Seroprevalence of MERS-CoV in healthy adults in western Saudi Arabia, 2011–2016
Identifieur interne : 000E55 ( Pmc/Corpus ); précédent : 000E54; suivant : 000E56Seroprevalence of MERS-CoV in healthy adults in western Saudi Arabia, 2011–2016
Auteurs : Afnan A. Degnah ; Sawsan S. Al-Amri ; Ahmed M. Hassan ; Abdulrahman S. Almasoud ; Manar Mousa ; Sarah A. Almahboub ; Rowa Y. Alhabbab ; Ahmed A. Mirza ; Salwa I. Hindawi ; Naif Khalaf Alharbi ; Esam I. Azhar ; Anwar M. HashemSource :
- Journal of Infection and Public Health [ 1876-0341 ] ; 2020.
Abstract
The Middle East respiratory syndrome coronavirus (MERS-CoV) is a newly recognized zoonotic coronavirus. Current evidence confirms the role of dromedaries in primary human infections but does not explain the sporadic community cases. However, asymptomatic or subclinical cases could represent a possible source of infection in the community.
Archived human sera (7461) collected between 2011 and 2016 from healthy adult blood donors from 50 different nationalities in the western part of Saudi Arabia were obtained for MERS-CoV seroprevalence investigation. Samples were tested for MERS-CoV S1-specific antibodies (Abs) by ELISA and confirmed by testing for neutralizing Abs (nAbs) using both pseudotyped and live virus neutralization assays.
Out of 7461 samples, 174 sera from individuals with 18 different nationalities were ELISA positive (2.3%, 95% CI 2.0–2.7). Presence of nAbs was confirmed in 17 samples (0.23%, 95% CI 0.1–0.4) of which one sample exhibited positivity in both neutralization assays. Confirmed seropositivity was identified in young (15–44 years) men and women from Saudi Arabia, Egypt, Yemen, Pakistan, Palestine, Sudan, and India without significant preference.
An increasing trend of MERS-CoV seroprevalence was observed in the general population in western Saudi Arabia, suggesting that asymptomatic or mild infections might exist and act as an unrecognized source of infection. Seropositivity of individuals from different nationalities underscores the potential MERS exportation outside of the Arabian Peninsula. Thus, enhanced and continuous surveillance is highly warranted.
Url:
DOI: 10.1016/j.jiph.2020.01.001
PubMed: 32005618
PubMed Central: 7104088
Links to Exploration step
PMC:7104088Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Seroprevalence of MERS-CoV in healthy adults in western Saudi Arabia, 2011–2016</title><author><name sortKey="Degnah, Afnan A" sort="Degnah, Afnan A" uniqKey="Degnah A" first="Afnan A." last="Degnah">Afnan A. Degnah</name><affiliation><nlm:aff id="aff0005">Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation><affiliation><nlm:aff id="aff0010">Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Al Amri, Sawsan S" sort="Al Amri, Sawsan S" uniqKey="Al Amri S" first="Sawsan S." last="Al-Amri">Sawsan S. Al-Amri</name><affiliation><nlm:aff id="aff0015">Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Hassan, Ahmed M" sort="Hassan, Ahmed M" uniqKey="Hassan A" first="Ahmed M." last="Hassan">Ahmed M. Hassan</name><affiliation><nlm:aff id="aff0005">Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Almasoud, Abdulrahman S" sort="Almasoud, Abdulrahman S" uniqKey="Almasoud A" first="Abdulrahman S." last="Almasoud">Abdulrahman S. Almasoud</name><affiliation><nlm:aff id="aff0020">Department of Infectious Disease Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Mousa, Manar" sort="Mousa, Manar" uniqKey="Mousa M" first="Manar" last="Mousa">Manar Mousa</name><affiliation><nlm:aff id="aff0025">Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Almahboub, Sarah A" sort="Almahboub, Sarah A" uniqKey="Almahboub S" first="Sarah A." last="Almahboub">Sarah A. Almahboub</name><affiliation><nlm:aff id="aff0015">Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Alhabbab, Rowa Y" sort="Alhabbab, Rowa Y" uniqKey="Alhabbab R" first="Rowa Y." last="Alhabbab">Rowa Y. Alhabbab</name><affiliation><nlm:aff id="aff0010">Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Mirza, Ahmed A" sort="Mirza, Ahmed A" uniqKey="Mirza A" first="Ahmed A." last="Mirza">Ahmed A. Mirza</name><affiliation><nlm:aff id="aff0010">Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Hindawi, Salwa I" sort="Hindawi, Salwa I" uniqKey="Hindawi S" first="Salwa I." last="Hindawi">Salwa I. Hindawi</name><affiliation><nlm:aff id="aff0030">Department of Hematology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Alharbi, Naif Khalaf" sort="Alharbi, Naif Khalaf" uniqKey="Alharbi N" first="Naif Khalaf" last="Alharbi">Naif Khalaf Alharbi</name><affiliation><nlm:aff id="aff0020">Department of Infectious Disease Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia</nlm:aff></affiliation><affiliation><nlm:aff id="aff0035">King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Azhar, Esam I" sort="Azhar, Esam I" uniqKey="Azhar E" first="Esam I." last="Azhar">Esam I. Azhar</name><affiliation><nlm:aff id="aff0005">Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation><affiliation><nlm:aff id="aff0010">Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Hashem, Anwar M" sort="Hashem, Anwar M" uniqKey="Hashem A" first="Anwar M." last="Hashem">Anwar M. Hashem</name><affiliation><nlm:aff id="aff0015">Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation><affiliation><nlm:aff id="aff0025">Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32005618</idno><idno type="pmc">7104088</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7104088</idno><idno type="RBID">PMC:7104088</idno><idno type="doi">10.1016/j.jiph.2020.01.001</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000E55</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000E55</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Seroprevalence of MERS-CoV in healthy adults in western Saudi Arabia, 2011–2016</title><author><name sortKey="Degnah, Afnan A" sort="Degnah, Afnan A" uniqKey="Degnah A" first="Afnan A." last="Degnah">Afnan A. Degnah</name><affiliation><nlm:aff id="aff0005">Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation><affiliation><nlm:aff id="aff0010">Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Al Amri, Sawsan S" sort="Al Amri, Sawsan S" uniqKey="Al Amri S" first="Sawsan S." last="Al-Amri">Sawsan S. Al-Amri</name><affiliation><nlm:aff id="aff0015">Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Hassan, Ahmed M" sort="Hassan, Ahmed M" uniqKey="Hassan A" first="Ahmed M." last="Hassan">Ahmed M. Hassan</name><affiliation><nlm:aff id="aff0005">Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Almasoud, Abdulrahman S" sort="Almasoud, Abdulrahman S" uniqKey="Almasoud A" first="Abdulrahman S." last="Almasoud">Abdulrahman S. Almasoud</name><affiliation><nlm:aff id="aff0020">Department of Infectious Disease Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Mousa, Manar" sort="Mousa, Manar" uniqKey="Mousa M" first="Manar" last="Mousa">Manar Mousa</name><affiliation><nlm:aff id="aff0025">Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Almahboub, Sarah A" sort="Almahboub, Sarah A" uniqKey="Almahboub S" first="Sarah A." last="Almahboub">Sarah A. Almahboub</name><affiliation><nlm:aff id="aff0015">Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Alhabbab, Rowa Y" sort="Alhabbab, Rowa Y" uniqKey="Alhabbab R" first="Rowa Y." last="Alhabbab">Rowa Y. Alhabbab</name><affiliation><nlm:aff id="aff0010">Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Mirza, Ahmed