found in KSA (710, 59.9%). In a globally connected world, travel is a risk factor for emerging infections, and health systems in all countries should implement better triage systems for potential imported cases of MERS-CoV to prevent large epidemics.
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Affiliation(s)
- Xin Chen
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Amalie Dyda
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Chandini Raina MacIntyre
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- College of Public Service and Community Solutions, Arizona State University, Tempe, AZ 85287, USA
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39
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Widagdo W, Okba NM, Stalin Raj V, Haagmans BL. MERS-coronavirus: From discovery to intervention. One Health 2017; 3:11-16. [PMID: 28616497 PMCID: PMC5454172 DOI: 10.1016/j.onehlt.2016.12.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 12/15/2016] [Accepted: 12/21/2016] [Indexed: 01/16/2023] Open
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) still causes outbreaks despite public awareness and implementation of health care measures, such as rapid viral diagnosis and patient quarantine. Here we describe the current epidemiological picture of MERS-CoV, focusing on humans and animals affected by this virus and propose specific intervention strategies that would be appropriate to control MERS-CoV. One-third of MERS-CoV patients develop severe lower respiratory tract infection and succumb to a fatal outcome; these patients would require effective therapeutic antiviral therapy. Because of the lack of such intervention strategies, supportive care is the best that can be offered at the moment. Limiting viral spread from symptomatic human cases to health care workers and family members, on the other hand, could be achieved through prophylactic administration of MERS-CoV neutralizing antibodies and vaccines. To ultimately prevent spread of the virus into the human population, however, vaccination of dromedary camels - currently the only confirmed animal host for MERS-CoV - may be the best option to achieve a sustained drop in human MERS cases in time. In the end, a One Health approach combining all these different efforts is needed to tackle this zoonotic outbreak.
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Affiliation(s)
| | | | | | - Bart L. Haagmans
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
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40
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Rapid development of vaccines against emerging pathogens: The replication-deficient simian adenovirus platform technology. Vaccine 2017; 35:4461-4464. [PMID: 28576573 PMCID: PMC5571606 DOI: 10.1016/j.vaccine.2017.04.085] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/13/2017] [Accepted: 04/26/2017] [Indexed: 12/11/2022]
Abstract
Despite the fact that there had been multiple small outbreaks of Ebola Virus Disease, when a large outbreak occurred in 2014 there were no vaccines or drugs available for use. Clinical development of multiple candidate vaccines was then initiated in parallel with attempts to contain the outbreak but only one vaccine was eventually tested in a phase III trial. In order to be better prepared for future outbreaks of known human pathogens, platform technologies to accelerate vaccine development should be employed, allowing vaccine developers to take advantage of detailed knowledge of the vaccine platform and facilitating rapid progress to clinical trials and eventually to vaccine stockpiles. This review gives an example of one such vaccine platform, replication-deficient simian adenoviruses, and describes progress in human and livestock vaccine development for three outbreak pathogens, Ebola virus, Rift Valley Fever Virus and Middle East Respiratory Syndrome Coronavirus.
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Rabaan AA, Bazzi AM, Al-Ahmed SH, Al-Tawfiq JA. Molecular aspects of MERS-CoV. Front Med 2017; 11:365-377. [PMID: 28500431 PMCID: PMC7089120 DOI: 10.1007/s11684-017-0521-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/23/2017] [Indexed: 01/19/2023]
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) is a betacoronavirus which can cause acute respiratory distress in humans and is associated with a relatively high mortality rate. Since it was first identified in a patient who died in a Jeddah hospital in 2012, the World Health Organization has been notified of 1735 laboratory-confirmed cases from 27 countries, including 628 deaths. Most cases have occurred in Saudi Arabia. MERS-CoVancestors may be found in OldWorld bats of the Vespertilionidae family. After a proposed bat to camel switching event, transmission of MERS-CoV to humans is likely to have been the result of multiple zoonotic transfers from dromedary camels. Human-to-human transmission appears to require close contact with infected persons, with outbreaks mainly occurring in hospital environments. Outbreaks have been associated with inadequate infection prevention and control implementation, resulting in recommendations on basic and more advanced infection prevention and control measures by the World Health Organization, and issuing of government guidelines based on these recommendations in affected countries including Saudi Arabia. Evolutionary changes in the virus, particularly in the viral spike protein which mediates virus-host cell contact may potentially increase transmission of this virus. Efforts are on-going to identify specific evidence-based therapies or vaccines. The broad-spectrum antiviral nitazoxanide has been shown to have in vitro activity against MERS-CoV. Synthetic peptides and candidate vaccines based on regions of the spike protein have shown promise in rodent and non-human primate models. GLS-5300, a prophylactic DNA-plasmid vaccine encoding S protein, is the first MERS-CoV vaccine to be tested in humans, while monoclonal antibody, m336 has given promising results in animal models and has potential for use in outbreak situations.
