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.

A number of key gaps remain in epidemiology, including transmission, population-based incidence or prevalence rates, and geographic and demographic distributions of infections. Based on the limited human seroprevalence data so far, it seems likely that population prevalence is low, but the baseline should be established. It is also not clear whether seropositivity is a reliable indicator of prior infection. The finding of variable low antibody titers at 1 year postinfection indicates that methods other than traditional serosurveys may be required (Reusken et al. 2013a ). If serology is not reliable, this raises the question of how to screen populations. There are methods that are both more sensitive and more specific for antibody detection (Mishra et al. 2018) , as well as assays of cellular immunity (Zhao et al. 2017 ), but are costlier and more difficult for population screening.