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Presence of Middle East respiratory syndrome coronavirus antibodies in Saudi Arabia: a nationwide, cross-sectional, serological study.
Lancet Infect Dis. 2015 May; 15(5):559-64.LI

Abstract

BACKGROUND

Scientific evidence suggests that dromedary camels are the intermediary host for the Middle East respiratory syndrome coronavirus (MERS-CoV). However, the actual number of infections in people who have had contact with camels is unknown and most index patients cannot recall any such contact. We aimed to do a nationwide serosurvey in Saudi Arabia to establish the prevalence of MERS-CoV antibodies, both in the general population and in populations of individuals who have maximum exposure to camels.

METHODS

In the cross-sectional serosurvey, we tested human serum samples obtained from healthy individuals older than 15 years who attended primary health-care centres or participated in a national burden-of-disease study in all 13 provinces of Saudi Arabia. Additionally, we tested serum samples from shepherds and abattoir workers with occupational exposure to camels. Samples were screened by recombinant ELISA and MERS-CoV seropositivity was confirmed by recombinant immunofluorescence and plaque reduction neutralisation tests. We used two-tailed Mann Whitney U exact tests, χ(2), and Fisher's exact tests to analyse the data.

FINDINGS

Between Dec 1, 2012, and Dec 1, 2013, we obtained individual serum samples from 10,009 individuals. Anti-MERS-CoV antibodies were confirmed in 15 (0·15%; 95% CI 0·09-0·24) of 10,009 people in six of the 13 provinces. The mean age of seropositive individuals was significantly younger than that of patients with reported, laboratory-confirmed, primary Middle Eastern respiratory syndrome (43·5 years [SD 17·3] vs 53·8 years [17·5]; p=0·008). Men had a higher antibody prevalence than did women (11 [0·25%] of 4341 vs two [0·05%] of 4378; p=0·028) and antibody prevalence was significantly higher in central versus coastal provinces (14 [0·26%] of 5479 vs one [0·02%] of 4529; p=0·003). Compared with the general population, seroprevalence of MERS-CoV antibodies was significantly increased by 15 times in shepherds (two [2·3%] of 87, p=0·0004) and by 23 times in slaughterhouse workers (five [3·6%] of 140; p<0·0001).

INTERPRETATION

Seroprevalence of MERS-CoV antibodies was significantly higher in camel-exposed individuals than in the general population. By simple multiplication, a projected 44,951 (95% CI 26,971-71,922) individuals older than 15 years might be seropositive for MERS-CoV in Saudi Arabia. These individuals might be the source of infection for patients with confirmed MERS who had no previous exposure to camels.

FUNDING

European Union, German Centre for Infection Research, Federal Ministry of Education and Research, German Research Council, and Ministry of Health of Saudi Arabia.

Authors+Show Affiliations

Institute of Virology, University of Bonn Medical Centre, Bonn, Germany.Institute of Virology, University of Bonn Medical Centre, Bonn, Germany.Institute of Virology, University of Bonn Medical Centre, Bonn, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Bonn, Germany.King Abdulaziz Medical City & Advisor Royal Court, Riyadh, Saudi Arabia.King Abdulaziz Medical City & Advisor Royal Court, Riyadh, Saudi Arabia; Makkah Regional Health Affairs, Ministry of Health, Makkah, Saudi Arabia.Institute of Virology, University of Bonn Medical Centre, Bonn, Germany.Institute of Virology, University of Bonn Medical Centre, Bonn, Germany.Institute of Virology, University of Bonn Medical Centre, Bonn, Germany.Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands.Euroimmun AG, Lübeck, Germany.King Abdulaziz Medical City & Advisor Royal Court, Riyadh, Saudi Arabia.King Abdulaziz Medical City & Advisor Royal Court, Riyadh, Saudi Arabia.Saudi Center for Disease Control, Riyadh, Saudi Arabia.National Health Laboratory, Riyadh, Saudi Arabia.Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA.Institute of Evolutionary Biology, University of Edinburgh, Centre for Infection, Immunity and Evolution, Edinburgh, UK.King Abdulaziz Medical City & Advisor Royal Court, Riyadh, Saudi Arabia.Institute of Virology, University of Bonn Medical Centre, Bonn, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Bonn, Germany. Electronic address: drosten@virology-bonn.de.King Abdulaziz Medical City & Advisor Royal Court, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia. Electronic address: zmemish@yahoo.com.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25863564

