MERS-CoV in the Middle East and Africa: from surveillance gaps in humans and dromedary camels to One Health frameworks for spillover, prevention, research and response preparedness.

Authors

Esam I Azhar, Manaf Alqahtani, Abdullah M Assiri, Seif S Al-Abri, Tieble Traore, Francine Ntoumi, Moses Bockarie, Eskild Petersen, Giuseppe Ippolito, David S Hui, Brian McCloskey, Stanley Perlman, Alimuddin Zumla

Published in

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. Pages 109046. Aug 15, 2026. Epub Aug 15, 2026.

Abstract

Middle East respiratory syndrome coronavirus (MERS-CoV) remains a low-incidence but high-consequence zoonotic coronavirus threat. Since its identification in Saudi Arabia in 2012, more than 2600 laboratory-confirmed cases have been reported from 27 countries, most from the Arabian Peninsula; the reported case fatality ratio is high but probably overestimates infection fatality because mild and asymptomatic infections are under-detected. Dromedary camels across the Middle East, North Africa, East Africa, the Horn of Africa, and parts of the Sahel show extensive evidence of MERS-CoV infection or exposure, yet PCR-confirmed human disease has rarely been reported from Africa. This "Africa paradox" is one of the most important unresolved issues in MERS-CoV epidemiology. We propose a dromedary camel-centred One Health framework for the connected Middle East-Africa dromedary belt. The framework is organised around two linked barriers: an upstream barrier that detects and reduces zoonotic spillover at the camel-human interface, and a downstream healthcare barrier that prevents amplification after human infection occurs. Preparedness should include sentinel surveillance for severe acute respiratory infection and atypical pneumonia in camel-exposed populations, linked animal-human genomic surveillance, culturally respectful and occupationally practical risk reduction, rapid diagnostic pathways, healthcare infection prevention and control, mass-gathering and travel preparedness, and pre-approved research platforms. A Middle East-Africa preparedness compact aligned with the International Health Regulations, One Health governance, and equitable pathogen access and benefit sharing could transform fragmented surveillance into a standing transregional system for early detection, prevention, and research-ready response.

PMID:
42603685
Bibliographic data and abstract were imported from PubMed on 16 Aug 2026.

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