Min Jae, Cella Eleonora, Ciccozzi Massimo, Pelosi Antonello, Salemi Marco, Prosperi Mattia
Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610-0231 USA.
Department of Infectious, Parasitic and Immune-mediated Diseases, National Institute of Health, Viale Regina Elena, 299, 00161 Rome, Italy.
Glob Health Res Policy. 2016 Sep 28;1:14. doi: 10.1186/s41256-016-0014-7. eCollection 2016.
Since its discovery in 2012, over 1700 confirmed cases of Middle East Respiratory Syndrome (MERS) have been documented worldwide and more than a third of those cases have died. While the greatest number of cases has occurred in Saudi Arabia, the recent export of MERS-coronavirus (MERS-CoV) to Republic of Korea showed that a pandemic is a possibility that cannot be ignored. Due to the deficit of knowledge in transmission methodology, targeted treatment and possible vaccines, understanding this virus should be a priority. Our aim was to combine epidemiological data from literature with genetic information from viruses sequenced around the world to present a phylodynamic picture of MERS spread molecular level to global scale.
We performed a qualitative meta-analysis of all laboratory confirmed cases worldwide to date based on literature, with emphasis on international transmission and healthcare associated infections. In parallel, we used publicly available MERS-CoV genomes from GenBank to create a phylogeographic tree, detailing geospatial timeline of viral evolution.
Several healthcare associated outbreaks starting with the retrospectively identified hospital outbreak in Jordan to the most recent outbreak in Riyadh, Saudi Arabia have occurred. MERS has also crossed many oceans, entering multiple nations in eight waves between 2012 and 2015. In this paper, the spatiotemporal history of MERS cases, as documented epidemiologically, was examined by Bayesian phylogenetic analysis. Distribution of sequences into geographic clusters and interleaving of MERS-CoV sequences from camels among those isolated from humans indicated that multiple zoonotic introductions occurred in endemic nations. We also report a summary of basic reproduction numbers for MERS-CoV in humans and camels.
Together, these analyses can help us identify factors associated with viral evolution and spread as well as establish efficacy of infection control measures. The results are especially pertinent to countries without current MERS-CoV endemic, since their unfamiliarity makes them particularly susceptible to uncontrollable spread of a virus that may be imported by travelers.
自2012年被发现以来，全球已记录了1700多例中东呼吸综合征（MERS）确诊病例，其中超过三分之一的病例死亡。虽然病例数最多的是沙特阿拉伯，但最近中东呼吸综合征冠状病毒（MERS-CoV）传播到韩国表明，大流行是一个不可忽视的可能性。由于在传播方法、靶向治疗和可能的疫苗方面知识不足，了解这种病毒应成为优先事项。我们的目的是将文献中的流行病学数据与世界各地测序病毒的基因信息相结合，以呈现MERS从分子水平到全球范围传播的系统发育动力学图景。
我们基于文献对迄今为止全球所有实验室确诊病例进行了定性荟萃分析，重点关注国际传播和医疗保健相关感染。同时，我们使用来自GenBank的公开可用MERS-CoV基因组创建了一个系统发育地理树，详细说明了病毒进化的地理空间时间线。
已经发生了几起与医疗保健相关的疫情，从约旦追溯确定的医院疫情开始，到沙特阿拉伯利雅得最近的疫情。MERS也跨越了许多海洋，在2012年至2015年期间分八波进入多个国家。在本文中，通过贝叶斯系统发育分析研究了流行病学记录的MERS病例的时空历史。序列分布到地理集群以及从骆驼中分离出的MERS-CoV序列与从人类中分离出的序列交织在一起，表明在流行国家发生了多次人畜共患病毒引入。我们还报告了MERS-CoV在人类和骆驼中的基本繁殖数摘要。
这些分析共同可以帮助我们识别与病毒进化和传播相关的因素，并确定感染控制措施的效果。这些结果对于目前没有MERS-CoV流行的国家尤其相关，因为它们的不熟悉使它们特别容易受到旅行者可能带入的病毒的无法控制的传播。
