A one health approach to the investigation and control of MERS-CoV among camel and human populations in Jordan as a potential model for the region

中东呼吸综合征冠状病毒(MERS-CoV)是一种新发传染病，于2012年在约旦和沙特阿拉伯首次发现。临床病例表现为急性呼吸道感染，并伴有迅速发病的肺炎，在许多病例中死亡。迄今为止，已有1800多例实验室确诊病例，其中643例死亡(截至2016年10月2日)，分布在27个国家。骆驼已被确定为人类感染的主要病毒宿主(尽管骆驼感染在很大程度上没有症状)，也发生了人与人之间的第二次传播。患有共病(既有疾病)的个人特别容易受到感染，大多数疫情发生在医院环境中。超过90%的确诊病例发生在沙特阿拉伯。目前在对MERS-CoV的了解方面存在关键知识空白--特别是从骆驼到人的疾病传播的性质--这一项目试图解决这一问题。通过确定骆驼传人的具体风险因素，该项目旨在制定控制措施，以减轻这些风险。这种控制措施必须在文化上适当，并与高危群体直接合作制定，以确保它们能够在基层得到有效实施。此外，该项目力求查明在理解MERS-CoV骆驼传人方面的关键知识差距，这些知识差距可构成今后的目标研究工作。该项目还试图通过约旦科技大学(JUST)将约旦确立为国际中东呼吸综合征冠状病毒研究、监测、培训和控制领域的区域领导者。考虑到这一点，该项目将采用‘同一健康’的方法来实现这些目标，利用来自不同领域的一些世界专家的专业知识，包括：兽医公共、人类公共卫生、流行病学、病毒学和人类学。该项目将由伦敦皇家兽医学院(RVC)协调，与伦敦卫生和热带医学院(LSHTM)、Just和美国国家卫生研究所建立战略合作伙伴关系。RVC与Just和美国国立卫生研究院合作进行的研究已经发现，约旦南部的骆驼中存在高水平的MERS冠状病毒感染。该项目的实地工作将包括对约旦南部的高危贝都因人社区进行随机抽样，收集血液样本、鼻拭子和痰样本，并收集问卷以评估感染的风险因素。此时还将进行例行健康检查。如果被选中的人是骆驼主人，将从这些骆驼身上收集鼻拭子。将分析所有收集的样本以寻找MERS冠状病毒感染的证据，然后将这些数据与从问卷中收集的数据结合起来，以确定MERS冠状病毒感染的风险因素。此外，还将进行一项人种学研究，以审查骆驼在贝都因阿拉伯社会中的作用，并了解如何最有效地实施可能控制中东呼吸综合征冠状病毒感染的方法。还将在高风险的贝都因社区中举办关于人畜共患(动物传人)感染风险的社区卫生讲习班，包括中东呼吸综合征冠状病毒，并就如何降低这些风险提供培训和建议。

Middle Eastern Respiratory Syndrome coronavirus (MERS-CoV) is an emerging infectious disease that was first identified in Jordan and Saudi Arabia in 2012. Clinical cases present as an acute respiratory infection with rapid onset pneumonia and in many cases death. To date there have been over 1800 laboratory confirmed cases, with 643 deaths (as 2nd October 2016) spanning 27 countries. Camels have been identified as the primary viral host reservoir for infection in humans (although infection in camels is largely asymptomatic) with secondary human-to-human transmission also occurring. Individuals with co-morbidities (pre-existing medical conditions) are at particular risk of infection, with the majority of outbreaks occurring in hospital settings. Over 90% of confirmed cases have been in Saudi Arabia.There are current key knowledge gaps in the understanding of MERS-CoV - particularly the nature of disease transmission from camels-to-humans - that this project seeks to address. Through identifying specific risk factors for camel-to-human transmission the project aims to develop control measures to mitigate these risks. Such control measures must be culturally appropriate and developed in direct collaboration with high risk groups, to ensure they can be effectively implemented at a grassroots level. In addition the project seeks to identify key knowledge gaps in the understanding of MERS-CoV camel-to-human transmission that can form the target research efforts in the future. The project also seeks to establish Jordan, through Jordan University of Science and Technology (JUST), as a regional leader in international MERS-CoV research, surveillance, training and control. With this in mind the project will adopt a 'One Health' approach to achieving these aims, drawing on the expertise of a number of world expert from various fields including; veterinary public, human public health, epidemiology, virology and anthropology. The project will be coordinated by the Royal Veterinary College (RVC), London, working in strategic partnership with the London School of Hygiene and Tropical Medicine (LSHTM), JUST and the US National Institute of Health. Studies already conducted by the RVC in partnership with JUST and US NIH have already identified high levels of MERS-CoV infection among camels in the south of Jordan.Project field work will involve random sampling of high risk Bedouin communities in the south of Jordan, collecting blood samples, nasal swabs and sputum samples alongside a questionnaire to assess risk factors for infection. A routine health check will also be performed at this time. Where selected individuals are camel owners nasal swabs will be collected from these camels. All samples collected will be analysed for evidence of MERS-CoV infection, and this data then combined with the data collected from the questionnaires in order to identify risk factors for MERS-CoV infection. In addition an ethnographic study will be conducted to examine the role of camels in Bedouin Arab society and understand how potential control methods for MERS-CoV exposure can most effectively be implemented. Community health workshops will also be run among high risk Bedouin communities regarding the risk of zoonotic (animal-to-human) infections, including MERS-CoV, and give training and advice on how to reduce these risk.