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Affiliation(s)
- Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, 31311, Saudi Arabia.
| | - Ali M Bazzi
- Microbiology Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, 31311, Saudi Arabia
| | - Shamsah H Al-Ahmed
- Specialty Paediatric Medicine, Qatif Central Hospital, Qatif, 32654, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, 31311, Saudi Arabia.,University School of Medicine, Indianapolis, IN, 46202, USA
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Okba NM, Raj VS, Haagmans BL. Middle East respiratory syndrome coronavirus vaccines: current status and novel approaches. Curr Opin Virol 2017; 23:49-58. [PMID: 28412285 PMCID: PMC7102752 DOI: 10.1016/j.coviro.2017.03.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 03/20/2017] [Indexed: 12/26/2022]
Abstract
MERS-CoV vaccines for dromedary camels and their human contacts can potentially stop virus transmission in the community. Both neutralizing antibody and T-cell responses are required for protection MERS-CoV vaccines should aim at inducing (long term) mucosal immunity in the different target populations. The spike protein induces both neutralizing antibodies and T-cell responses and is the main target of the current vaccine candidates. Epitope-based vaccines, focusing at (cross)-protective epitopes, could induce higher and/or broader responses.
Middle East respiratory syndrome coronavirus (MERS-CoV) is a cause of severe respiratory infection in humans, specifically the elderly and people with comorbidities. The re-emergence of lethal coronaviruses calls for international collaboration to produce coronavirus vaccines, which are still lacking to date. Ongoing efforts to develop MERS-CoV vaccines should consider the different target populations (dromedary camels and humans) and the correlates of protection. Extending on our current knowledge of MERS, vaccination of dromedary camels to induce mucosal immunity could be a promising approach to diminish MERS-CoV transmission to humans. In addition, it is equally important to develop vaccines for humans that induce broader reactivity against various coronaviruses to be prepared for a potential next CoV outbreak.
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Affiliation(s)
- Nisreen Ma Okba
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - V Stalin Raj
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bart L Haagmans
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands.
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43
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Abstract
Middle East Respiratory Syndrome coronavirus (MERS-CoV) emerged in 2012 has since resulted in sporadic cases, intra-familial transmission and major outbreaks in healthcare settings. The clinical picture of MERS-CoV includes asymptomatic infections, mild or moderately symptomatic cases and fatal disease. Transmissions of MERS-CoV within healthcare settings are facilitated by overcrowding, poor compliance with basic infection control measures, unrecognized infections, the superspreaders phenomenon and poor triage systems. The actual contributing factors to the spread of MERS-CoV are yet to be systematically studied, but data to date suggest viral, host and environmental factors play a major role. Here, we summarize the known factors for the diverse transmission of MERS-CoV.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- a Medical Department , Johns Hopkins Aramco Healthcare , Dhahran , Saudi Arabia.,b Department of Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Ziad A Memish
- c Medical Department , Ministry of Health , Riyadh , Kingdom of Saudi Arabia.,d College of Medicine , Alfaisal University , Riyadh , Kingdom of Saudi Arabia
