title: MERS coronavirus: data gaps for laboratory preparedness.
abstract: Since the emergence of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in 2012, many questions remain on modes of transmission and sources of virus. In outbreak situations, especially with emerging organisms causing severe human disease, it is important to understand the full spectrum of disease, and shedding kinetics in relation to infectivity and the ability to transmit the microorganism. Laboratory response capacity during the early stages of an outbreak focuses on development of virological and immunological methods for patient diagnosis, for contact tracing, and for epidemiological studies into sources, modes of transmission, identification of risk groups, and animal reservoirs. However, optimal use of this core public health laboratory capacity requires a fundamental understanding of kinetics of viral shedding and antibody response, of assay validation and of interpretation of test outcomes. We reviewed available data from MERS-CoV case reports, and compared this with data on kinetics of shedding and immune response from published literature on other human coronaviruses (hCoVs). We identify and discuss important data gaps, and biases that limit the laboratory preparedness to this novel disease. Public health management will benefit from standardised reporting of methods used, details of test outcomes by sample type, sampling date, in relation to symptoms and risk factors, along with the currently reported demographic, clinical and epidemiological findings.
authors.affiliation: Centre for Infectious Disease Research, Diagnostics and Screening, Division Virology, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; The European Programme for Public Health Microbiology Training (EUPHEM), European Center for Disease Control, Stockholm, Sweden.
authors.forename: Rita
authors.initials: R
authors.lastname: de Sousa
authors.affiliation: Centre for Infectious Disease Research, Diagnostics and Screening, Division Virology, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Department of Viroscience, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Chantal
authors.initials: C
authors.lastname: Reusken
authors.affiliation: Centre for Infectious Disease Research, Diagnostics and Screening, Division Virology, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Department of Viroscience, Erasmus Medical Centre, Rotterdam, The Netherlands. Electronic address: marion.koopmans@rivm.nl.
authors.forename: Marion
authors.initials: M
authors.lastname: Koopmans
mesh_terms: D000818:Animals; D057191:Capacity Building / Q000639:trends*; D003332:Coronaviridae / Q000145:classification / Q000302:isolation & purification*; D018352:Coronavirus Infections / Q000175:diagnosis* / Q000821:virology*; D014943:Global Health; D006801:Humans; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000821:virology*
keywords: Coronavirus; Laboratory preparedness; Middle East Respiratory Syndrome Coronavirus; SARS