A" sort="Mirza, Ahmed A" uniqKey="Mirza A" first="Ahmed A." last="Mirza">Ahmed A. Mirza</name><affiliation><nlm:aff id="aff0010">Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Hindawi, Salwa I" sort="Hindawi, Salwa I" uniqKey="Hindawi S" first="Salwa I." last="Hindawi">Salwa I. Hindawi</name><affiliation><nlm:aff id="aff0030">Department of Hematology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Alharbi, Naif Khalaf" sort="Alharbi, Naif Khalaf" uniqKey="Alharbi N" first="Naif Khalaf" last="Alharbi">Naif Khalaf Alharbi</name><affiliation><nlm:aff id="aff0020">Department of Infectious Disease Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia</nlm:aff></affiliation><affiliation><nlm:aff id="aff0035">King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Azhar, Esam I" sort="Azhar, Esam I" uniqKey="Azhar E" first="Esam I." last="Azhar">Esam I. Azhar</name><affiliation><nlm:aff id="aff0005">Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation><affiliation><nlm:aff id="aff0010">Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Hashem, Anwar M" sort="Hashem, Anwar M" uniqKey="Hashem A" first="Anwar M." last="Hashem">Anwar M. Hashem</name><affiliation><nlm:aff id="aff0015">Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation><affiliation><nlm:aff id="aff0025">Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Infection and Public Health</title><idno type="ISSN">1876-0341</idno><idno type="eISSN">1876-035X</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The Middle East respiratory syndrome coronavirus (MERS-CoV) is a newly recognized zoonotic coronavirus. Current evidence confirms the role of dromedaries in primary human infections but does not explain the sporadic community cases. However, asymptomatic or subclinical cases could represent a possible source of infection in the community.</p></sec><sec><title>Methods</title><p>Archived human sera (7461) collected between 2011 and 2016 from healthy adult blood donors from 50 different nationalities in the western part of Saudi Arabia were obtained for MERS-CoV seroprevalence investigation. Samples were tested for MERS-CoV S1-specific antibodies (Abs) by ELISA and confirmed by testing for neutralizing Abs (nAbs) using both pseudotyped and live virus neutralization assays.</p></sec><sec><title>Results</title><p>Out of 7461 samples, 174 sera from individuals with 18 different nationalities were ELISA positive (2.3%, 95% CI 2.0–2.7). Presence of nAbs was confirmed in 17 samples (0.23%, 95% CI 0.1–0.4) of which one sample exhibited positivity in both neutralization assays. Confirmed seropositivity was identified in young (15–44 years) men and women from Saudi Arabia, Egypt, Yemen, Pakistan, Palestine, Sudan, and India without significant preference.</p></sec><sec><title>Conclusions</title><p>An increasing trend of MERS-CoV seroprevalence was observed in the general population in western Saudi Arabia, suggesting that asymptomatic or mild infections might exist and act as an unrecognized source of infection. Seropositivity of individuals from different nationalities underscores the potential MERS exportation outside of the Arabian Peninsula. Thus, enhanced and continuous surveillance is highly warranted.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Zaki, A M" uniqKey="Zaki A">A.M. Zaki</name></author><author><name sortKey="Van Boheemen, S" uniqKey="Van Boheemen S">S. van Boheemen</name></author><author><name sortKey="Bestebroer, T M" uniqKey="Bestebroer T">T.M. Bestebroer</name></author><author><name sortKey="Osterhaus, A D" uniqKey="Osterhaus A">A.D. Osterhaus</name></author><author><name sortKey="Fouchier, R A" uniqKey="Fouchier R">R.A. Fouchier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Al Abdallat, M M" uniqKey="Al Abdallat M">M.M. Al-Abdallat</name></author><author><name sortKey="Payne, D C" uniqKey="Payne D">D.C. Payne</name></author><author><name sortKey="Alqasrawi, S" uniqKey="Alqasrawi S">S. Alqasrawi</name></author><author><name sortKey="Rha, B" uniqKey="Rha B">B. Rha</name></author><author><name sortKey="Tohme, R A" uniqKey="Tohme R">R.A. Tohme</name></author><author><name sortKey="Abedi, G R" uniqKey="Abedi G">G.R. Abedi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Assiri, A" uniqKey="Assiri A">A. Assiri</name></author><author><name sortKey="Al Tawfiq, J A" uniqKey="Al Tawfiq J">J.A. Al-Tawfiq</name></author><author><name sortKey="Al Rabeeah, A A" uniqKey="Al Rabeeah A">A.A. Al-Rabeeah</name></author><author><name sortKey="Al Rabiah, F A" uniqKey="Al Rabiah F">F.A. Al-Rabiah</name></author><author><name sortKey="Al Hajjar, S" uniqKey="Al Hajjar S">S. Al-Hajjar</name></author><author><name sortKey="Al Barrak, A" uniqKey="Al Barrak A">A. Al-Barrak</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Song, Y J" uniqKey="Song Y">Y.J. Song</name></author><author><name sortKey="Yang, J S" uniqKey="Yang J">J.S. Yang</name></author><author><name sortKey="Yoon, H J" uniqKey="Yoon H">H.J. Yoon</name></author><author><name sortKey="Nam, H S" uniqKey="Nam H">H.S. Nam</name></author><author><name sortKey="Lee, S Y" uniqKey="Lee S">S.Y. Lee</name></author><author><name sortKey="Cheong, H K" uniqKey="Cheong H">H.K. Cheong</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Muller, M A" uniqKey="Muller M">M.A. Müller</name></author><author><name sortKey="Meyer, B" uniqKey="Meyer B">B. Meyer</name></author><author><name sortKey="Corman, V M" uniqKey="Corman V">V.M. Corman</name></author><author><name sortKey="Al Masri, M" uniqKey="Al Masri M">M. Al-Masri</name></author><author><name sortKey="Turkestani, A" uniqKey="Turkestani A">A. Turkestani</name></author><author><name sortKey="Ritz, D" uniqKey="Ritz D">D. Ritz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Al Hammadi, Z M" uniqKey="Al Hammadi Z">Z.M. Al Hammadi</name></author><author><name sortKey="Chu, D K" uniqKey="Chu D">D.K. Chu</name></author><author><name sortKey="Eltahir, Y M" uniqKey="Eltahir Y">Y.M. Eltahir</name></author><author><name sortKey="Al Hosani, F" uniqKey="Al Hosani F">F. Al Hosani</name></author><author><name sortKey="Al Mulla, M" uniqKey="Al Mulla M">M. Al Mulla</name></author><author><name sortKey="Tarnini, W" uniqKey="Tarnini W">W. Tarnini</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alagaili, A N" uniqKey="Alagaili A">A.N. Alagaili</name></author><author><name sortKey="Briese, T" uniqKey="Briese T">T. Briese</name></author><author><name sortKey="Mishra, N" uniqKey="Mishra N">N. Mishra</name></author><author><name sortKey="Kapoor, V" uniqKey="Kapoor V">V. Kapoor</name></author><author><name sortKey="Sameroff, S C" uniqKey="Sameroff S">S.C. Sameroff</name></author><author><name sortKey="Burbelo, P D" uniqKey="Burbelo P">P.D. Burbelo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Miguel, E" uniqKey="Miguel E">E. Miguel</name></author><author><name sortKey="Chevalier, V" uniqKey="Chevalier V">V. Chevalier</name></author><author><name sortKey="Ayelet, G" uniqKey="Ayelet G">G. Ayelet</name></author><author><name sortKey="Ben Bencheikh, M N" uniqKey="Ben Bencheikh M">M.N. Ben Bencheikh</name></author><author><name sortKey="Boussini, H" uniqKey="Boussini H">H. Boussini</name></author><author><name sortKey="Chu, D K" uniqKey="Chu D">D.K. Chu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Reusken, C B" uniqKey="Reusken C">C.B. Reusken</name></author><author><name sortKey="Ababneh, M" uniqKey="Ababneh