MERS-CoV spillover at the camel-human interface

Gytis Dudas; Luiz Max Carvalho; Andrew Rambaut; Trevor Bedford; Ali M. Somily; Mazin Barry; Sarah S. Al Subaie; Abdulaziz A. BinSaeed; Fahad A. Alzamil; Waleed Zaher; Theeb Al Qahtani; Khaldoon Al Jerian; Scott J.N. McNabb; Imad A. Al-Jahdali; Ahmed M. Alotaibi; Nahid A. Batarfi; Matthew Cotten; Simon J. Watson; Spela Binter; Paul Kellam

Middle East respiratory syndrome coronavirus (MERS-CoV), endemic in camels in the Arabian Peninsula, is the causative agent of zoonotic infections and limited outbreaks in humans. The virus, first discovered in 2012 (Zaki et al., 2012; Boheemen et al., 2012) , has caused more than 2000 infections and over 700 deaths, according to the World Health Organization (WHO) (World Health Organization, 2017) . Its epidemiology remains obscure, largely because infections are observed among the most severely affected individuals, such as older males with comorbidities (Assiri et al., 2013a; The WHO MERS-CoV Research Group, 2013) . While contact with camels is often reported, other patients do not recall contact with any livestock, suggesting an unobserved community contribution to the outbreak (The WHO MERS-CoV Research Group, 2013) . Previous studies on MERS-CoV epidemiology have used serology to identify factors associated with MERS-CoV exposure in potential risk groups (Reusken et al., 2015 (Reusken et al., , 2013 . Such data have shown high seroprevalence in camels (Müller et al., 2014; Corman et al., 2014; Chu et al., 2014; Reusken et al., 2013 Reusken et al., , 2014 and evidence of contact with MERS-CoV in workers with occupational exposure to camels (Reusken et al., 2015; Müller et al., 2015) . Separately, epidemiological modelling approaches have been used to look at incidence reports through time, space and across hosts (Cauchemez et al., 2016) .