Risk of global spread of Middle East respiratory syndrome coronavirus (MERS-CoV) via the air transport network.
BACKGROUND
Middle East respiratory syndrome coronavirus (MERS-CoV) emerged from the Kingdom of Saudi Arabia (KSA) in 2012 and has since spread to 26 countries. All cases reported so far have either been in the Middle East or linked to the region through passenger air travel, with the largest outbreak outside KSA occurring in South Korea. Further international spread is likely due to the high travel volumes of global travel, as well as the occurrence of large annual mass gathering such as the Haj and Umrah pilgrimages that take place in the region.


METHODS
In this study, a transport network modelling framework was used to quantify the risk of MERS-CoV spreading internationally via air travellers. All regions connected to MERS-CoV affected countries via air travel are considered, and the countries at highest risk of travel-related importations of MERS-CoV were identified, ranked and compared with actual spread of MERS cases.


RESULTS
The model identifies all countries that have previously reported a travel acquired case to be in the top 50 at-risk countries. India, Pakistan and Bangladesh are the highest risk countries which have yet to report a case, and should be prepared for the possibility of (pilgrims and general) travellers returning infected with MERS-CoV. In addition, the UK, Egypt, Turkey and the USA are at risk of more cases.


CONCLUSIONS
We have demonstrated a risk-analysis approach, using travel patterns, to prioritize countries at highest risk for MERS-CoV importations. In order to prevent global outbreaks such as the one seen in South Korea, it is critical for high-risk countries to be prepared and have appropriate screening and triage protocols in place to identify travel-related cases of MERS-CoV. The results from the model can be used by countries to prioritize their airport and hospital screening and triage protocols.
School of Civil and Environmental Engineering, UNSW Australia, Sydney, NSW 2052, Australia l.gardner@unsw.edu.au.
Lauren M
LM
Gardner
School of Public Health and Community Medicine, Faculty of Medicine, UNSW Australia, Sydney, NSW, 2052, Australia.
Abrar A
AA
Chughtai
School of Public Health and Community Medicine, Faculty of Medicine, UNSW Australia, Sydney, NSW, 2052, Australia College of Public Services and Community Solutions, Arizona State University, Tempe, AZ, USA.
C Raina
CR
MacIntyre
D059028:Airports; D001359:Aviation; D003140:Communicable Disease Control / Q000379:methods; D018352:Coronavirus Infections / Q000517:prevention & control / Q000635:transmission*; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D014943:Global Health; D006801:Humans; D008877:Middle East; D065207:Middle East Respiratory Syndrome Coronavirus; D018570:Risk Assessment; D014195:Travel
MERS-CoV; air travel; network modeling; risk