M">M. Ababneh</name></author><author><name sortKey="Raj, V S" uniqKey="Raj V">V.S. Raj</name></author><author><name sortKey="Meyer, B" uniqKey="Meyer B">B. Meyer</name></author><author><name sortKey="Eljarah, A" uniqKey="Eljarah A">A. Eljarah</name></author><author><name sortKey="Abutarbush, S" uniqKey="Abutarbush S">S. Abutarbush</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Munyua, P" uniqKey="Munyua P">P. Munyua</name></author><author><name sortKey="Corman, V M" uniqKey="Corman V">V.M. Corman</name></author><author><name sortKey="Bitek, A" uniqKey="Bitek A">A. Bitek</name></author><author><name sortKey="Osoro, E" uniqKey="Osoro E">E. Osoro</name></author><author><name sortKey="Meyer, B" uniqKey="Meyer B">B. Meyer</name></author><author><name sortKey="Muller, M A" uniqKey="Muller M">M.A. Müller</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ommeh, S" uniqKey="Ommeh S">S. Ommeh</name></author><author><name sortKey="Zhang, W" uniqKey="Zhang W">W. Zhang</name></author><author><name sortKey="Zohaib, A" uniqKey="Zohaib A">A. Zohaib</name></author><author><name sortKey="Chen, J" uniqKey="Chen J">J. Chen</name></author><author><name sortKey="Zhang, H" uniqKey="Zhang H">H. Zhang</name></author><author><name sortKey="Hu, B" uniqKey="Hu B">B. Hu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zohaib, A" uniqKey="Zohaib A">A. Zohaib</name></author><author><name sortKey="Saqib, M" uniqKey="Saqib M">M. Saqib</name></author><author><name sortKey="Athar, M A" uniqKey="Athar M">M.A. Athar</name></author><author><name sortKey="Chen, J" uniqKey="Chen J">J. Chen</name></author><author><name sortKey="Sial, A U" uniqKey="Sial A">A.U. Sial</name></author><author><name sortKey="Khan, S" uniqKey="Khan S">S. Khan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="So, R T" uniqKey="So R">R.T. So</name></author><author><name sortKey="Perera, R A" uniqKey="Perera R">R.A. Perera</name></author><author><name sortKey="Oladipo, J O" uniqKey="Oladipo J">J.O. Oladipo</name></author><author><name sortKey="Chu, D K" uniqKey="Chu D">D.K. Chu</name></author><author><name sortKey="Kuranga, S A" uniqKey="Kuranga S">S.A. Kuranga</name></author><author><name sortKey="Chan, K H" uniqKey="Chan K">K.H. Chan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chu, D K" uniqKey="Chu D">D.K. Chu</name></author><author><name sortKey="Poon, L L" uniqKey="Poon L">L.L. Poon</name></author><author><name sortKey="Gomaa, M M" uniqKey="Gomaa M">M.M. Gomaa</name></author><author><name sortKey="Shehata, M M" uniqKey="Shehata M">M.M. Shehata</name></author><author><name sortKey="Perera, R A" uniqKey="Perera R">R.A. Perera</name></author><author><name sortKey="Abu Zeid, D" uniqKey="Abu Zeid D">D. Abu Zeid</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hemida, M G" uniqKey="Hemida M">M.G. Hemida</name></author><author><name sortKey="Al Naeem, A" uniqKey="Al Naeem A">A. Al-Naeem</name></author><author><name sortKey="Perera, R A P M" uniqKey="Perera R">R.A.P.M. Perera</name></author><author><name sortKey="Chin, A W H" uniqKey="Chin A">A.W.H. Chin</name></author><author><name sortKey="Poon, L L M" uniqKey="Poon L">L.L.M. Poon</name></author><author><name sortKey="Peiris, M" uniqKey="Peiris M">M. Peiris</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Perera, R A" uniqKey="Perera R">R.A. Perera</name></author><author><name sortKey="Wang, P" uniqKey="Wang P">P. Wang</name></author><author><name sortKey="Gomaa, M R" uniqKey="Gomaa M">M.R. Gomaa</name></author><author><name sortKey="El Shesheny, R" uniqKey="El Shesheny R">R. El-Shesheny</name></author><author><name sortKey="Kandeil, A" uniqKey="Kandeil A">A. Kandeil</name></author><author><name sortKey="Bagato, O" uniqKey="Bagato O">O. Bagato</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kandeil, A" uniqKey="Kandeil A">A. Kandeil</name></author><author><name sortKey="Gomaa, M" uniqKey="Gomaa M">M. Gomaa</name></author><author><name sortKey="Shehata, M" uniqKey="Shehata M">M. Shehata</name></author><author><name sortKey="El Taweel, A" uniqKey="El Taweel A">A. El-Taweel</name></author><author><name sortKey="Kayed, A E" uniqKey="Kayed A">A.E. Kayed</name></author><author><name sortKey="Abiadh, A" uniqKey="Abiadh A">A. Abiadh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Breban, R" uniqKey="Breban R">R. Breban</name></author><author><name sortKey="Riou, J" uniqKey="Riou J">J. Riou</name></author><author><name sortKey="Fontanet, A" uniqKey="Fontanet A">A. Fontanet</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cauchemez, S" uniqKey="Cauchemez S">S. Cauchemez</name></author><author><name sortKey="Fraser, C" uniqKey="Fraser C">C. Fraser</name></author><author><name sortKey="Van Kerkhove, M D" uniqKey="Van Kerkhove M">M.D. Van Kerkhove</name></author><author><name sortKey="Donnelly, C A" uniqKey="Donnelly C">C.A. Donnelly</name></author><author><name sortKey="Riley, S" uniqKey="Riley S">S. Riley</name></author><author><name sortKey="Rambaut, A" uniqKey="Rambaut A">A. Rambaut</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Zhao, J" uniqKey="Zhao J">J. Zhao</name></author><author><name sortKey="Alshukairi, A N" uniqKey="Alshukairi A">A.N. Alshukairi</name></author><author><name sortKey="Baharoon, S A" uniqKey="Baharoon S">S.A. Baharoon</name></author><author><name sortKey="Ahmed, W A" uniqKey="Ahmed W">W.A. Ahmed</name></author><author><name sortKey="Bokhari, A A" uniqKey="Bokhari A">A.A. Bokhari</name></author><author><name sortKey="Nehdi, A M" uniqKey="Nehdi A">A.M. Nehdi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alshukairi, A N" uniqKey="Alshukairi A">A.N. Alshukairi</name></author><author><name sortKey="Zheng, J" uniqKey="Zheng J">J. Zheng</name></author><author><name sortKey="Zhao, J" uniqKey="Zhao J">J. Zhao</name></author><author><name sortKey="Nehdi, A" uniqKey="Nehdi A">A. Nehdi</name></author><author><name sortKey="Baharoon, S A" uniqKey="Baharoon S">S.A. Baharoon</name></author><author><name sortKey="Layqah, L" uniqKey="Layqah L">L. Layqah</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, C J" uniqKey="Kim C">C.J. Kim</name></author><author><name sortKey="Choi, W S" uniqKey="Choi W">W.S. Choi</name></author><author><name sortKey="Jung, Y" uniqKey="Jung Y">Y. Jung</name></author><author><name sortKey="Kiem, S" uniqKey="Kiem S">S. Kiem</name></author><author><name sortKey="Seol, H Y" uniqKey="Seol H">H.Y. Seol</name></author><author><name sortKey="Woo, H J" uniqKey="Woo H">H.J. Woo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Khudhair, A" uniqKey="Khudhair A">A. Khudhair</name></author><author><name sortKey="Killerby, M E" uniqKey="Killerby M">M.E. Killerby</name></author><author><name sortKey="Al Mulla, M" uniqKey="Al Mulla M">M. Al Mulla</name></author><author><name sortKey="Abou Elkheir, K" uniqKey="Abou Elkheir K">K. Abou Elkheir</name></author><author><name sortKey="Ternanni, W" uniqKey="Ternanni W">W. Ternanni</name></author><author><name sortKey="Bandar, Z" uniqKey="Bandar Z">Z. Bandar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Reusken, C B" uniqKey="Reusken C">C.B. Reusken</name></author><author><name sortKey="Farag, E A" uniqKey="Farag E">E.A. Farag</name></author><author><name sortKey="Haagmans, B L" uniqKey="Haagmans B">B.L. Haagmans</name></author><author><name sortKey="Mohran, K A" uniqKey="Mohran K">K.A. Mohran</name></author><author><name sortKey="Godeke, G J" uniqKey="Godeke G">G.J. Godeke</name></author><author><name