Epidemiology and evolution of Middle East respiratory syndrome coronavirus, 2012–2020

Infectious Diseases of Poverty

Ming-Jin Liu¹  Yang Yang¹  Kun Liu²  Wei Ma³  An-Ran Zhang⁴  Xin-Lou Li⁵  Guo-Ping Zhao⁶  Xiao-Ai Zhang⁷  Wen-Qiang Shi⁷  Wen-Hui Zhang⁷  Wei Liu⁷  Jin-Jin Chen⁷  Dong Miao⁷  Li-Qun Fang⁷ 

[1] Department of Biostatistics, College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA;Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi’an, People’s Republic of China;Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, People’s Republic of China;Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, People’s Republic of China;State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, 100071, Beijing, People’s Republic of China;Department of Biostatistics, College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA;Department of Medical Research, Key Laboratory of Environmental Sense Organ Stress and Health of the Ministry of Environmental Protection, PLA Stragetic Support Force Characteristic Medical Center, Beijing, People’s Republic of China;Logistics College of Chinese People’s Armed Police Forces, Tianjin, People’s Republic of China;State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, 100071, Beijing, People’s Republic of China;

关键词: Middle East respiratory syndrome;    MERS-CoV;    Case fatality rate;    Spatial diffusion;    Phylogeny;    Phylogeographic dynamic;   

DOI  :  10.1186/s40249-021-00853-0

来源: Springer

【 摘 要 】

BackgroundThe ongoing transmission of the Middle East respiratory syndrome coronavirus (MERS-CoV) in the Middle East and its expansion to other regions are raising concerns of a potential pandemic. An in-depth analysis about both population and molecular epidemiology of this pathogen is needed.MethodsMERS cases reported globally as of June 2020 were collected mainly from World Health Organization official reports, supplemented by other reliable sources. Determinants for case fatality and spatial diffusion of MERS were assessed with Logistic regressions and Cox proportional hazard models, respectively. Phylogenetic and phylogeographic analyses were performed to examine the evolution and migration history of MERS-CoV.ResultsA total of 2562 confirmed MERS cases with 150 case clusters were reported with a case fatality rate of 32.7% (95% CI: 30.9‒34.6%). Saudi Arabia accounted for 83.6% of the cases. Age of ≥ 65 years old, underlying conditions and ≥ 5 days delay in diagnosis were independent risk factors for death. However, a history of animal contact was associated with a higher risk (adjusted OR = 2.97, 95% CI: 1.10–7.98) among female cases < 65 years but with a lower risk (adjusted OR = 0.31, 95% CI: 0.18–0.51) among male cases ≥ 65 years old. Diffusion of the disease was fastest from its origin in Saudi Arabia to the east, and was primarily driven by the transportation network. The most recent sub-clade C5.1 (since 2013) was associated with non-synonymous mutations and a higher mortality rate. Phylogeographic analyses pointed to Riyadh of Saudi Arabia and Abu Dhabi of the United Arab Emirates as the hubs for both local and international spread of MERS-CoV.ConclusionsMERS-CoV remains primarily locally transmitted in the Middle East, with opportunistic exportation to other continents and a potential of causing transmission clusters of human cases. Animal contact is associated with a higher risk of death, but the association differs by age and sex. Transportation network is the leading driver for the spatial diffusion of the disease. These findings how this pathogen spread are helpful for targeting public health surveillance and interventions to control endemics and to prevent a potential pandemic.Graphical abstract

【 授权许可】

CC BY