What Have We Learned About Middle East Respiratory Syndrome Coronavirus Emergence in Humans? A Systematic Literature Review

Dawson, Patrick; Malik, Mamunur Rahman; Parvez, Faruque; Morse, Stephen S.

Dromedary camels are the only documented zoonotic source of human infection, and there is considerable circumstantial evidence supporting camel-to-human transmission, including evidence of camels and humans becoming infected with an identical MERS-CoV , Ferguson and Kerkhove 2014 ). Identical genomic sequences of MERS-CoV were isolated from a camel owner who died from MERS-CoV and his camel who had rhinorrhea at that time; identical MERS-CoV RNA fragments were later detected in the air at the camel barn . Serology suggested that the camel was infected before the owner . Critics have suggested that the identical sequences may be due to crosscontamination ), but the authors maintain that the isolates were collected on different days and processed in different facilities. Other epidemiologic investigations have found similar evidence, but directionality was not implied (Ferguson and Kerkhove 2014, Memish et al. 2014e) .