sortKey="Raj, S" uniqKey="Raj S">S. Raj</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gierer, S" uniqKey="Gierer S">S. Gierer</name></author><author><name sortKey="Hofmann Winkler, H" uniqKey="Hofmann Winkler H">H. Hofmann-Winkler</name></author><author><name sortKey="Albuali, W H" uniqKey="Albuali W">W.H. Albuali</name></author><author><name sortKey="Bertram, S" uniqKey="Bertram S">S. Bertram</name></author><author><name sortKey="Al Rubaish, A M" uniqKey="Al Rubaish A">A.M. Al-Rubaish</name></author><author><name sortKey="Yousef, A A" uniqKey="Yousef A">A.A. Yousef</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Aburizaiza, A S" uniqKey="Aburizaiza A">A.S. Aburizaiza</name></author><author><name sortKey="Mattes, F M" uniqKey="Mattes F">F.M. Mattes</name></author><author><name sortKey="Azhar, E I" uniqKey="Azhar E">E.I. Azhar</name></author><author><name sortKey="Hassan, A M" uniqKey="Hassan A">A.M. Hassan</name></author><author><name sortKey="Memish, Z A" uniqKey="Memish Z">Z.A. Memish</name></author><author><name sortKey="Muth, D" uniqKey="Muth D">D. Muth</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Memish, Z A" uniqKey="Memish Z">Z.A. Memish</name></author><author><name sortKey="Alsahly, A" uniqKey="Alsahly A">A. Alsahly</name></author><author><name sortKey="Masri, M A" uniqKey="Masri M">M.A. Masri</name></author><author><name sortKey="Heil, G L" uniqKey="Heil G">G.L. Heil</name></author><author><name sortKey="Anderson, B D" uniqKey="Anderson B">B.D. Anderson</name></author><author><name sortKey="Peiris, M" uniqKey="Peiris M">M. Peiris</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Al Kahlout, R A" uniqKey="Al Kahlout R">R.A. Al Kahlout</name></author><author><name sortKey="Nasrallah, G K" uniqKey="Nasrallah G">G.K. Nasrallah</name></author><author><name sortKey="Farag, E A" uniqKey="Farag E">E.A. Farag</name></author><author><name sortKey="Wang, L" uniqKey="Wang L">L. Wang</name></author><author><name sortKey="Lattwein, E" uniqKey="Lattwein E">E. Lattwein</name></author><author><name sortKey="Muller, M A" uniqKey="Muller M">M.A. Müller</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liljander, A" uniqKey="Liljander A">A. Liljander</name></author><author><name sortKey="Meyer, B" uniqKey="Meyer B">B. Meyer</name></author><author><name sortKey="Jores, J" uniqKey="Jores J">J. Jores</name></author><author><name sortKey="Muller, M A" uniqKey="Muller M">M.A. Müller</name></author><author><name sortKey="Lattwein, E" uniqKey="Lattwein E">E. Lattwein</name></author><author><name sortKey="Njeru, I" uniqKey="Njeru I">I. Njeru</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hashem, A M" uniqKey="Hashem A">A.M. Hashem</name></author><author><name sortKey="Al Amri, S S" uniqKey="Al Amri S">S.S. Al-Amri</name></author><author><name sortKey="Al Subhi, T L" uniqKey="Al Subhi T">T.L. Al-Subhi</name></author><author><name sortKey="Siddiq, L A" uniqKey="Siddiq L">L.A. Siddiq</name></author><author><name sortKey="Hassan, A M" uniqKey="Hassan A">A.M. Hassan</name></author><author><name sortKey="Alawi, M M" uniqKey="Alawi M">M.M. Alawi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Grehan, K" uniqKey="Grehan K">K. Grehan</name></author><author><name sortKey="Ferrara, F" uniqKey="Ferrara F">F. Ferrara</name></author><author><name sortKey="Temperton, N" uniqKey="Temperton N">N. Temperton</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hemida, M G" uniqKey="Hemida M">M.G. Hemida</name></author><author><name sortKey="Perera, R A" uniqKey="Perera R">R.A. Perera</name></author><author><name sortKey="Al Jassim, R A" uniqKey="Al Jassim R">R.A. Al Jassim</name></author><author><name sortKey="Kayali, G" uniqKey="Kayali G">G. Kayali</name></author><author><name sortKey="Siu, L Y" uniqKey="Siu L">L.Y. Siu</name></author><author><name sortKey="Wang, P" uniqKey="Wang P">P. Wang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Park, S W" uniqKey="Park S">S.W. Park</name></author><author><name sortKey="Perera, R A" uniqKey="Perera R">R.A. Perera</name></author><author><name sortKey="Choe, P G" uniqKey="Choe P">P.G. Choe</name></author><author><name sortKey="Lau, E H" uniqKey="Lau E">E.H. Lau</name></author><author><name sortKey="Choi, S J" uniqKey="Choi S">S.J. Choi</name></author><author><name sortKey="Chun, J Y" uniqKey="Chun J">J.Y. Chun</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Infect Public Health</journal-id><journal-id journal-id-type="iso-abbrev">J Infect Public Health</journal-id><journal-title-group><journal-title>Journal of Infection and Public Health</journal-title></journal-title-group><issn pub-type="ppub">1876-0341</issn><issn pub-type="epub">1876-035X</issn><publisher><publisher-name>Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32005618</article-id><article-id pub-id-type="pmc">7104088</article-id><article-id pub-id-type="publisher-id">S1876-0341(20)30001-0</article-id><article-id pub-id-type="doi">10.1016/j.jiph.2020.01.001</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Seroprevalence of MERS-CoV in healthy adults in western Saudi Arabia, 2011–2016</article-title></title-group><contrib-group><contrib contrib-type="author" id="aut0005"><name><surname>Degnah</surname><given-names>Afnan A.</given-names></name><xref rid="aff0005" ref-type="aff">a</xref><xref rid="aff0010" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="aut0010"><name><surname>Al-amri</surname><given-names>Sawsan S.</given-names></name><xref rid="aff0015" ref-type="aff">c</xref></contrib><contrib contrib-type="author" id="aut0015"><name><surname>Hassan</surname><given-names>Ahmed M.</given-names></name><xref rid="aff0005" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="aut0020"><name><surname>Almasoud</surname><given-names>Abdulrahman S.</given-names></name><xref rid="aff0020" ref-type="aff">d</xref></contrib><contrib contrib-type="author" id="aut0025"><name><surname>Mousa</surname><given-names>Manar</given-names></name><xref rid="aff0025" ref-type="aff">e</xref></contrib><contrib contrib-type="author" id="aut0030"><name><surname>Almahboub</surname><given-names>Sarah A.</given-names></name><xref rid="aff0015" ref-type="aff">c</xref></contrib><contrib contrib-type="author" id="aut0035"><name><surname>Alhabbab</surname><given-names>Rowa Y.</given-names></name><xref rid="aff0010" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="aut0040"><name><surname>Mirza</surname><given-names>Ahmed A.</given-names></name><xref rid="aff0010" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="aut0045"><name><surname>Hindawi</surname><given-names>Salwa I.</given-names></name><xref rid="aff0030" ref-type="aff">f</xref></contrib><contrib contrib-type="author" id="aut0050"><name><surname>Alharbi</surname><given-names>Naif Khalaf</given-names></name><xref rid="aff0020" ref-type="aff">d</xref><xref rid="aff0035" ref-type="aff">g</xref></contrib><contrib contrib-type="author" id="aut0055"><name><surname>Azhar</surname><given-names>Esam I.</given-names></name><email>eazhar@kau.edu.sa</email><xref rid="aff0005" ref-type="aff">a</xref><xref rid="aff0010" ref-type="aff">b</xref><xref rid="cor0010" ref-type="corresp">⁎⁎</xref></contrib><contrib contrib-type="author" id="aut0060"><name><surname>Hashem</surname><given-names>Anwar M.