Responding to the challenge of MERS-CoV: Development and testing of interventions to reduce risk among Bedouin populations in Southern Jordan

中东呼吸综合征冠状病毒（MERS-CoV）是最近发现的一种“新发传染病”，最早于2012年在约旦和沙特阿拉伯发现。临床病例可表现为突发性急性呼吸道感染，伴迅速发病的肺炎和死亡，但也会发生较轻的感染（在某些病例中根本没有任何症状）。自2012年首次暴发以来，已有近2500例确诊病例，其中三分之一以上的感染者随后死于该病（迄今已有848人）。27个国家报告了确诊病例，但大多数发生在阿拉伯半岛，其中沙特阿拉伯是疾病中心（占所有确诊病例的80%以上）。人类的初次感染是通过接触受感染的单峰骆驼（或骆驼产品）发生的，骆驼群体是病毒的宿主宿主，但骆驼感染只会引起轻微的症状，类似于普通感冒（可能根本没有症状）。一旦有人以这种方式受到感染，就可能发生病毒的二次人际传播（通常在医院环境中），并有可能引起大规模疫情，例如近年来在韩国和沙特阿拉伯发生的疫情。约旦处于当前中东危机中心的战略位置意味着它在该区域内的稳定具有全球意义。由于叙利亚、伊拉克和也门等国的冲突，大量流离失所者涌入约旦（占人口的30%以上），对约旦的国家疾病监测、应对和卫生保健服务提出了前所未有的要求，并增加了未来发生灾难性疾病暴发的风险，包括中东呼吸综合征冠状病毒。约旦与沙特阿拉伯之间漫长而疏于防范的边境线经常发生人员和牲畜流动（特别是在该国南部农村贝都因人之间），而且骆驼数量众多，这意味着中东呼吸综合征冠状病毒造成的风险仍然很高。世界卫生组织（世卫组织）已将中东呼吸综合征冠状病毒与埃博拉病毒、拉沙病毒和尼帕病毒等其他代表潜在全球威胁的“新发传染病”一起指定为研究与开发的蓝图重点疾病。用于骆驼和人类的中东呼吸综合征冠状病毒疫苗的开发已进入后期阶段，但目前缺乏有关该疾病流行病学和文化背景（这对有效部署疫苗至关重要）的知识。在过去，类似的知识缺乏曾推迟了其他疫苗的部署（例如，最近西非的拉沙病毒疫苗），因此，重要的是，未来中东呼吸综合征冠状病毒疫苗的部署不能因为同样的原因而推迟。因此，在高危人群中进行适当的研究至关重要。考虑到这一点，并在GRCF基金会奖成功研究结果的基础上，我们的目标是开展最先进的跨学科研究，以确定约旦南部高危贝都因人群中该疾病的生物学和社会文化背景。特别是，我们正在设法了解哪些个人或骆驼应该成为未来疫苗接种的目标，部署此类疫苗的正确季节以及导致感染的社会文化问题，在考虑包括疫苗接种在内的疾病潜在控制措施时，考虑这些社会文化问题至关重要。因此，通过这个项目，我们的目标是制定适当的、以社区为基础的行为干预措施，以减少这些社区的感染风险（并考虑疫苗在未来的潜在作用）。我们还致力于建设约旦开展战略研究、监测和控制活动的能力，以应对中东呼吸综合征冠状病毒（以及其他“新发传染病”）带来的挑战。

Middle Eastern Respiratory Syndrome coronavirus (MERS-CoV) is a recently identified 'emerging infectious disease' first seen in Jordan and Saudi Arabia in 2012. Clinical cases can present as a sudden acute respiratory infection, with rapid onset pneumonia and death, although milder infections also occur (in some cases without any symptoms at all). Since the initial outbreaks in 2012, there have been almost 2500 confirmed cases, with over a third of those infected subsequently dying from the disease (848 people to date).Confirmed cases have been reported across 27 countries, although the majority have been in the Arabian Peninsula, with Saudi Arabia the disease epicentre (over 80% of all confirmed cases). Primary infection in humans occurs through contact with infected dromedary camels (or camel products) and camel populations act as the host reservoir for the virus, however infection in camels causes only mild symptoms, similar to a common cold (and may cause no symptoms at all). Once someone becomes infected in this way secondary human-to-human transmission of the virus can then occur (often in a hospital setting) with the potential to cause large scale outbreaks such as those seen in South Korea and Saudi Arabia in recent years. Jordan's strategic location at the centre of current Middle Eastern crises means that its stability within the region is of global significance. Enormous influxes of displaced peoples into Jordan from the conflicts in Syria, Iraq and Yemen among others (accounting for over 30% of the population) have placed unprecedented demands on Jordan's national disease surveillance, response and health-care services and increased the risk of catastrophic disease outbreaks occurring in the future, including MERS-CoV. Jordan's long, porous border with Saudi Arabia, across which frequent movements of people and livestock occur (particularly among rural Bedouin populations in the south of the country) and large camel populations, mean that the risks posed by MERS-CoV remain high.The World Health Organization (WHO) have designated MERS-CoV to be a Blueprint Priority Disease for Research and Development, alongside other 'emerging infectious diseases' that represent a potential global threat, including Ebola, Lassa and Nipah viruses. The development of vaccines against MERS-CoV, for use in both camels and humans, is already at an advanced stage, however knowledge regarding the diseases epidemiology and cultural context (which are essential for effective vaccine deployment) is currently lacking. A similar lack of knowledge has delayed the deployment of other vaccines in the past (e.g. recently the Lassa virus vaccine in West Africa) and so it is important that deployment of future MERS-CoV vaccines is not delayed for the same reasons. It is crucial therefore that appropriate research be conducted among high-risk populations.With this in mind, and building on the findings of successful GRCF Foundation Award research, we aim to conduct state-of-the-art interdisciplinary research to determine the biological and sociocultural contexts of the disease among at-risk Bedouin populations in southern Jordan. In particular, we are seeking to understand which individuals, or camels, should be targeted for future vaccination, the correct seasons for the deployment of such vaccines and the sociocultural issues that are driving the infection, with consideration of these sociocultural issues vital when looking at potential control measures for the disease, including vaccination. Through this project we thus aim to develop appropriate, community based behavioural interventions that will reduce the risk of infection among these communities (as well as considering the potential role of vaccines in the future). We are also aiming to build Jordan's capacity for strategic research, surveillance and control activities to confront the challenge posed by MERS-CoV (as well as by other 'emerging infectious diseases').