Enzootic patterns of Middle East respiratory syndrome coronavirus in imported African and local Arabian dromedary camels: a prospective genomic study

Sherif A. El-Kafrawy, Victor M. Corman, Ahmed M. Tolah, Saad B. Al Masaudi, Ahmed M. Hassan, Marcel A. Müller, Tobias Bleicker, Steve M. Harakeh, Abdulrahman A. Alzahrani, Ghaleb A. Alsaaidi, Abdulaziz N. Alagili, Anwar M. Hashem, Alimuddin Zumla, Christian Drosten, Esam I. Azhar

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


Background: The Middle East respiratory syndrome coronavirus (MERS-CoV) is a lethal zoonotic pathogen endemic to the Arabian Peninsula. Dromedary camels are a likely source of infection and the virus probably originated in Africa. We studied the genetic diversity, geographical structure, infection prevalence, and age-associated prevalence among camels at the largest entry port of camels from Africa into the Arabian Peninsula. Methods: In this prospective genomic study, we took nasal samples from camels imported from Sudan and Djibouti into the Port of Jeddah in Jeddah, Saudi Arabia, over an almost 2-year period and local Arabian camels over 2 months in the year after surveillance of the port. We determined the prevalence of MERS-CoV infection, age-associated patterns of infection, and undertook phylogeographical and migration analyses to determine intercountry virus transmission after local lineage establishment. We compared all virological characteristics between the local and imported cohorts. We compared major gene deletions between African and Arabian strains of the virus. Reproductive numbers were inferred with Bayesian birth death skyline analyses. Findings: Between Aug 10, 2016, and May 3, 2018, we collected samples from 1196 imported camels, of which 868 originated from Sudan and 328 from Djibouti, and between May 1, and June 25, 2018, we collected samples from 472 local camels, of which 189 were from Riyadh and 283 were from Jeddah, Saudi Arabia. Virus prevalence was higher in local camels than in imported camels (224 [47·5%] of 472 vs 157 [13·1%] of 1196; p
Original languageEnglish (US)
Pages (from-to)e521-e528
Number of pages1
JournalThe Lancet Planetary Health
Issue number12
StatePublished - Dec 19 2019
Externally publishedYes

Bibliographical note

KAUST Repository Item: Exported on 2022-06-13
Acknowledgements: The work was supported by the German Ministry of Research and Education (grant number 01KI1723A) and the EU Horizon 2020 project Compare. EIA thanks the King Fahd Medical Research Center and the King Abdullah University of Science and Technology (KAUST) for support. AZ and CD are members of the Pan-African Network on Emerging and Re-emerging Infections and thank the European and Developing Countries Clinical Trials Partnership for support under EU Horizon 2020, the EU's Framework Programme for Research and Innovation. AZ has received a National Institutes of Health Research senior investigator award.
This publication acknowledges KAUST support, but has no KAUST affiliated authors.


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