</given-names></name><email>amhashem@kau.edu.sa</email><xref rid="aff0015" ref-type="aff">c</xref><xref rid="aff0025" ref-type="aff">e</xref><xref rid="cor0005" ref-type="corresp">⁎</xref></contrib></contrib-group><aff id="aff0005"><label>a</label>Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia</aff><aff id="aff0010"><label>b</label>Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia</aff><aff id="aff0015"><label>c</label>Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia</aff><aff id="aff0020"><label>d</label>Department of Infectious Disease Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia</aff><aff id="aff0025"><label>e</label>Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia</aff><aff id="aff0030"><label>f</label>Department of Hematology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia</aff><aff id="aff0035"><label>g</label>King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia</aff><author-notes><corresp id="cor0005"><label>⁎</label>Corresponding author at: Faculty of Medicine and King Fahd Medical Research Center, King Abdulaziz University, P.O. Box 80205, Jeddah 21859, Saudi Arabia. <email>amhashem@kau.edu.sa</email></corresp><corresp id="cor0010"><label>⁎⁎</label>Corresponding author at: Faculty of Applied Medical Sciences and King Fahd Medical Research Center, King Abdulaziz University, P.O. Box 80205, Jeddah 21859, Saudi Arabia. <email>eazhar@kau.edu.sa</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>28</day><month>1</month><year>2020</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>28</day><month>1</month><year>2020</year></pub-date><elocation-id></elocation-id><history><date date-type="received"><day>27</day><month>9</month><year>2019</year></date><date date-type="rev-recd"><day>4</day><month>12</month><year>2019</year></date><date date-type="accepted"><day>15</day><month>1</month><year>2020</year></date></history><permissions><copyright-statement>© 2020 Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder></copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract id="abs0005"><sec><title>Background</title><p>The Middle East respiratory syndrome coronavirus (MERS-CoV) is a newly recognized zoonotic coronavirus. Current evidence confirms the role of dromedaries in primary human infections but does not explain the sporadic community cases. However, asymptomatic or subclinical cases could represent a possible source of infection in the community.</p></sec><sec><title>Methods</title><p>Archived human sera (7461) collected between 2011 and 2016 from healthy adult blood donors from 50 different nationalities in the western part of Saudi Arabia were obtained for MERS-CoV seroprevalence investigation. Samples were tested for MERS-CoV S1-specific antibodies (Abs) by ELISA and confirmed by testing for neutralizing Abs (nAbs) using both pseudotyped and live virus neutralization assays.</p></sec><sec><title>Results</title><p>Out of 7461 samples, 174 sera from individuals with 18 different nationalities were ELISA positive (2.3%, 95% CI 2.0–2.7). Presence of nAbs was confirmed in 17 samples (0.23%, 95% CI 0.1–0.4) of which one sample exhibited positivity in both neutralization assays. Confirmed seropositivity was identified in young (15–44 years) men and women from Saudi Arabia, Egypt, Yemen, Pakistan, Palestine, Sudan, and India without significant preference.</p></sec><sec><title>Conclusions</title><p>An increasing trend of MERS-CoV seroprevalence was observed in the general population in western Saudi Arabia, suggesting that asymptomatic or mild infections might exist and act as an unrecognized source of infection. Seropositivity of individuals from different nationalities underscores the potential MERS exportation outside of the Arabian Peninsula. Thus, enhanced and continuous surveillance is highly warranted.</p></sec></abstract><kwd-group id="kwd0005"><title>Keywords</title><kwd>MERS-CoV</kwd><kwd>Blood donors</kwd><kwd>Seroprevalence</kwd><kwd>Saudi Arabia</kwd></kwd-group></article-meta></front><body><sec id="sec0005"><title>Introduction</title><p id="par0005">The Middle East respiratory syndrome (MERS) is an emerging respiratory infection associated with a global public health concern. It is caused by a novel lineage C beta coronavirus that first emerged in 2012 in the Arabian Peninsula [<xref rid="bib0005" ref-type="bibr">1</xref>,<xref rid="bib0010" ref-type="bibr">2</xref>]. Typical MERS symptoms include fever, myalgia, cough, chest pain, and shortness of breath with pneumonia, gastrointestinal symptoms, multiple organs failure (MOF), and death being frequent in severe cases especially in the elderly and patients with comorbidities [<xref rid="bib0005" ref-type="bibr">[1]</xref>, <xref rid="bib0010" ref-type="bibr">[2]</xref>, <xref rid="bib0015" ref-type="bibr">[3]</xref>, <xref rid="bib0020" ref-type="bibr">[4]</xref>]. Nonetheless, mild and asymptomatic infections are clearly not uncommon [<xref rid="bib0020" ref-type="bibr">[4]</xref>, <xref rid="bib0025" ref-type="bibr">[5]</xref>, <xref rid="bib0030" ref-type="bibr">[6]</xref>].</p><p id="par0010">Dromedaries in Saudi Arabia and several other Middle Eastern and African countries are a major MERS-CoV reservoir [<xref rid="bib0035" ref-type="bibr">[7]</xref>, <xref rid="bib0040" ref-type="bibr">[8]</xref>, <xref rid="bib0045" ref-type="bibr">[9]</xref>, <xref rid="bib0050" ref-type="bibr">[10]</xref>, <xref rid="bib0055" ref-type="bibr">[11]</xref>, <xref rid="bib0060" ref-type="bibr">[12]</xref>, <xref rid="bib0065" ref-type="bibr">[13]</xref>, <xref rid="bib0070" ref-type="bibr">[14]</xref>, <xref rid="bib0075" ref-type="bibr">[15]</xref>]. While some studies have shown some seropositivity in common non-camelid livestock species such as sheep and goats suggesting a possible role of these animals in MERS-CoV transmission, especially when they are in contact with infected camels [<xref rid="bib0045" ref-type="bibr">9</xref>,<xref rid="bib0080" ref-type="bibr">16</xref>,<xref rid="bib0085" ref-type="bibr">17</xref>], further studies are required to confirm these findings. Therefore, current epidemiological data highly suggest that infected camels could be the main source of primary zoonotic human cases. However, many sporadic presumably primary cases reported no contact or exposure history with camels, and thus a clear epidemiological link of transmission is not well-established [<xref rid="bib0025" ref-type="bibr">5</xref>,<xref rid="bib0030" ref-type="bibr">6</xref>]. Furthermore, despite the fact that most secondary cases were due to human-to-human spread in household and/or healthcare settings [<xref rid="bib0010" ref-type="bibr">2</xref>,<xref rid="bib0015" ref-type="bibr">3</xref>], there is no evidence of sustained human-to-human transmission, and the virus does not seem to pass easily between humans [<xref rid="bib0090" ref-type="bibr">18</xref>,<xref rid="bib0095" ref-type="bibr">19</xref>].