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What Have We Learned About Middle East Respiratory Syndrome Coronavirus Emergence in Humans? A Systematic Literature Review.
Vector Borne Zoonotic Dis. 2019 03; 19(3):174-192.VB

Abstract

BACKGROUND

Middle East respiratory syndrome coronavirus (MERS-CoV) was first identified in humans in 2012. A systematic literature review was conducted to synthesize current knowledge and identify critical knowledge gaps.

MATERIALS AND METHODS

We conducted a systematic review on MERS-CoV using PRISMA guidelines. We identified 407 relevant, peer-reviewed publications and selected 208 of these based on their contributions to four key areas: virology; clinical characteristics, outcomes, therapeutic and preventive options; epidemiology and transmission; and animal interface and the search for natural hosts of MERS-CoV.

RESULTS

Dipeptidyl peptidase 4 (DPP4/CD26) was identified as the human receptor for MERS-CoV, and a variety of molecular and serological assays developed. Dromedary camels remain the only documented zoonotic source of human infection, but MERS-like CoVs have been detected in bat species globally, as well as in dromedary camels throughout the Middle East and Africa. However, despite evidence of camel-to-human MERS-CoV transmission and cases apparently related to camel contact, the source of many primary cases remains unknown. There have been sustained health care-associated human outbreaks in Saudi Arabia and South Korea, the latter originating from one traveler returning from the Middle East. Transmission mechanisms are poorly understood; for health care, this may include environmental contamination. Various potential therapeutics have been identified, but not yet evaluated in human clinical trials. At least one candidate vaccine has progressed to Phase I trials.

CONCLUSIONS

There has been substantial MERS-CoV research since 2012, but significant knowledge gaps persist, especially in epidemiology and natural history of the infection. There have been few rigorous studies of baseline prevalence, transmission, and spectrum of disease. Terms such as "camel exposure" and the epidemiological relationships of cases should be clearly defined and standardized. We strongly recommend a shared and accessible registry or database. Coronaviruses will likely continue to emerge, arguing for a unified "One Health" approach.

Authors+Show Affiliations

1 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.2 Infectious Hazard Management, Department of Health Emergency, World Health Organization Eastern Mediterranean Regional Office (WHO/EMRO), Cairo, Egypt.3 Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York.1 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.

Pub Type(s)

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

Language

eng

PubMed ID

30676269

Citation

Dawson, Patrick, et al. "What Have We Learned About Middle East Respiratory Syndrome Coronavirus Emergence in Humans? a Systematic Literature Review." Vector Borne and Zoonotic Diseases (Larchmont, N.Y.), vol. 19, no. 3, 2019, pp. 174-192.
Dawson P, Malik MR, Parvez F, et al. What Have We Learned About Middle East Respiratory Syndrome Coronavirus Emergence in Humans? A Systematic Literature Review. Vector Borne Zoonotic Dis. 2019;19(3):174-192.
Dawson, P., Malik, M. R., Parvez, F., & Morse, S. S. (2019). What Have We Learned About Middle East Respiratory Syndrome Coronavirus Emergence in Humans? A Systematic Literature Review. Vector Borne and Zoonotic Diseases (Larchmont, N.Y.), 19(3), 174-192. https://doi.org/10.1089/vbz.2017.2191
Dawson P, et al. What Have We Learned About Middle East Respiratory Syndrome Coronavirus Emergence in Humans? a Systematic Literature Review. Vector Borne Zoonotic Dis. 2019;19(3):174-192. PubMed PMID: 30676269.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - What Have We Learned About Middle East Respiratory Syndrome Coronavirus Emergence in Humans? A Systematic Literature Review. AU - Dawson,Patrick, AU - Malik,Mamunur Rahman, AU - Parvez,Faruque, AU - Morse,Stephen S, Y1 - 2019/01/24/ PY - 2019/1/25/pubmed PY - 2019/8/14/medline PY - 2019/1/25/entrez KW - MERS KW - MERS epidemiology KW - MERS-CoV KW - coronaviruses KW - severe acute respiratory infection (SARI) KW - zoonotic disease SP - 174 EP - 192 JF - Vector borne and zoonotic diseases (Larchmont, N.Y.) JO - Vector Borne Zoonotic Dis VL - 19 IS - 3 N2 - BACKGROUND: Middle East respiratory syndrome coronavirus (MERS-CoV) was first identified in humans in 2012. A systematic literature review was conducted to synthesize current knowledge and identify critical knowledge gaps. MATERIALS AND METHODS: We conducted a systematic review on MERS-CoV using PRISMA guidelines. We identified 407 relevant, peer-reviewed publications and selected 208 of these based on their contributions to four key areas: virology; clinical characteristics, outcomes, therapeutic and preventive options; epidemiology and transmission; and animal interface and the search for natural hosts of MERS-CoV. RESULTS: Dipeptidyl peptidase 4 (DPP4/CD26) was identified as the human receptor for MERS-CoV, and a variety of molecular and serological assays developed. Dromedary camels remain the only documented zoonotic source of human infection, but MERS-like CoVs have been detected in bat species globally, as well as in dromedary camels throughout the Middle East and Africa. However, despite evidence of camel-to-human MERS-CoV transmission and cases apparently related to camel contact, the source of many primary cases remains unknown. There have been sustained health care-associated human outbreaks in Saudi Arabia and South Korea, the latter originating from one traveler returning from the Middle East. Transmission mechanisms are poorly understood; for health care, this may include environmental contamination. Various potential therapeutics have been identified, but not yet evaluated in human clinical trials. At least one candidate vaccine has progressed to Phase I trials. CONCLUSIONS: There has been substantial MERS-CoV research since 2012, but significant knowledge gaps persist, especially in epidemiology and natural history of the infection. There have been few rigorous studies of baseline prevalence, transmission, and spectrum of disease. Terms such as "camel exposure" and the epidemiological relationships of cases should be clearly defined and standardized. We strongly recommend a shared and accessible registry or database. Coronaviruses will likely continue to emerge, arguing for a unified "One Health" approach. SN - 1557-7759 UR - https://www.unboundmedicine.com/medline/citation/30676269/What_Have_We_Learned_About_Middle_East_Respiratory_Syndrome_Coronavirus_Emergence_in_Humans_A_Systematic_Literature_Review_ L2 - https://www.liebertpub.com/doi/10.1089/vbz.2017.2191?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -