title: Middle East respiratory syndrome coronavirus in dromedary camels: an outbreak investigation.
abstract: BACKGROUND
  Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe lower respiratory tract infection in people. Previous studies suggested dromedary camels were a reservoir for this virus. We tested for the presence of MERS-CoV in dromedary camels from a farm in Qatar linked to two human cases of the infection in October, 2013.
  
  
  METHODS
  We took nose swabs, rectal swabs, and blood samples from all camels on the Qatari farm. We tested swabs with RT-PCR, with amplification targeting the E gene (upE), nucleocapsid (N) gene, and open reading frame (ORF) 1a. PCR positive samples were tested by different MERS-CoV specific PCRs and obtained sequences were used for phylogentic analysis together with sequences from the linked human cases and other human cases. We tested serum samples from the camels for IgG immunofluorescence assay, protein microarray, and virus neutralisation assay.
  
  
  RESULTS
  We obtained samples from 14 camels on Oct 17, 2013. We detected MERS-CoV in nose swabs from three camels by three independent RT-PCRs and sequencing. The nucleotide sequence of an ORF1a fragment (940 nucleotides) and a 4·2 kb concatenated fragment were very similar to the MERS-CoV from two human cases on the same farm and a MERS-CoV isolate from Hafr-Al-Batin. Eight additional camel nose swabs were positive on one or more RT-PCRs, but could not be confirmed by sequencing. All camels had MERS-CoV spike-binding antibodies that correlated well with the presence of neutralising antibodies to MERS-CoV.
  
  
  CONCLUSIONS
  Our study provides virological confirmation of MERS-CoV in camels and suggests a recent outbreak affecting both human beings and camels. We cannot conclude whether the people on the farm were infected by the camels or vice versa, or if a third source was responsible.
  
  
  BACKGROUND
  European Union projects EMPERIE (contract number 223498), ANTIGONE (contract number 278976), and the VIRGO consortium.
authors.affiliation: Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: Bart L
authors.initials: BL
authors.lastname: Haagmans
authors.affiliation: Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Said H S
authors.initials: SH
authors.lastname: Al Dhahiry
authors.affiliation: Centre for Infectious Disease Research, Diagnostics and Screening, Division of Virology, National Institute for Public Health and the Environment, Bilthoven, Netherlands.
authors.forename: Chantal B E M
authors.initials: CB
authors.lastname: Reusken
authors.affiliation: Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: V Stalin
authors.initials: VS
authors.lastname: Raj
authors.affiliation: Virus Reference Department, Public Health England, London, UK.
authors.forename: Monica
authors.initials: M
authors.lastname: Galiano
authors.affiliation: Virus Reference Department, Public Health England, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Myers
authors.affiliation: Centre for Infectious Disease Research, Diagnostics and Screening, Division of Virology, National Institute for Public Health and the Environment, Bilthoven, Netherlands.
authors.forename: Gert-Jan
authors.initials: GJ
authors.lastname: Godeke
authors.affiliation: Centre for Infectious Disease Research, Diagnostics and Screening, Division of Virology, National Institute for Public Health and the Environment, Bilthoven, Netherlands.
authors.forename: Marcel
authors.initials: M
authors.lastname: Jonges
authors.affiliation: Supreme Council of Health, Doha, Qatar.
authors.forename: Elmoubasher
authors.initials: E
authors.lastname: Farag
authors.affiliation: Supreme Council of Health, Doha, Qatar.
authors.forename: Ayman
authors.initials: A
authors.lastname: Diab
authors.affiliation: Supreme Council of Health, Doha, Qatar.
authors.forename: Hazem
authors.initials: H
authors.lastname: Ghobashy
authors.affiliation: Supreme Council of Health, Doha, Qatar.
authors.forename: Farhoud
authors.initials: F
authors.lastname: Alhajri
authors.affiliation: Supreme Council of Health, Doha, Qatar.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Al-Thani
authors.affiliation: Supreme Council of Health, Doha, Qatar.
authors.forename: Salih A
authors.initials: SA
authors.lastname: Al-Marri
authors.affiliation: Supreme Council of Health, Doha, Qatar.
authors.forename: Hamad E
authors.initials: HE
authors.lastname: Al Romaihi
authors.affiliation: Supreme Council of Health, Doha, Qatar.
authors.forename: Abdullatif
authors.initials: A
authors.lastname: Al Khal
authors.affiliation: Virus Reference Department, Public Health England, London, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Bermingham
authors.affiliation: Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: Albert D M E
authors.initials: AD
authors.lastname: Osterhaus
authors.affiliation: Supreme Council of Health, Doha, Qatar. Electronic address: malhajri1@sch.gov.qa.
authors.forename: Mohd M
authors.initials: MM
authors.lastname: AlHajri
authors.affiliation: Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands; Centre for Infectious Disease Research, Diagnostics and Screening, Division of Virology, National Institute for Public Health and the Environment, Bilthoven, Netherlands. Electronic address: m.koopmans@erasmusmc.nl.
authors.forename: Marion P G
authors.initials: MP
authors.lastname: Koopmans
mesh_terms: D000328:Adult; D000818:Animals; D001483:Base Sequence; D002162:Camelus / Q000821:virology*; D017934:Coronavirus / Q000235:genetics / Q000302:isolation & purification*; D018352:Coronavirus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000662:veterinary* / Q000821:virology; D004196:Disease Outbreaks / Q000662:veterinary*; D004197:Disease Reservoirs / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D010802:Phylogeny; D011780:Qatar / Q000453:epidemiology; D012367:RNA, Viral / Q000032:analysis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D017423:Sequence Analysis, RNA; D015047:Zoonoses / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology
chemical_list: D012367:RNA, Viral