</p><p id="par0015">As of December 2019, more than 2499 laboratory-confirmed human cases have been reported from 27 countries with ∼35% mortality [<xref rid="bib0100" ref-type="bibr">20</xref>]. However, this seems to be an overestimation of the true mortality rate as mild and asymptomatic MERS cases might be missed during routine testing and can only be identified via enhanced molecular, serological, and immunological surveillance [<xref rid="bib0020" ref-type="bibr">[4]</xref>, <xref rid="bib0025" ref-type="bibr">[5]</xref>, <xref rid="bib0030" ref-type="bibr">[6]</xref>,<xref rid="bib0105" ref-type="bibr">21</xref>,<xref rid="bib0110" ref-type="bibr">22</xref>]. Such cases are usually more common among camel handlers as well as household individuals and/or healthcare workers who are in contact with MERS patients [<xref rid="bib0020" ref-type="bibr">4</xref>,<xref rid="bib0025" ref-type="bibr">5</xref>,<xref rid="bib0110" ref-type="bibr">[22]</xref>, <xref rid="bib0115" ref-type="bibr">[23]</xref>, <xref rid="bib0120" ref-type="bibr">[24]</xref>, <xref rid="bib0125" ref-type="bibr">[25]</xref>]. Furthermore, while few early small studies have reported no serological evidence of MERS-CoV in children, abattoir workers, veterinarians, animal handlers and even unexposed individuals in Saudi Arabia [<xref rid="bib0075" ref-type="bibr">15</xref>,<xref rid="bib0130" ref-type="bibr">[26]</xref>, <xref rid="bib0135" ref-type="bibr">[27]</xref>, <xref rid="bib0140" ref-type="bibr">[28]</xref>], at least one large cross-sectional study has revealed ∼0.15% seropositivity in the general Saudi population [<xref rid="bib0025" ref-type="bibr">5</xref>]. Similarly, a study from Qatar showed that 0.21% of the general population were seropositive by ELISA screening of 4719 blood donors however the presence of nAbs was only confirmed in one blood donor (0.02%) [<xref rid="bib0145" ref-type="bibr">29</xref>]. Interestingly, despite the high prevalence of MERS-CoV in camels from different countries such as Kenya, Nigeria, Egypt and Pakistan, confirmed evidence of MERS cases among humans is very limited in these countries except for two seropositive camel handlers in Kenya [<xref rid="bib0050" ref-type="bibr">[10]</xref>, <xref rid="bib0055" ref-type="bibr">[11]</xref>, <xref rid="bib0060" ref-type="bibr">[12]</xref>, <xref rid="bib0065" ref-type="bibr">[13]</xref>, <xref rid="bib0070" ref-type="bibr">[14]</xref>,<xref rid="bib0150" ref-type="bibr">30</xref>]. Such data clearly suggest that unknown asymptomatic and subclinical MERS infections or even unrecognized cases might in fact exist in the general population and could represent an underappreciated source of human-to-human transmission. Therefore, it is essential to conduct continuous and enhanced surveillance and epidemiological studies to determine MERS-CoV prevalence especially in endemic regions.</p><p id="par0020">Several serological methods have been proven to be valuable in MERS epidemiological studies where screening assays such as ELISA or immunofluorescence should be confirmed by neutralization assays for increased specificity. Here, we used validated recombinant S1-ELISA (rS1-ELISA) [<xref rid="bib0155" ref-type="bibr">31</xref>] combined with neutralization assays to investigate the seroprevalence rate of MERS-CoV in a large cohort of archived sera collected between 2011 and 2016 from healthy blood donors from 50 different nationalities residing in western Saudi Arabia. All samples that tested positive using the rS1-ELISA were confirmed by both MERS-pseudotyped and live virus neutralization assays, and cases that were positive in either neutralization assay were considered confirmed seropositive for MERS antibodies (Abs).</p></sec><sec id="sec0010"><title>Materials and methods</title><sec id="sec0015"><title>Clinical samples</title><p id="par0025">A total of 7461 archived sera collected from healthy blood donors older than 17 years between 2011 and 2016 were retrieved. Demographic data including sex, age and nationality were obtained. Ethical approval was obtained from the Unit of Biomedical Ethics in King Abdulaziz University Hospital. Before starting the study, all samples were anonymized using serial numbers.</p></sec><sec id="sec0020"><title>Cell line, virus and recombinant protein</title><p id="par0030">African Green monkey kidney-derived Vero E6 cells (ATCC #1568) were cultured and maintained in complete Dulbecco’s modified Eagle’s medium (DMEM). Human MERS-CoV/Hu/Taif/SA/2015 isolate was propagated and titrated in Vero E6 cells by tissue culture infection dose 50 (TCID<sub>50</sub>) assay.</p></sec><sec id="sec0025"><title>Recombinant S1-enzyme linked immunosorbent assay (rS1-ELISA)</title><p id="par0035">In-house indirect MERS-CoV S1 subunit protein based ELISA (rS1-ELISA) was used for the initial screening of MERS-CoV Abs in serum samples as previously described [<xref rid="bib0155" ref-type="bibr">31</xref>]. In brief, 1:400 diluted serum samples were incubated on blocked flat bottom microtiter plates (Thermo Scientific, Rochester, NY) coated with 2 μg/ml recombinant MERS-CoV S1 protein (SinoBiological, China) for 1 h at room temperature. Subsequently, 1:2000 diluted peroxidase-conjugated sheep anti-human IgG Abs (Amersham ECL, Pittsburgh, PA) were added, and colorimetric reaction was developed using tetramethylbenzidine (TMB) substrate. TMB BlueSTOP Solution (KPL, Gaithersburg, MD) was used to stop the reaction, and absorbance was read at 650 nm. All samples were tested in duplicates and samples with an optical density (OD) above the cut-off value of 0.26 were considered positive as previously described [<xref rid="bib0155" ref-type="bibr">31</xref>]. This cut-off value was predetermined as the average OD values of known negative serum samples +3 standard deviation (SD), and showed 100% sensitivity and 90% specificity as previously described [<xref rid="bib0155" ref-type="bibr">31</xref>].</p></sec><sec id="sec0030"><title>MERS-pseudotyped neutralization test (ppNT)</title><p id="par0040">MERS pseudotyped neutralization test (ppNT) was performed as described previously with minor modifications [<xref rid="bib0160" ref-type="bibr">32</xref>]. Heat-inactivated serum samples at 1:20 and 1:40 dilutions were co-incubated with a standard amount of the MERS pseudotyped viral particles (∼200,000 RLU) in the presence of Huh7.5 cells (∼10,000 cells) per well, and plates were incubated for 48 h at 37 °C. Cells only and cells with MERS pseudotyped (MERSpp) viral particles (with no serum) were included in quadruplicates as controls in all tested plates. Then, cells were lysed, and luciferase activity was measured using Bright-Glo™ Luciferase Assay System (Promega, Madison, WI) according to manufacturer’s instructions. Samples were tested in duplicates in two independent experiments, and samples were considered positive with ppNT titer of >20 upon 50% reduction of luciferase activity in all wells in the two experiments compared to cells with MERSpp viral particles control.</p></sec><sec id="sec0035"><title>Live virus microneutralization test (MNT)</title><p id="par0045">Live virus microneutralization assay was performed as previously described [<xref rid="bib0155" ref-type="bibr">31</xref>]. Briefly, serially diluted (2-fold) heat-inactivated rS1-ELISA positive serum samples were co-incubated with equal DMEM volume containing 100 TCID<sub>50</sub> of MERS-CoV and tested in quadruplicates to determine the highest dilution that inhibits cytopathic effect (CPE) in confluent Vero E6 cells. Virus control and cell only control were always included in each plate. Neutralizing Ab (nAb) titers were expressed as the reciprocal of the highest dilution of each serum sample that completely prevented CPE in all wells, and MN<sub>100</sub> titer of ≥ 1:10 dilution was considered positive. Samples were tested twice independently.</p></sec><sec id="sec0040"><title>Statistical analysis</title><p id="par0050">Yates corrected two-tail Chi² (χ²) test, Fisher’s exact tests, and 95% Mid-P Exact confidence limits (95% Cls) were calculated using OpenEpi (Open Source Epidemiologic Statistics for Public Health).