High Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia

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...

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Autores principales:	Abeer N. Alshukairi, Jian Zheng, Jingxian Zhao, Atef Nehdi, Salim A. Baharoon, Laila Layqah, Ahmad Bokhari, Sameera M. Al Johani, Nosaibah Samman, Mohamad Boudjelal, Patrick Ten Eyck, Maha A. Al-Mozaini, Jincun Zhao, Stanley Perlman, Abdulaziz N. Alagaili
Formato:	article
Lenguaje:	EN
Publicado:	American Society for Microbiology 2018
Materias:	human Middle East respiratory syndrome coronavirus virus-specific antibody response virus-specific T cell response antibody camel workers Microbiology QR1-502
Acceso en línea:	https://doaj.org/article/ad89a1e8bb6c44479ecac515531b6ce0
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spelling	oai:doaj.org-article:ad89a1e8bb6c44479ecac515531b6ce02021-11-15T15:58:20ZHigh Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia10.1128/mBio.01985-182150-7511https://doaj.org/article/ad89a1e8bb6c44479ecac515531b6ce02018-11-01T00:00:00Zhttps://journals.asm.org/doi/10.1128/mBio.01985-18https://doaj.org/toc/2150-7511ABSTRACT 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.Abeer N. AlshukairiJian ZhengJingxian ZhaoAtef NehdiSalim A. BaharoonLaila LayqahAhmad BokhariSameera M. Al JohaniNosaibah SammanMohamad BoudjelalPatrick Ten EyckMaha A. Al-MozainiJincun ZhaoStanley PerlmanAbdulaziz N. AlagailiAmerican Society for Microbiologyarticlehuman Middle East respiratory syndromecoronavirusvirus-specific antibody responsevirus-specific T cell responseantibodycamel workersMicrobiologyQR1-502ENmBio, Vol 9, Iss 5 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	human Middle East respiratory syndrome coronavirus virus-specific antibody response virus-specific T cell response antibody camel workers Microbiology QR1-502
spellingShingle	human Middle East respiratory syndrome coronavirus virus-specific antibody response virus-specific T cell response antibody camel workers Microbiology QR1-502 Abeer N. Alshukairi Jian Zheng Jingxian Zhao Atef Nehdi Salim A. Baharoon Laila Layqah Ahmad Bokhari Sameera M. Al Johani Nosaibah Samman Mohamad Boudjelal Patrick Ten Eyck Maha A. Al-Mozaini Jincun Zhao Stanley Perlman Abdulaziz N. Alagaili High Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia
description	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.
format	article
author	Abeer N. Alshukairi Jian Zheng Jingxian Zhao Atef Nehdi Salim A. Baharoon Laila Layqah Ahmad Bokhari Sameera M. Al Johani Nosaibah Samman Mohamad Boudjelal Patrick Ten Eyck Maha A. Al-Mozaini Jincun Zhao Stanley Perlman Abdulaziz N. Alagaili
author_facet	Abeer N. Alshukairi Jian Zheng Jingxian Zhao Atef Nehdi Salim A. Baharoon Laila Layqah Ahmad Bokhari Sameera M. Al Johani Nosaibah Samman Mohamad Boudjelal Patrick Ten Eyck Maha A. Al-Mozaini Jincun Zhao Stanley Perlman Abdulaziz N. Alagaili
author_sort	Abeer N. Alshukairi
title	High Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia
title_short	High Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia
title_full	High Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia
title_fullStr	High Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia
title_full_unstemmed	High Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia
title_sort	high prevalence of mers-cov infection in camel workers in saudi arabia
publisher	American Society for Microbiology
publishDate	2018
url	https://doaj.org/article/ad89a1e8bb6c44479ecac515531b6ce0
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High Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia

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