The global spread of Middle East respiratory syndrome:an analysis fusing traditional epidemiological tracing and molecular phylodynamics  

作　　者：Jae Min Eleonora Cella Massimo Ciccozzi Antonello Pelosi Marco Salemi Mattia Prosperi 

机构地区：[1]Department of Epidemiology,College of Public Health&Health Professions and College of Medicine,University of Florida,2004 Mowry Rd,Gainesville,FL 32610-0231,USA [2]Department of Infectious,Parasitic and Immune-mediated Diseases,National Institute of Health,Viale Regina Elena,299,00161 Rome,Italy [3]Department of Public Health and Infectious Diseases,Sapienza University of Rome,Piazzale Aldo Moro,5,00185 Rome,Italy [4]Department of Pathology,Immunology and Laboratory Medicine,Emerging Pathogens Institute,University of Florida,2055 Mowry Rd,Gainesville,FL 32611,USA [5]Department of Clinical Pathology and Microbiology Laboratory,University of Biomedical Campus,Via Alvaro del Portillo,21,Rome,Italy

出　　处：《Global Health Research and Policy》2016年第1期116-129,共14页全球健康研究与政策（英文）

基　　金：supported by the Virogenesis project;funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No.634650.

摘　　要：Background: 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 ofcases has occurred in Saudi Arabia, the recent export of MERS-coronavirus (MERS-CoV) to Republic of Korea showedthat a pandemic is a possibility that cannot be ignored. Due to the deficit of knowledge in transmissionmethodology, targeted treatment and possible vaccines, understanding this virus should be a priority. Our aim wasto combine epidemiological data from literature with genetic information from viruses sequenced around theworld to present a phylodynamic picture of MERS spread molecular level to global scale.Methods: We performed a qualitative meta-analysis of all laboratory confirmed cases worldwide to date based onliterature, with emphasis on international transmission and healthcare associated infections. In parallel, we usedpublicly available MERS-CoV genomes from GenBank to create a phylogeographic tree, detailing geospatial timelineof viral evolution.Results: Several healthcare associated outbreaks starting with the retrospectively identified hospital outbreak inJordan 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 MERScases, as documented epidemiologically, was examined by Bayesian phylogenetic analysis. Distribution ofsequences into geographic clusters and interleaving of MERS-CoV sequences from camels among those isolatedfrom humans indicated that multiple zoonotic introductions occurred in endemic nations. We also report asummary of basic reproduction numbers for MERS-CoV in humans and camels.Conclusion: Together, these analyses can help us identify factors associated with viral evolution and spread as wellas establish efficacy of infection control measures. The results are especially pertinent to countries without currentM

关 键 词：Middle East Respiratory Syndrome CORONAVIRUS Epidemiology PHYLODYNAMICS 

分 类 号：R51[医药卫生—内科学]