</p></sec></sec><sec id="sec0045"><title>Results</title><p id="par0055">Between 2011 and 2016, 7461 archived sera from healthy blood donors were obtained to evaluate the burden of MERS-CoV in the western region of Saudi Arabia. Specifically, 90, 1360, 999, and 5012 archived serum samples were retrieved from the years 2011, 2012, 2013, and 2016, respectively. Demographic data were available for 6658 individuals (89.2%) of the total archived samples (<xref rid="tbl0005" ref-type="table">Table 1</xref>). The mean age of the tested individuals with available demographic information was 30.8 ± 8.5 years (median age 30 years, range 17–65 years including 6183 males (92.9%) and 475 females (7.1%). The mean age was 31.3 ± 8.4 years for males (median age 30 years, range 17–65 years), and 25 ± 7.6 years for females (median age 22 years, range 17–59 years). Tested samples were from individuals from 50 different countries (<xref rid="fig0005" ref-type="fig">Fig. 1</xref>) in which Saudis represented the majority (3273, 43.9%) followed by Yemenis (1310, 17.5%) and Egyptians (372, 5.0%).<table-wrap position="float" id="tbl0005"><label>Table 1</label><caption><p>Socio-demographic characteristics of tested blood donors.<xref rid="tblfn0005" ref-type="table-fn">a</xref></p></caption><alt-text id="at0015">Table 1</alt-text><table frame="hsides" rules="groups"><thead><tr><th align="left">Characteristic</th><th align="left">Categories</th><th align="left">n (%)</th></tr></thead><tbody><tr><td align="left">Sex</td><td align="left">Male</td><td align="left">6183 (92.9)</td></tr><tr><td align="left"></td><td align="left">Female</td><td align="left">475 (7.1)</td></tr><tr><td align="left">Age group (years)</td><td align="left">15–24</td><td align="left">1743 (26.2)</td></tr><tr><td align="left"></td><td align="left">25–34</td><td align="left">2916 (43.8)</td></tr><tr><td align="left"></td><td align="left">35–44</td><td align="left">1486 (22.3)</td></tr><tr><td align="left"></td><td align="left">45–54</td><td align="left">448 (6.7)</td></tr><tr><td align="left"></td><td align="left"><bold>≥</bold>55</td><td align="left">65 (1.0)</td></tr><tr><td align="left">Nationality</td><td align="left">Saudi</td><td align="left">3273 (49.2)</td></tr><tr><td align="left"></td><td align="left">Non-Saudi</td><td align="left">3385 (50.8)</td></tr><tr><td align="left">Total</td><td align="left"></td><td align="left">6658</td></tr></tbody></table><table-wrap-foot><fn id="tblfn0005"><label>a</label><p id="npar0005">Socio-demographic data were only available for 6658 samples (89.2%) out of the 7461 tested archived serum samples.</p></fn></table-wrap-foot></table-wrap><fig id="fig0005"><label>Fig. 1</label><caption><p>Demographic information of tested individuals based on country of origin. Asterisks indicate mean age of subjects from each country.</p></caption><alt-text id="at0005">Fig. 1</alt-text><graphic xlink:href="gr1_lrg"></graphic></fig></p><p id="par0060">Out of the 7461 tested serum samples, 174 samples (2.3%, 95% CI 2.0–2.7) were found positive for anti-MERS binding IgG Abs with OD values above the cut-off value. While 1.1% (1/90) in 2011 and 0.7% (10/1360) in 2012 of the samples were positive for MERS-CoV IgG, higher seroprevalence of 1.5% (15/999) and 3.0% (148/5012) were observed in 2013 and 2016, respectively, suggesting possible increase in seropositivity in the general population in the western region of Saudi Arabia (<xref rid="tbl0010" ref-type="table">Table 2</xref>). To confirm MERS seropositivity, samples were subjected to ppNT and MNT assays and samples that are positive in either test were considered confirmed positive. Out of the 174 rS1-ELISA positive sera, 9.8% (i.e. 17 specimens, 0.23%, 95% CI 0.1–0.4) were confirmed to have nAbs (<xref rid="fig0010" ref-type="fig">Fig. 2</xref>and <xref rid="tbl0010" ref-type="table">Table 2</xref>). All these confirmed positive samples were obtained in 2016 in which only one sample was positive in both ppNT and MNT assays with a MNT<sub>100</sub> titer of 20 (<xref rid="tbl0010" ref-type="table">Table 2</xref>). Notably, testing a large number of rS1-ELISA negative samples by these confirmatory assays showed no false negative results further confirming the validity of our in-house developed indirect rS1-ELISA with a 100% sensitivity and even higher specificity (97.9%) compared to our previous report [<xref rid="bib0155" ref-type="bibr">31</xref>].<table-wrap position="float" id="tbl0010"><label>Table 2</label><caption><p>Seroprevalence of MERS-CoV in blood donors based on year of collection.</p></caption><alt-text id="at0020">Table 2</alt-text><table frame="hsides" rules="groups"><thead><tr><th align="left"></th><th align="left">Total samples</th><th align="left">rS1-ELISA positive</th><th align="left">ppNT<sub>50</sub> positive</th><th align="left">MNT<sub>100</sub> positive</th></tr><tr><th align="left">Year</th><th align="left">n (%)</th><th align="left">n (%) (95% CI)</th><th align="left">n (%) (95% CI)</th><th align="left">n (%) (95% CI)</th></tr></thead><tbody><tr><td align="left">2011</td><td align="left">90 (1.2)</td><td align="left">1 (1.1) (0.1–5.4)</td><td align="left">0 (0.0) (0.0–3.3)</td><td align="left">0 (0.0) (0.0–3.3)</td></tr><tr><td align="left">2012</td><td align="left">1360 (18.2)</td><td align="left">10 (0.7) (0.4–1.3)</td><td align="left">0 (0.0) (0.0–0.2)</td><td align="left">0 (0.0) (0.0–0.2)</td></tr><tr><td align="left">2013</td><td align="left">999 (13.4)</td><td align="left">15 (1.5) (0.9–2.4)</td><td align="left">0 (0.0) (0.0–0.3)</td><td align="left">0 (0.0) (0.0–0.3)</td></tr><tr><td align="left">2016</td><td align="left">5012 (67.2)</td><td align="left">148 (3.0) (2.5–3.4)</td><td align="left">17 (0.3) (0.2–0.5)</td><td align="left">1 (0.0) (0.0–0.1)</td></tr><tr><td align="left">Total</td><td align="left">7461</td><td align="left">174 (2.3) (2.0–2.7)</td><td align="left">17 (0.2) (0.1–0.4)</td><td align="left">1 (0.0) (0.0–0.1)</td></tr></tbody></table></table-wrap><fig id="fig0010"><label>Fig. 2</label><caption><p>Overall seroprevalence result of samples for the period between 2011–2016. 174 positive samples with OD value above the cut-off in rS1-ELISA. Only 17 samples were confirmed to have nAbs by either ppNT or MNT assays from 2016, and are shown in red. Dotted black line indicates the cut-off of the rS1-ELISA.</p></caption><alt-text id="at0010">Fig. 2</alt-text><graphic xlink:href="gr2_lrg"></graphic></fig></p><p id="par0065">Cases were confirmed in individuals between the age of 15–44 years with highest rate in the 25–34 age group, however there was no statistical differences between the groups (<xref rid="tbl0015" ref-type="table">Table 3</xref>). Based on confirmed cases, no significant difference was observed between men (16 [0.26%] of 6183 and women 1 [0.21%] of 475) using Fisher’s exact test. Furthermore, confirmed seropositivity was identified in individuals from Saudi Arabia, Egypt, Yemen, Pakistan, Palestine, Sudan, and India without significant preference (<xref rid="tbl0020" ref-type="table">Table 4</xref>). While proportion of confirmed infected cases was higher in this study (0.23%) compared to the previously reported 0.00% rate in a cohort from the western region of Saudi Arabia in 2013 from a nation-wide study [<xref rid="bib0025" ref-type="bibr">5</xref>], we observed no statistical differences between the examined cohorts (<xref rid="tbl0025" ref-type="table">Table 5</xref>). Data summary of positive cases are shown in Supplementary data.