Middle East Respiratory Syndrome Coronavirus - Annotated Bibliography Example

Human Geography: MERS-CoV virus Name: Tutor: Course: Date: Article 1: Occupational exposure to Dromedaries and risk for MERS-CoV infection, Qatar, 2013-2-14 (Reusken et al., 2015) Serum samples from persons with and without dromedary contact in Qatar were tested for MERS-CoV virus by determining the presence of neutralizing antibodies. The study area was confined to the following locations in Qatar; Doha, Dukhan (Western Qatar), Northern Qatar, and Al Shahaniya, as well as Netherlands and Germany. Measurement of the health outcome has been aggregated at two levels based on cohorts of (i) animal contact persons; slaughterhouse workers, central animal market workers, barn workers and camel farm workers. ii) Non-contact persons are; construction workers, sheep farmers and specificity controls. Explanatory variables: Zoonotic risk for MERS-CoV infection and presence of MERS-CoV antibodies. Zoonotic risk for MERS-CoV infection is located in the habitat where the animals are slaughtered while the presence of MERS-CoV antibodies was tested in population cohorts. The study findings showed that MERS-CoV neutralizing antibodies were detected in persons with daily contact with dromedaries and not those without contact. The study shows that habitats with continuous flow of dromedaries from different immune statuses and places of origin expose dromedary handlers to MERS-CoV infection. These places include barns, slaughterhouses and camel racing tracks. The authors justified the use of observation units based on exposure type by using both the experimental group (dromedary contact) and control group (No dromedary contact). This level of aggregation is not sensible as it did not include institutions, public health workers and physicians coming into contact with infected persons. These findings were a surprise given that most of the persons, especially slaughterers showed high evidence of MERS-CoV infection. Some earlier studies had indicated that actual MERS-CoV was less transmissible from camels to humans regardless of contact. I learned that rapid waning of antibodies can create short-lived antibody peak which may alter the results. Article 2: Risk factors for Primary Middle East Respiratory Syndrome Coronavirus Illness in Humans, Saudi Arabia, 2014 (Alraddadi et al., 2016). Laboratory-confirmed MERS-CoV cases were undertaken for persons falling under four clinical definitions; community-acquired pneumonia, healthcare-associated pneumonia, acute febrile and probable or confirmed MERS-CoV infection. This was between March 16 and November 13, 2014. The City or governorate of residence of persons covered in the study included the following locations in Saudi Arabia; Najran, Bishah, Riyadh, Al Baha, Makkh, Taif, Jeddah, Tabuk, Sakaka, Al Khobar, Wadi Al Dawasir, Al Hofuf and Hafar al Batin. Data for the observations were aggregated according to case-patients, level of exposure and the control group. Case-patients were observed based on age, gender, nationality, income, education and marital status. Exposure to health care settings, animal and food are attributed to both habitat and behavior while case-patient attributes such as age, sex and education appeal to the population effects. This study obtains that MERS-CoV illness is directly associated with contact with dromedaries 2 weeks before the onset of illness. However, MERS-CoV illness is not associated with exposure to sheep, horses, goats and bats. MERSCoV illness was prevalent in households with some members visiting or working on the farm where dromedaries are milked or slaughtered. Middle-aged men are more vulnerable to MERS-CoV infection than women. The authors did justify the use of experimental (case-patients) and the control group for animal related exposures and underlying health conditions and behaviors. This level of data aggregation makes sense as it attempts to differentiate MERS-CoV illness due to animal related exposures or contact with infected persons having symptoms of other infectious diseases. The study confirms the past knowledge of MERS-CoV infection that it is infectious especially in locations and habitats of dromedary camels. Moreover, zoonotic transmission of MERS-CoV is through human-dromedary interactions. I learned that the risk factor for MERS-CoV illness is provided by epidemiologic evidence of diabetes, smoking and heart diseases. Article 3: MERS-CoV geography and ecology in the Middle East: analyses of reported camel exposures and a preliminary risk map (Reeves, Samy & Peterson, 2015). The study investigated MERS-CoV infections and the interplay between camels and humans in being disease victims and reservoirs for further transmission. The extent of study area was limited to the following locations; Eastern Jordan, Saudi Arabia, Southern Iran, UAE and Northern Oman. Data was aggregated based on; persons with existing co-morbidities, healthcare workers, and exposed persons to domestic animals (camels). The following explanatory variables were used; bioclimatic set, age, sex, locality, level of exposure reporting, extent of contact with domestic animals and country. Bioclimatic set and country relates to habitat of dromedaries while age, sex and locality of the patients relate to the population characteristics. On the other hand, level of exposure reporting and extent of contact with domestic animals is attributed to the behavior of patients. The study found that MERS-CoV case-occurrence was more concentrated in Saudi Arabia. MERS-CoV cases reporting of exposure patterns are rather unreliable and uneven. Moreover, camel-to-human MERSCoV transmission is particularly likely in circumscribed portions of the Arabian Peninsula. Despite the restricted niche breadth in the camel-exposed