title: Human-Dromedary Camel Interactions and the Risk of Acquiring Zoonotic Middle East Respiratory Syndrome Coronavirus Infection.
abstract: Middle East respiratory syndrome coronavirus (MERS-CoV) cases without documented contact with another human MERS-CoV case make up 61% (517/853) of all reported cases. These primary cases are of particular interest for understanding the source(s) and route(s) of transmission and for designing long-term disease control measures. Dromedary camels are the only animal species for which there is convincing evidence that it is a host species for MERS-CoV and hence a potential source of human infections. However, only a small proportion of the primary cases have reported contact with camels. Other possible sources and vehicles of infection include food-borne transmission through consumption of unpasteurized camel milk and raw meat, medicinal use of camel urine and zoonotic transmission from other species. There are critical knowledge gaps around this new disease which can only be closed through traditional field epidemiological investigations and studies designed to test hypothesis regarding sources of infection and risk factors for disease. Since the 1960s, there has been a radical change in dromedary camel farming practices in the Arabian Peninsula with an intensification of the production and a concentration of the production around cities. It is possible that the recent intensification of camel herding in the Arabian Peninsula has increased the virus' reproductive number and attack rate in camel herds while the 'urbanization' of camel herding increased the frequency of zoonotic 'spillover' infections from camels to humans. It is reasonable to assume, although difficult to measure, that the sensitivity of public health surveillance to detect previously unknown diseases is lower in East Africa than in Saudi Arabia and that sporadic human cases may have gone undetected there.
authors.affiliation: European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.|School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Gossner
authors.affiliation: European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
authors.forename: N
authors.initials: N
authors.lastname: Danielson
authors.affiliation: Animal and Plant Health Unit, European Food Safety Authority (EFSA), Parma, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Gervelmeyer
authors.affiliation: Animal and Plant Health Unit, European Food Safety Authority (EFSA), Parma, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Berthe
authors.affiliation: FAO/CIRAD-ES, Campus International de Baillarguet, Montpellier, France.
authors.forename: B
authors.initials: B
authors.lastname: Faye
authors.affiliation: European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Kaasik Aaslav
authors.affiliation: European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Adlhoch
authors.affiliation: European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Zeller
authors.affiliation: European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Penttinen
authors.affiliation: European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
authors.forename: D
authors.initials: D
authors.lastname: Coulombier
mesh_terms: D000328:Adult; D000822:Animal Husbandry / Q000379:methods; D000818:Animals; D002162:Camelus / Q000821:virology; D018352:Coronavirus Infections / Q000453:epidemiology* / Q000635:transmission; D004199:Disease Vectors; D005260:Female; D006801:Humans; D008297:Male; D008377:Maps as Topic; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D065207:Middle East Respiratory Syndrome Coronavirus; D012307:Risk Factors; D015047:Zoonoses / Q000453:epidemiology / Q000635:transmission* / Q000821:virology
keywords: Arabian Peninsula; MERS-CoV; camels; coronavirus; zoonoses