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Omrani AS, Al-Tawfiq JA, Memish ZA. Middle East respiratory syndrome coronavirus (MERS-CoV): animal to human interaction. Pathog Glob Health 2016; 109:354-62. [PMID: 26924345 PMCID: PMC4809235 DOI: 10.1080/20477724.2015.1122852] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The Middle East respiratory syndrome coronavirus (MERS-CoV) is a novel enzootic betacoronavirus that was first described in September 2012. The clinical spectrum of MERS-CoV infection in humans ranges from an asymptomatic or mild respiratory illness to severe pneumonia and multi-organ failure; overall mortality is around 35.7%. Bats harbour several betacoronaviruses that are closely related to MERS-CoV but more research is needed to establish the relationship between bats and MERS-CoV. The seroprevalence of MERS-CoV antibodies is very high in dromedary camels in Eastern Africa and the Arabian Peninsula. MERS-CoV RNA and viable virus have been isolated from dromedary camels, including some with respiratory symptoms. Furthermore, near-identical strains of MERS-CoV have been isolated from epidemiologically linked humans and camels, confirming inter-transmission, most probably from camels to humans. Though inter-human spread within health care settings is responsible for the majority of reported MERS-CoV cases, the virus is incapable at present of causing sustained human-to-human transmission. Clusters can be readily controlled with implementation of appropriate infection control procedures. Phylogenetic and sequencing data strongly suggest that MERS-CoV originated from bat ancestors after undergoing a recombination event in the spike protein, possibly in dromedary camels in Africa, before its exportation to the Arabian Peninsula along the camel trading routes. MERS-CoV serosurveys are needed to investigate possible unrecognized human infections in Africa. Amongst the important measures to control MERS-CoV spread are strict regulation of camel movement, regular herd screening and isolation of infected camels, use of personal protective equipment by camel handlers and enforcing rules banning all consumption of unpasteurized camel milk and urine.
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Affiliation(s)
- Ali S Omrani
- 1 Department of Medicine, Section of Infectious Diseases, King Faisal Specialist Hospital and Research Centre , Riyadh, Saudi Arabia
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45
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Funk AL, Goutard FL, Miguel E, Bourgarel M, Chevalier V, Faye B, Peiris JSM, Van Kerkhove MD, Roger FL. MERS-CoV at the Animal-Human Interface: Inputs on Exposure Pathways from an Expert-Opinion Elicitation. Front Vet Sci 2016; 3:88. [PMID: 27761437 PMCID: PMC5051548 DOI: 10.3389/fvets.2016.00088] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 09/14/2016] [Indexed: 12/30/2022] Open
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.
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Affiliation(s)
| | | | - Eve Miguel
- Cirad, UPR AGIRs Research Unit, Montpellier, France; UMR MIVEGEC, IRD 224-CNRS 5290-UM, Montpellier, France
| | | | | | - Bernard Faye
- Cirad, UPR AGIRs Research Unit , Montpellier , France
| | - J S Malik Peiris
- HKU-Pasteur Research Pole, Hong Kong, China; School of Public Health, University of Hong Kong, Hong Kong, China
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46
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Younan M, Bornstein S, Gluecks IV. MERS and the dromedary camel trade between Africa and the Middle East. Trop Anim Health Prod 2016; 48:1277-82. [PMID: 27324244 PMCID: PMC7089074 DOI: 10.1007/s11250-016-1089-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 06/08/2016] [Indexed: 12/21/2022]
Abstract
Dromedary camels are the most likely source for the coronavirus that sporadically causes Middle East respiratory syndrome (MERS) in humans. Serological results from archived camel sera provide evidence for circulation of MERS coronavirus (MERS-CoV) among dromedary camels in the Greater Horn of Africa as far back as 1983 and in Saudi Arabia as far back as 1992. High seroprevalences of MERS-CoV antibodies and the high virus prevalence in Saudi Arabian dromedary camels indicate an endemicity of the virus in the Arabian Peninsula, which predates the 2012 human MERS index case. Saudi Arabian dromedary camels show significantly higher MERS-CoV carrier rates than dromedary camels imported from Africa. Two MERS-CoV lineages identified in Nigerian camels were found to be genetically distinct from those found in camels and humans in the Middle East. This supports the hypothesis that camel imports from Africa are not of significance for circulation of the virus in camel populations of the Arabian Peninsula.