models, MERS-CoV is transmitted from camels to humans. This study offers a detailed geographical sampling of MERS-CoV and confirms that it emanates from camel-human transmissions. I am not surprised that lead cases of the virus were dominant in Saudi Arabia. Again, the study did not find any evidence of bat or sheep transmissions of the virus across human populations. Article 4: Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study (Assiri et al., 2013). The study investigated 47 cases of MERS-CoV infections reported from Saudi Arabia between June 15, 2013 and Sept 1, 2012. The study area was limited to the following locations in Saudi Arabia; Asir province, Bishah, Jeddah, Taif, Waddi Addawasir, Al-Hasa, Eastern region, Riyadh, Al Qassim and Hafar Al Batin. The level of data aggregation were; healthcare workers, hospitals and patients. Specifically, 47 patients were screened of existing comorbidities and symptoms of MERS-CoV viral antibodies. The explanatory variables were divided into three; demographic factors, clinical features and laboratory results. The demographic features are located in the population while clinical features related to the habitat. On the other hand, laboratory results were associated with the behavior of patients during the investigation. The study found that hospital outbreak, as the case in Al-Hasa in 2012, led to transmission in two health-care facilities due to readmissions and transfer of patients. The findings show that case-fatality rates of MERS-CoV rose with increasing age. MERS-CoV cases reported had the largest number from Saudi Arabia. Person-to-person transmission is highly likely in MERSCoV infection. I was surprised to learn of the outbreak, in a Saudi Arabian hospital, of MERS-CoV virus and subsequent deaths were as a result of patients with serious respiratory diseases, diabetes and chronic renal diseases. These results confirm that MERS-CoV infection results from camel-human transmission and the rising mortality cases are due to the effect of comorbidities upon susceptibility. Question 3: Review of articles All the four articles agree that MERS-CoV infection is as a result of camel-human transmission. They hold that the most vulnerable part of the population is those persons in direct contact with the dromedary camels and their immediate family members. Moreover, the studies agree that there is limited evidence of MERS-CoV transmission in sheep, bats and other domestic animals. However, they differ of sample sizes and study area. For example, Assiri et al. (2013) and Reeves et al. (2015) agree that MERS-CoV has higher prevalence among middle aged men in Saudi Arabia while Alraddadi et al. (2016) and Reusken et al. (2015) observe that MERS-CoV is sporadic and more likely to be worsened by existing medical comorbidities. The articles converge towards a common understanding of MERS-CoV as being associated with milk and meat of dromedaries and have a long history in the Middle East. The investigation into the clinical illness caused by MERS-CoV offers deep insights into the laboratory epidemiological, clinical, and demographic characteristics of the virus and how to control its spread. The articles provide greatly to knowledge of clinical spectrum, community prevalence and epidemiology of infection which requires urgent definition. I learned that is fatal especially when infected persons have existing comorbidities such as diabetes, respiratory infections and chronic renal diseases. The focus of the articles is Middle East and response to the need for behavioral change, habitat review and certain population characteristics among the nomadic population and abattoirs in handling the risk factors of MERS-CoV virus. Question 4: Review of Triangle of Human Ecology The Triangle of Human Ecology from the perspective of the four articles shows that the population of country is susceptible given the behavior of people under certain habitats. With Saudi Arabia being a high risk country for MERS-CoV virus, it is probable that the diseases spread to the population. I have learned that MERS-CoV virus is transmitted to humans from camels when they come into contact. The triangle offers a broader understanding of the diseases since camel farmers, barn workers and slaughterers come into contact with camels at various stages. Most Saudi Arabian farmers keep camels and their social organization is hinged on camel and sheep. However, MERS-CoV is prevalent in milk and meat which is used by majority of the population in the Middle East. This is confirmed in the Triangle of Human Ecology that comprises of Population, Behavior and Habitat. The results show that the triangle can be amended to include ‘level of awareness’ as a factor that helps to break the transmission of MERS-CoV from ‘contact’ to ‘non-contact population. Nonetheless, I believe that the triangle forms the basic skeleton of MERS-CoV virus spread and control at the same time. For example, behavior change among the persons coming into contact with camels can limit MERS-CoV to a limited area and prevents it from affecting a larger part of the population. References Alraddadi, B.M. et al. (2016). Risk Factors for Primary Middle East Respiratory Syndrome Coronavirus Illness in Humans, Saudi Arabia, 2014. Emerging Infectious Diseases, 22(1): 49-55. Assiri, A. et al. (2013). Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus. The Lancet Infectious Diseases. Research Gate. Reeves, T., Samy, A.M. & Peterson, A.T. (2015). MERS-CoV geography and ecology in the Middle East: analyses of reported camel exposures and a preliminary risk map. BioMed Central Res Notes, 8(801): 2-7. Reusken, C.B. et al. (2015). Occupational Exposure to Dromedaries and Risk for MERS-CoV Infection, Qatar, 2013–2014. Emerging Infectious Diseases, 21(8): 1422-1425. Read More