Clinical Scorecard: MERS-CoV in the Middle East and Africa: Addressing Surveillance Deficiencies in Humans and Dromedary Camels Through One Health Approaches for Spillover Prevention, Research, and Preparedness

At a Glance

Key Highlights

• As of July 5, 2026, WHO had reported 2,637 laboratory-confirmed human MERS-CoV cases from 27 countries, including 965 deaths (36.6%).

• Recognized human infection ranges from asymptomatic or mild respiratory illness to severe pneumonia, acute respiratory distress syndrome, renal impairment, multiorgan failure, and death.

• The reported case-fatality proportion likely overestimates infection fatality because mild and asymptomatic infections are underdetected.

• Dromedary camels are the principal reservoir for repeated zoonotic transmission of MERS-CoV to humans.

• The “Africa paradox” refers to extensive evidence of MERS-CoV infection or exposure in African dromedaries despite very few PCR-confirmed human cases.

Guideline-Based Recommendations

Diagnosis

• The authors propose sentinel MERS-CoV testing for severe acute respiratory infection, atypical pneumonia, unexplained respiratory deterioration, and healthcare-associated respiratory clusters, particularly where camel exposure is common.

• Camel-exposure history should be incorporated into respiratory triage, and rapid MERS-CoV RT-PCR pathways should be available for suspected cases.

Management

• Healthcare preparedness should include rapid isolation, appropriate personal protective equipment, respiratory protection, contact tracing, healthcare-worker monitoring, environmental cleaning, and infection prevention and control measures.

• Clinical care remains supportive because no routinely deployed MERS-CoV-specific antiviral, monoclonal antibody, or licensed human vaccine is available for public-health use.

Monitoring & Follow-up

• Surveillance should link camel PCR and serology with human respiratory surveillance, occupational cohorts, outbreak investigation, genomic sequencing, and shared human–animal data.

• High-risk camel settings such as farms, markets, abattoirs, transport routes, and pastoralist systems should be included in ongoing surveillance.

Risks

• Recurrent zoonotic spillover from dromedary camels remains a continuing risk.

• Delayed recognition of human infection can permit healthcare-associated amplification and large outbreaks.

Patient & Prescribing Data

The review focuses on populations with potential MERS-CoV exposure, particularly people with occupational or other contact with dromedary camels and patients presenting with severe or atypical respiratory illness in camel-exposed regions.

No routinely deployed MERS-CoV-specific antiviral, monoclonal antibody, or licensed human vaccine is available for public-health use. Clinical care therefore remains supportive, while surveillance, early diagnosis, infection prevention and control, exposure reduction, contact tracing, and preparedness remain central public-health tools.

Clinical Best Practices

• Integrate human, animal, occupational, clinical, environmental, and genomic surveillance within a One Health framework.

• Record camel exposure when evaluating severe acute respiratory infection or atypical pneumonia in at-risk regions.

• Maintain rapid diagnostic and healthcare infection prevention and control pathways for suspected MERS-CoV.

• Strengthen reciprocal Middle Eastern and African leadership in surveillance, laboratory capacity, genomic analysis, research, data interpretation, and benefit sharing.

Related Resources & Content

• Zumla A, Hui DS, Perlman S. “Middle East respiratory syndrome.” The Lancet. 2015;386(9997):995–1007.

• Hui DS, Azhar EI, Kim YJ, Memish ZA, Oh MD, Zumla A. “Middle East respiratory syndrome coronavirus: risk factors and determinants of primary, household, and nosocomial transmission.” The Lancet Infectious Diseases. 2018;18(8):e217–e227.

• Sikkema RS, Farag EABA, Islam M, Atta M, Reusken CBEM, Al-Hajri MM, et al. “Global status of Middle East respiratory syndrome coronavirus in dromedary camels: a systematic review.” Epidemiology and Infection. 2019;147:e84.

• Azhar EI, Velavan TP, Rungsung I, Traore T, Hui DS, McCloskey B, et al. “Middle East respiratory syndrome coronavirus—a 10-year (2012–2022) global analysis of human and camel infections, genomic sequences, lineages, and geographical origins.” International Journal of Infectious Diseases. 2023;131:87–94.

• Arabi YM, Asiri AY, Assiri AM, Balkhy HH, Al Bshabshe A, Al Jeraisy M, et al. “Interferon beta-1b and lopinavir–ritonavir for Middle East respiratory syndrome.” New England Journal of Medicine. 2020;383:1645–1656.