Citation

Müller, Marcel A., et al. "Presence of Middle East Respiratory Syndrome Coronavirus Antibodies in Saudi Arabia: a Nationwide, Cross-sectional, Serological Study." The Lancet. Infectious Diseases, vol. 15, no. 5, 2015, pp. 559-64.
Müller MA, Meyer B, Corman VM, et al. Presence of Middle East respiratory syndrome coronavirus antibodies in Saudi Arabia: a nationwide, cross-sectional, serological study. Lancet Infect Dis. 2015;15(5):559-64.
Müller, M. A., Meyer, B., Corman, V. M., Al-Masri, M., Turkestani, A., Ritz, D., Sieberg, A., Aldabbagh, S., Bosch, B. J., Lattwein, E., Alhakeem, R. F., Assiri, A. M., Albarrak, A. M., Al-Shangiti, A. M., Al-Tawfiq, J. A., Wikramaratna, P., Alrabeeah, A. A., Drosten, C., & Memish, Z. A. (2015). Presence of Middle East respiratory syndrome coronavirus antibodies in Saudi Arabia: a nationwide, cross-sectional, serological study. The Lancet. Infectious Diseases, 15(5), 559-64. https://doi.org/10.1016/S1473-3099(15)70090-3
Müller MA, et al. Presence of Middle East Respiratory Syndrome Coronavirus Antibodies in Saudi Arabia: a Nationwide, Cross-sectional, Serological Study. Lancet Infect Dis. 2015;15(5):559-64. PubMed PMID: 25863564.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Presence of Middle East respiratory syndrome coronavirus antibodies in Saudi Arabia: a nationwide, cross-sectional, serological study. AU - Müller,Marcel A, AU - Meyer,Benjamin, AU - Corman,Victor M, AU - Al-Masri,Malak, AU - Turkestani,Abdulhafeez, AU - Ritz,Daniel, AU - Sieberg,Andrea, AU - Aldabbagh,Souhaib, AU - Bosch,Berend-J, AU - Lattwein,Erik, AU - Alhakeem,Raafat F, AU - Assiri,Abdullah M, AU - Albarrak,Ali M, AU - Al-Shangiti,Ali M, AU - Al-Tawfiq,Jaffar A, AU - Wikramaratna,Paul, AU - Alrabeeah,Abdullah A, AU - Drosten,Christian, AU - Memish,Ziad A, Y1 - 2015/04/08/ PY - 2015/4/13/entrez PY - 2015/4/13/pubmed PY - 2015/7/15/medline SP - 559 EP - 64 JF - The Lancet. Infectious diseases JO - Lancet Infect Dis VL - 15 IS - 5 N2 - BACKGROUND: Scientific evidence suggests that dromedary camels are the intermediary host for the Middle East respiratory syndrome coronavirus (MERS-CoV). However, the actual number of infections in people who have had contact with camels is unknown and most index patients cannot recall any such contact. We aimed to do a nationwide serosurvey in Saudi Arabia to establish the prevalence of MERS-CoV antibodies, both in the general population and in populations of individuals who have maximum exposure to camels. METHODS: In the cross-sectional serosurvey, we tested human serum samples obtained from healthy individuals older than 15 years who attended primary health-care centres or participated in a national burden-of-disease study in all 13 provinces of Saudi Arabia. Additionally, we tested serum samples from shepherds and abattoir workers with occupational exposure to camels. Samples were screened by recombinant ELISA and MERS-CoV seropositivity was confirmed by recombinant immunofluorescence and plaque reduction neutralisation tests. We used two-tailed Mann Whitney U exact tests, χ(2), and Fisher's exact tests to analyse the data. FINDINGS: Between Dec 1, 2012, and Dec 1, 2013, we obtained individual serum samples from 10,009 individuals. Anti-MERS-CoV antibodies were confirmed in 15 (0·15%; 95% CI 0·09-0·24) of 10,009 people in six of the 13 provinces. The mean age of seropositive individuals was significantly younger than that of patients with reported, laboratory-confirmed, primary Middle Eastern respiratory syndrome (43·5 years [SD 17·3] vs 53·8 years [17·5]; p=0·008). Men had a higher antibody prevalence than did women (11 [0·25%] of 4341 vs two [0·05%] of 4378; p=0·028) and antibody prevalence was significantly higher in central versus coastal provinces (14 [0·26%] of 5479 vs one [0·02%] of 4529; p=0·003). Compared with the general population, seroprevalence of MERS-CoV antibodies was significantly increased by 15 times in shepherds (two [2·3%] of 87, p=0·0004) and by 23 times in slaughterhouse workers (five [3·6%] of 140; p<0·0001). INTERPRETATION: Seroprevalence of MERS-CoV antibodies was significantly higher in camel-exposed individuals than in the general population. By simple multiplication, a projected 44,951 (95% CI 26,971-71,922) individuals older than 15 years might be seropositive for MERS-CoV in Saudi Arabia. These individuals might be the source of infection for patients with confirmed MERS who had no previous exposure to camels. FUNDING: European Union, German Centre for Infection Research, Federal Ministry of Education and Research, German Research Council, and Ministry of Health of Saudi Arabia. SN - 1474-4457 UR - https://www.unboundmedicine.com/medline/citation/25863564/Presence_of_Middle_East_respiratory_syndrome_coronavirus_antibodies_in_Saudi_Arabia:_a_nationwide_cross_sectional_serological_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1473-3099(15)70090-3 DB - PRIME DP - Unbound Medicine ER -