tetano
Editor, Senior Moderator
Int J Infect Dis
. 2026 Aug 15:109046.
doi: 10.1016/j.ijid.2026.109046. Online ahead of print.
MERS-CoV in the Middle East and Africa: from surveillance gaps in humans and dromedary camels to One Health frameworks for spillover, prevention, research and response preparedness
Esam I Azhar[SUP] 1 [/SUP], Manaf Alqahtani[SUP] 2 [/SUP], Abdullah M Assiri[SUP] 3 [/SUP], Seif S Al-Abri[SUP] 4 [/SUP], Tieble Traore[SUP] 5 [/SUP], Francine Ntoumi[SUP] 6 [/SUP], Moses Bockarie[SUP] 7 [/SUP], Eskild Petersen[SUP] 8 [/SUP], Giuseppe Ippolito[SUP] 9 [/SUP], David S Hui[SUP] 10 [/SUP], Brian McCloskey[SUP] 11 [/SUP], Stanley Perlman[SUP] 12 [/SUP], Alimuddin Zumla[SUP] 13 [/SUP]
Affiliations
Middle East respiratory syndrome coronavirus (MERS-CoV) remains a low-incidence but high-consequence zoonotic coronavirus threat. Since its identification in Saudi Arabia in 2012, more than 2600 laboratory-confirmed cases have been reported from 27 countries, most from the Arabian Peninsula; the reported case fatality ratio is high but probably overestimates infection fatality because mild and asymptomatic infections are under-detected. Dromedary camels across the Middle East, North Africa, East Africa, the Horn of Africa, and parts of the Sahel show extensive evidence of MERS-CoV infection or exposure, yet PCR-confirmed human disease has rarely been reported from Africa. This "Africa paradox" is one of the most important unresolved issues in MERS-CoV epidemiology. We propose a dromedary camel-centred One Health framework for the connected Middle East-Africa dromedary belt. The framework is organised around two linked barriers: an upstream barrier that detects and reduces zoonotic spillover at the camel-human interface, and a downstream healthcare barrier that prevents amplification after human infection occurs. Preparedness should include sentinel surveillance for severe acute respiratory infection and atypical pneumonia in camel-exposed populations, linked animal-human genomic surveillance, culturally respectful and occupationally practical risk reduction, rapid diagnostic pathways, healthcare infection prevention and control, mass-gathering and travel preparedness, and pre-approved research platforms. A Middle East-Africa preparedness compact aligned with the International Health Regulations, One Health governance, and equitable pathogen access and benefit sharing could transform fragmented surveillance into a standing transregional system for early detection, prevention, and research-ready response.
Keywords: Africa paradox; Africa: evidence mapping; Compact; MERS-CoV; Middle East; One Health; dromedary camel; preparedness; prevention; research; response; spillover surveillance.
. 2026 Aug 15:109046.
doi: 10.1016/j.ijid.2026.109046. Online ahead of print.
MERS-CoV in the Middle East and Africa: from surveillance gaps in humans and dromedary camels to One Health frameworks for spillover, prevention, research and response preparedness
Esam I Azhar[SUP] 1 [/SUP], Manaf Alqahtani[SUP] 2 [/SUP], Abdullah M Assiri[SUP] 3 [/SUP], Seif S Al-Abri[SUP] 4 [/SUP], Tieble Traore[SUP] 5 [/SUP], Francine Ntoumi[SUP] 6 [/SUP], Moses Bockarie[SUP] 7 [/SUP], Eskild Petersen[SUP] 8 [/SUP], Giuseppe Ippolito[SUP] 9 [/SUP], David S Hui[SUP] 10 [/SUP], Brian McCloskey[SUP] 11 [/SUP], Stanley Perlman[SUP] 12 [/SUP], Alimuddin Zumla[SUP] 13 [/SUP]
Affiliations
- PMID: 42603685
- DOI: 10.1016/j.ijid.2026.109046
Middle East respiratory syndrome coronavirus (MERS-CoV) remains a low-incidence but high-consequence zoonotic coronavirus threat. Since its identification in Saudi Arabia in 2012, more than 2600 laboratory-confirmed cases have been reported from 27 countries, most from the Arabian Peninsula; the reported case fatality ratio is high but probably overestimates infection fatality because mild and asymptomatic infections are under-detected. Dromedary camels across the Middle East, North Africa, East Africa, the Horn of Africa, and parts of the Sahel show extensive evidence of MERS-CoV infection or exposure, yet PCR-confirmed human disease has rarely been reported from Africa. This "Africa paradox" is one of the most important unresolved issues in MERS-CoV epidemiology. We propose a dromedary camel-centred One Health framework for the connected Middle East-Africa dromedary belt. The framework is organised around two linked barriers: an upstream barrier that detects and reduces zoonotic spillover at the camel-human interface, and a downstream healthcare barrier that prevents amplification after human infection occurs. Preparedness should include sentinel surveillance for severe acute respiratory infection and atypical pneumonia in camel-exposed populations, linked animal-human genomic surveillance, culturally respectful and occupationally practical risk reduction, rapid diagnostic pathways, healthcare infection prevention and control, mass-gathering and travel preparedness, and pre-approved research platforms. A Middle East-Africa preparedness compact aligned with the International Health Regulations, One Health governance, and equitable pathogen access and benefit sharing could transform fragmented surveillance into a standing transregional system for early detection, prevention, and research-ready response.
Keywords: Africa paradox; Africa: evidence mapping; Compact; MERS-CoV; Middle East; One Health; dromedary camel; preparedness; prevention; research; response; spillover surveillance.