Thanks to Greg Folkers for sending the link to this report in the International Journal of Infectious Diseases: MERS CoV infection - ecological investigations. The abstract:
First discovered in the summer of 2012 in Saudi Arabia, the Middle Eastern Respiratory Syndrome (MERS) caused by the Middle Eastern Respiratory Syndrome Corona virus (MERS CoV) is an emerging infection that has, evoked fears of precipitating a worldwide pandemic. Till date, 163 laboratory confirmed cases have been reported in 9 countries worldwide with the vast majority (n = 132) of these cases of MERS CoV infection occurring in Saudi Arabia.
Spatially, most of the remaining cases have occurred in the Middle East. Cases (n = 12) from other than the Middle East (France, Germany, Italy, Tunisia, UK) have all been linked with recent travel to the region. However, much remains unknown about the reservoirs and transmission pathways of this virus.
Methods & Materials:
To better understand the transmission dynamics of MERS CoV, we carried out environmental assessment of laboratory confirmed cases of MERS CoV infection in Bisha, Qaseem, Hafr Batin and Ahsa regions of Saudi Arabia. We reviewed initial case investigation files of the case prior to interviewing them and/or their contacts (for cases that had died or were in ICU). Their houses and surrounding environment were investigated for possible environmental clues to MERS CoV transmission. This led us to caves, farms and abandoned buildings.
Contrary to the media frenzy about camels and MERS CoV transmission, rarely did any of the cases we investigated have exposure to camels. In the Ahsa outbreak in the Eastern region of Saudi Arabia, a large subset of the patients investigated were initially reported as having no animal exposure.
We observed the unrestricted mixing of wild and domestic animals in animal markets in a manner that could definitely facilitate repeated pathogen spillover and emergence. Additionally, some of these animals were overtly sick. Evidence for trading in bats was also documented. Wild animals were transported to the markets over large distances in questionable welfare conditions that may also encourage disease emergence.
Not only did our investigations reveal complex environmental exposures initially undocumented, our experience reinforces the need for rapid investigation of emerging zoonotic infections such as MERS while wholly incorporating the One Health paradigm.