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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
Journal article   Open access   Peer reviewed

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

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, …
International journal of infectious diseases, Vol.171, 109046
10/01/2026
DOI: 10.1016/j.ijid.2026.109046
PMID: 42603685
url
https://doi.org/10.1016/j.ijid.2026.109046View
Published (Version of record) Open Access

Abstract

•The Africa MERS-CoV camel-human paradox reveals key knowledge gaps.•A camel-human integrated approach can define and reduce MERS-CoV risk.•A One Health MERS-CoV global preparedness framework is overdue.•Two linked barriers approach strengthens MERS-CoV preparedness.•Integrated proactive spillover surveillance enables earlier detection.•A global MERS-CoV surveillance and research compact improves response readiness. 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.
 Middle East Africa paradox Africa: evidence mapping Compact dromedary camel MERS-CoV One Health preparedness prevention response spillover surveillance

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