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High Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia.
mBio. 2018 10 30; 9(5)MBIO

Abstract

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.IMPORTANCE 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.

Authors+Show Affiliations

Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudia Arabia.Department of Microbiology and Immunology, University of Iowa, Iowa City, Iowa, USA.State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.Department of Medical Research Core Facility and Platforms, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.Department of Critical Care, King Saud Bin Abdulaziz for Health Sciences University, Riyadh, Kingdom of Saudi Arabia.Department of Medical Research Core Facility and Platforms, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia.College of Science and Health Professions, King Saud Bin Abdulaziz for Health Sciences University, Riyadh, Kingdom of Saudi Arabia.Department of Medical Research Core Facility and Platforms, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.Department of Medical Research Core Facility and Platforms, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa, USA.Department of Infection and Immunology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China. Guangzhou Eighth People's Hospital of Guangzhou Medical University, Guangzhou, China.Department of Microbiology and Immunology, University of Iowa, Iowa City, Iowa, USA stanley-perlman@uiowa.edu aalagaili@ksu.edu.sa. State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.KSU Mammals Research Chair, Zoology Department, King Saud University, Riyadh, Kingdom of Saudi Arabia stanley-perlman@uiowa.edu aalagaili@ksu.edu.sa.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30377284

Citation

Alshukairi, Abeer N., et al. "High Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia." MBio, vol. 9, no. 5, 2018.
Alshukairi AN, Zheng J, Zhao J, et al. High Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia. mBio. 2018;9(5).
Alshukairi, A. N., Zheng, J., Zhao, J., Nehdi, A., Baharoon, S. A., Layqah, L., Bokhari, A., Al Johani, S. M., Samman, N., Boudjelal, M., Ten Eyck, P., Al-Mozaini, M. A., Zhao, J., Perlman, S., & Alagaili, A. N. (2018). High Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia. MBio, 9(5). https://doi.org/10.1128/mBio.01985-18
Alshukairi AN, et al. High Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia. mBio. 2018 10 30;9(5) PubMed PMID: 30377284.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia. AU - Alshukairi,Abeer N, AU - Zheng,Jian, AU - Zhao,Jingxian, AU - Nehdi,Atef, AU - Baharoon,Salim A, AU - Layqah,Laila, AU - Bokhari,Ahmad, AU - Al Johani,Sameera M, AU - Samman,Nosaibah, AU - Boudjelal,Mohamad, AU - Ten Eyck,Patrick, AU - Al-Mozaini,Maha A, AU - Zhao,Jincun, AU - Perlman,Stanley, AU - Alagaili,Abdulaziz N, Y1 - 2018/10/30/ PY - 2018/11/1/entrez PY - 2018/11/1/pubmed PY - 2019/2/27/medline KW - Middle East respiratory syndrome KW - T cells KW - antibody KW - camel workers KW - coronavirus KW - human Middle East respiratory syndrome KW - virus-specific T cell response KW - virus-specific antibody response JF - mBio JO - mBio VL - 9 IS - 5 N2 - 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.IMPORTANCE 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. SN - 2150-7511 UR - https://www.unboundmedicine.com/medline/citation/30377284/High_Prevalence_of_MERS_CoV_Infection_in_Camel_Workers_in_Saudi_Arabia_ L2 - http://mbio.asm.org/cgi/pmidlookup?view=long&pmid=30377284 DB - PRIME DP - Unbound Medicine ER -