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Affiliation(s)
- M Younan
- Animal Health and Livestock Consultant, P.O. Box 847-10400, Nanyuki, Kenya.
| | - S Bornstein
- National Veterinary Institute, Uppsala, Sweden
| | - I V Gluecks
- Animal Health and Livestock Consultant, P.O. Box 25654-00603, Nairobi, Kenya
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47
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Modjarrad K, Moorthy VS, Ben Embarek P, Van Kerkhove M, Kim J, Kieny MP. A roadmap for MERS-CoV research and product development: report from a World Health Organization consultation. Nat Med 2016; 22:701-5. [PMID: 27387881 PMCID: PMC7096003 DOI: 10.1038/nm.4131] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
As part of the World Health Organization (WHO) R&D Blueprint initiative, leading stakeholders on Middle East respiratory syndrome coronavirus (MERS-CoV) convened to agree on strategic public-health goals and global priority research activities that are needed to combat MERS-CoV.
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Affiliation(s)
- Kayvon Modjarrad
- Kayvon Modjarrad is in the US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.,
| | - Vasee S Moorthy
- Vasee S. Moorthy, Peter Ben Embarek and Marie-Paule Kieny are in the World Health Organization, Geneva, Switzerland.,
| | - Peter Ben Embarek
- Vasee S. Moorthy, Peter Ben Embarek and Marie-Paule Kieny are in the World Health Organization, Geneva, Switzerland.,
| | - Maria Van Kerkhove
- Maria Van Kerkhove is at the Institut Pasteur, Center for Global Health, Paris, France.,
| | - Jerome Kim
- Jerome Kim is at the International Vaccine Institute, Seoul, Republic of Korea.,
| | - Marie-Paule Kieny
- Vasee S. Moorthy, Peter Ben Embarek and Marie-Paule Kieny are in the World Health Organization, Geneva, Switzerland.,
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48
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Adney DR, Bielefeldt-Ohmann H, Hartwig AE, Bowen RA. Infection, Replication, and Transmission of Middle East Respiratory Syndrome Coronavirus in Alpacas. Emerg Infect Dis 2016; 22:1031-7. [PMID: 27070385 DOI: 10.3201/2206.160192] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Middle East respiratory syndrome coronavirus is a recently emerged pathogen associated with severe human disease. Zoonotic spillover from camels appears to play a major role in transmission. Because of logistic difficulties in working with dromedaries in containment, a more manageable animal model would be desirable. We report shedding and transmission of this virus in experimentally infected alpacas (n = 3) or those infected by contact (n = 3). Infectious virus was detected in all infected animals and in 2 of 3 in-contact animals. All alpacas seroconverted and were rechallenged 70 days after the original infection. Experimentally infected animals were protected against reinfection, and those infected by contact were partially protected. Necropsy specimens from immunologically naive animals (n = 3) obtained on day 5 postinfection showed virus in the upper respiratory tract. These data demonstrate efficient virus replication and animal-to-animal transmission and indicate that alpacas might be useful surrogates for camels in laboratory studies.
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49
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Reusken CB, Schilp C, Raj VS, De Bruin E, Kohl RH, Farag EA, Haagmans BL, Al-Romaihi H, Le Grange F, Bosch BJ, Koopmans MP. MERS-CoV Infection of Alpaca in a Region Where MERS-CoV is Endemic. Emerg Infect Dis 2016; 22:1129-31. [PMID: 27070501 PMCID: PMC4880085 DOI: 10.3201/eid2206.152113] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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50
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Adney DR, Bielefeldt-Ohmann H, Hartwig AE, Bowen RA. Infection, Replication, and Transmission of Middle East Respiratory Syndrome Coronavirus in Alpacas. Emerg Infect Dis 2016. [PMID: 27070385 PMCID: PMC4880070 DOI: 10.3201/eid2206.160192] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Middle East respiratory syndrome coronavirus is a recently emerged pathogen associated with severe human disease. Zoonotic spillover from camels appears to play a major role in transmission. Because of logistic difficulties in working with dromedaries in containment, a more manageable animal model would be desirable. We report shedding and transmission of this virus in experimentally infected alpacas (n = 3) or those infected by contact (n = 3). Infectious virus was detected in all infected animals and in 2 of 3 in-contact animals. All alpacas seroconverted and were rechallenged 70 days after the original infection. Experimentally infected animals were protected against reinfection, and those infected by contact were partially protected. Necropsy specimens from immunologically naive animals (n = 3) obtained on day 5 postinfection showed virus in the upper respiratory tract. These data demonstrate efficient virus replication and animal-to-animal transmission and indicate that alpacas might be useful surrogates for camels in laboratory studies.
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