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

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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.