High Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia.
High Prevalence of MERS-CoV Infection in Camel Workers in Saudi Arabia.
复制标题
沙特阿拉伯骆驼工人中中东呼吸综合征冠状病毒感染率很高
DOI：
10.1128/mbio.01985-18
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发表时间：
2018-10-30
期刊：
影响因子：
6.4
通讯作者：
Alagaili AN
中科院分区：
文献类型：
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作者：
Alshukairi AN;Zheng J;Zhao J;Nehdi A;Baharoon SA;Layqah L;Bokhari A;Al Johani SM;Samman N;Boudjelal M;Ten Eyck P;Al-Mozaini MA;Zhao J;Perlman S;Alagaili AN
中东呼吸综合征（MERS）是一种由冠状病毒（CoV）介导的呼吸道疾病。病毒传播发生在卫生保健机构内，但病例也零星出现在社区中。据信骆驼是社区获得性病例的来源，但大多数患者并未接触过骆驼。在这里，我们评估了接触骆驼鼻和口腔分泌物率高的骆驼工人（CWs）是否有MERS-CoV感染的证据。结果表明，很高比例的CWs病毒特异性免疫反应呈阳性，但没有明显的呼吸道疾病史。因此，中东呼吸综合征反复爆发的一个可能解释是，CWs发展为轻度或亚临床疾病。然后，这些CWs将病毒传播给未感染的个体，其中一些人极易感染，发展为严重疾病，并在社区中被发现为中东呼吸综合征的原发性病例。中东呼吸综合征（MERS）是一种由新型冠状病毒（MERS- cov）引起的高致死性呼吸道疾病，是一种具有高流行传播潜力的新兴疾病。它已被世界卫生组织和流行病防范创新联盟（CEPI）列为疫苗开发的重要目标。虽然最初大多数中东呼吸综合征病例是医院获得性的，但中东呼吸综合征的持续出现归因于社区获得性，骆驼可能是直接或间接来源。然而，大多数患者没有描述骆驼接触，使得传播途径不清楚。在这里，我们使用敏感的免疫学检测和一组有充分记录的骆驼暴露的骆驼工人（CWs），我们发现沙特阿拉伯王国（KSA）约50%的骆驼工人（CWs）和0%的对照者以前感染过。我们从30名骆驼牧民、卡车司机和有充分记录的骆驼接触者以及健康供体中获取了血液样本，并测量了mers - cov特异性酶联免疫吸附试验（ELISA）、免疫荧光试验（IFA）、中和抗体滴度以及T细胞反应。通过mers - cov特异性ELISA和/或中和抗体滴度检测，共有16/30名妇女和0/30名健康对照献血者血清呈阳性，另外4名妇女血清呈阴性，但血液中含有病毒特异性T细胞。虽然没有正式证明来自化学武器的病毒传播，但对中东呼吸综合征反复爆发的一种可能解释是，化学武器发展为轻度疾病，然后将病毒传播给未感染的个体。其中一些人的感染，例如那些有合并症的人，会导致严重的疾病，并出现中东呼吸综合征患者的发作性症状。中东呼吸综合征（MERS）是一种冠状病毒（CoV）介导的呼吸道疾病。病毒传播发生在卫生保健机构内，但病例也零星出现在社区中。据信骆驼是社区获得性病例的来源，但大多数患者并未接触过骆驼。在这里，我们评估了接触骆驼鼻和口腔分泌物率高的骆驼工人（CWs）是否有MERS-CoV感染的证据。结果表明，很高比例的CWs病毒特异性免疫反应呈阳性，但没有明显的呼吸道疾病史。因此，中东呼吸综合征反复爆发的一个可能解释是，CWs发展为轻度或亚临床疾病。然后，这些CWs将病毒传播给未感染的个体，其中一些人极易感染，发展为严重疾病，并在社区中被发现为中东呼吸综合征的原发性病例。
The Middle East respiratory syndrome (MERS) is a coronavirus (CoV)-mediated respiratory disease. Virus transmission occurs within health care settings, but cases also appear sporadically in the community. Camels are believed to be the source for community-acquired cases, but most patients do not have camel exposure. Here, we assessed whether camel workers (CWs) with high rates of exposure to camel nasal and oral secretions had evidence of MERS-CoV infection. The results indicate that a high percentage of CWs were positive for virus-specific immune responses but had no history of significant respiratory disease. Thus, a possible explanation for repeated MERS outbreaks is that CWs develop mild or subclinical disease. These CWs then transmit the virus to uninfected individuals, some of whom are highly susceptible, develop severe disease, and are detected as primary MERS cases in the community. ABSTRACT Middle East respiratory syndrome (MERS), a highly lethal respiratory disease caused by a novel coronavirus (MERS-CoV), is an emerging disease with high potential for epidemic spread. It has been listed by the WHO and the Coalition for Epidemic Preparedness Innovations (CEPI) as an important target for vaccine development. While initially the majority of MERS cases were hospital acquired, continued emergence of MERS is attributed to community acquisition, with camels likely being the direct or indirect source. However, the majority of patients do not describe camel exposure, making the route of transmission unclear. Here, using sensitive immunological assays and a cohort of camel workers (CWs) with well-documented camel exposure, we show that approximately 50% of camel workers (CWs) in the Kingdom of Saudi Arabia (KSA) and 0% of controls were previously infected. We obtained blood samples from 30 camel herders, truck drivers, and handlers with well-documented camel exposure and from healthy donors, and measured MERS-CoV-specific enzyme-linked immunosorbent assay (ELISA), immunofluorescence assay (IFA), and neutralizing antibody titers, as well as T cell responses. Totals of 16/30 CWs and 0/30 healthy control donors were seropositive by MERS-CoV-specific ELISA and/or neutralizing antibody titer, and an additional four CWs were seronegative but contained virus-specific T cells in their blood. Although virus transmission from CWs has not been formally demonstrated, a possible explanation for repeated MERS outbreaks is that CWs develop mild disease and then transmit the virus to uninfected individuals. Infection of some of these individuals, such as those with comorbidities, results in severe disease and in the episodic appearance of patients with MERS. IMPORTANCE The Middle East respiratory syndrome (MERS) is a coronavirus (CoV)-mediated respiratory disease. Virus transmission occurs within health care settings, but cases also appear sporadically in the community. Camels are believed to be the source for community-acquired cases, but most patients do not have camel exposure. Here, we assessed whether camel workers (CWs) with high rates of exposure to camel nasal and oral secretions had evidence of MERS-CoV infection. The results indicate that a high percentage of CWs were positive for virus-specific immune responses but had no history of significant respiratory disease. Thus, a possible explanation for repeated MERS outbreaks is that CWs develop mild or subclinical disease. These CWs then transmit the virus to uninfected individuals, some of whom are highly susceptible, develop severe disease, and are detected as primary MERS cases in the community.