<table-wrap position="float" id="tbl0015"><label>Table 3</label><caption><p>Seroprevalence of MERS-CoV in blood donors based on age group.</p></caption><alt-text id="at0025">Table 3</alt-text><table frame="hsides" rules="groups"><thead><tr><th align="left"></th><th align="left">Total samples</th><th align="left">rS1-ELISA positive</th><th align="left">ppNT<sub>50</sub> positive</th><th align="left">MNT<sub>100</sub> positive</th></tr><tr><th align="left">Age group</th><th align="left">n (%)</th><th align="left">n (%) (95% CI)</th><th align="left">n (%) (95% CI)</th><th align="left">n (%) (95% CI)</th></tr></thead><tbody><tr><td align="left">15–24</td><td align="left">1743 (23.4)</td><td align="left">46 (2.6) (2.0–3.5)</td><td align="left">1 (0.1) (0.0–0.3)</td><td align="left">0 (0.0) (0.0–0.2)</td></tr><tr><td align="left">25–34</td><td align="left">2916 (39.1)</td><td align="left">72 (2.5) (2.0–3.1)</td><td align="left">11 (0.4) (0.2–0.7)</td><td align="left">1 (0.0) (0.0–0.2)</td></tr><tr><td align="left">35–44</td><td align="left">1486 (19.9)</td><td align="left">32 (2.2) (1.5–3.0)</td><td align="left">5 (0.3) (0.1–0.7)</td><td align="left">0 (0.0) (0.0–0.2)</td></tr><tr><td align="left">45–54</td><td align="left">448 (6.0)</td><td align="left">7 (1.6) (0.7–3.1)</td><td align="left">0 (0.0) (0.0–0.7)</td><td align="left">0 (0.0) (0.0–0.7)</td></tr><tr><td align="left">≥55</td><td align="left">65 (0.9)</td><td align="left">5 (7.7) (2.9–16.2)</td><td align="left">0 (0.0) (0.0–0.5)</td><td align="left">0 (0.0) (0.0–0.5)</td></tr><tr><td align="left">Unknown<xref rid="tblfn0010" ref-type="table-fn">a</xref></td><td align="left">803 (10.8)</td><td align="left">12 (0.5) (0.8–2.5)</td><td align="left">0 (0.0) (0.0–0.4)</td><td align="left">0 (0.0) (0.0–0.4)</td></tr><tr><td align="left">Total</td><td align="left">7461</td><td align="left">174 (2.3) (2.0–2.7)</td><td align="left">17 (0.2) (0.1–0.4)</td><td align="left">1 (0.0) (0.0–0.1)</td></tr></tbody></table><table-wrap-foot><fn id="tblfn0010"><label>a</label><p id="npar0010">Individuals with unknown age information.</p></fn></table-wrap-foot></table-wrap><table-wrap position="float" id="tbl0020"><label>Table 4</label><caption><p>Seropositivity based on country of origin.</p></caption><alt-text id="at0030">Table 4</alt-text><table frame="hsides" rules="groups"><thead><tr><th align="left"></th><th align="left">Total samples</th><th align="left">rS1-ELISA positive</th><th align="left">Confirmed cases</th></tr><tr><th align="left">Country</th><th align="left">n (%)</th><th align="left">n (%) (95% CI)</th><th align="left">n (%) (95% CI)</th></tr></thead><tbody><tr><td align="left">Saudi Arabia</td><td align="left">3273 (43.9)</td><td align="left">83 (2.5; 2.0–3.1)</td><td align="left">9 (0.3) (0.1–0.5)</td></tr><tr><td align="left">Yemen</td><td align="left">1310 (17.5)</td><td align="left">32 (2.4) (1.7–3.4)</td><td align="left">3 (0.2) (0.1–0.6)</td></tr><tr><td align="left">Egypt</td><td align="left">372 (5.0)</td><td align="left">8 (2.2) (1.0–4.1)</td><td align="left">1 (0.3) (0.0–1.3)</td></tr><tr><td align="left">Pakistan</td><td align="left">306 (4.1)</td><td align="left">8 (2.6) (1.2–4.9)</td><td align="left">1 (0.3) (0.0–1.6)</td></tr><tr><td align="left">Palestine</td><td align="left">251 (3.4)</td><td align="left">4 (1.6) (0.5–3.8)</td><td align="left">1 (0.4) (0.0–1.9)</td></tr><tr><td align="left">Syria</td><td align="left">183 (2.5)</td><td align="left">2 (1.1) (0.2–3.5)</td><td align="left">0 (0.0) (0.0–1.6)</td></tr><tr><td align="left">Sudan</td><td align="left">158 (2.1)</td><td align="left">5 (3.2) (1.2–6.8)</td><td align="left">1 (0.6) (0.0–3.1)</td></tr><tr><td align="left">India</td><td align="left">106 (1.4)</td><td align="left">6 (5.7) (2.3–11.4)</td><td align="left">1 (0.9) (0.0–4.6)</td></tr><tr><td align="left">Jordan</td><td align="left">79 (1.1)</td><td align="left">3 (3.8) (1.0–9.9)</td><td align="left">0 (0.0) (0.0–3.7)</td></tr><tr><td align="left">Myanmar</td><td align="left">75 (1.0)</td><td align="left">1 (1.3) (0.1–6.4)</td><td align="left">0 (0.0) (0.0–3.9)</td></tr><tr><td align="left">Bangladesh</td><td align="left">57 (0.8)</td><td align="left">1 (1.8) (0.1–8.3)</td><td align="left">0 (0.0) (0.0–5.1)</td></tr><tr><td align="left">Eritrea</td><td align="left">55 (0.8)</td><td align="left">2 (3.6; 0.6–11.5)</td><td align="left">0 (0.0) (0.0–5.3)</td></tr><tr><td align="left">Chad</td><td align="left">38 (0.7)</td><td align="left">2 (5.3) (0.9–16.3)</td><td align="left">0 (0.0) (0.0–7.6)</td></tr><tr><td align="left">Afghanistan</td><td align="left">37 (0.5)</td><td align="left">1 (2.7) (0.1–12.6)</td><td align="left">0 (0.0) (0.0–7.8)</td></tr><tr><td align="left">Nigeria</td><td align="left">14 (0.2)</td><td align="left">1 (7.1) (0.4–32.5)</td><td align="left">0 (0.0) (0.0–20.6)</td></tr><tr><td align="left">Mali</td><td align="left">8 (0.1)</td><td align="left">1 (12.5) (0.6–48.0)</td><td align="left">0 (0.0) (0.0–31.2)</td></tr><tr><td align="left">UAE</td><td align="left">2 (0.0)</td><td align="left">1 (50.0) (2.5–97.5)</td><td align="left">0 (0.0) (0.0–77.6)</td></tr><tr><td align="left">USA</td><td align="left">1 (0.0)</td><td align="left">1 (100) (5–100)</td><td align="left">0 (0.0) (0.0–95.0)</td></tr><tr><td align="left">Other countries<xref rid="tblfn0015" ref-type="table-fn">a</xref></td><td align="left">333 (4.5)</td><td align="left">0 (0.0) (0.0–0.9)</td><td align="left">0 (0.0) (0.0–0.9)</td></tr><tr><td align="left">Unknown<xref rid="tblfn0020" ref-type="table-fn">b</xref></td><td align="left">803 (10.8)</td><td align="left">12 (0.5) (0.8–2.5)</td><td align="left">0 (0.0) (0.0–0.4)</td></tr><tr><td align="left">Total</td><td align="left">7461</td><td align="left">174 (2.3) (2.0–2.7)</td><td align="left">17 (0.2) (0.1–0.4)</td></tr></tbody></table><table-wrap-foot><fn id="tblfn0015"><label>a</label><p id="npar0015">Countries where no individuals had seropositivity in rS1-ELISA screening assay.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tblfn0020"><label>b</label><p id="npar0020">Individuals with unknown country of origin.</p></fn></table-wrap-foot></table-wrap><table-wrap position="float" id="tbl0025"><label>Table 5</label><caption><p>MERS-CoV Abs in the general population of the western region of Saudi Arabia vs the whole country.</p></caption><alt-text id="at0035">Table 5</alt-text><table frame="hsides" rules="groups"><thead><tr><th align="left"></th><th align="left">Total number</th><th colspan="2" align="left">rS1-ELISA positive<hr></hr></th><th colspan="2" align="left">Confirmed positive<hr></hr></th></tr><tr><th align="left">Study</th><th align="left"></th><th align="left">n (%; 95% CI)</th><th align="left">Chi<sup>2</sup> test<xref rid="tblfn0025" ref-type="table-fn">a</xref></th><th align="left">n (%; 95% CI)</th><th align="left">Chi<sup>2</sup> test<xref rid="tblfn0025" ref-type="table-fn">a</xref></th></tr></thead><tbody><tr><td align="left">Western region<xref rid="tblfn0030" ref-type="table-fn">b</xref></td><td align="left">7461</td><td align="left">174 (2.3) (2.0–2.7)</td><td align="left">–</td><td align="left">17 (0.2) (0.1–0.4)</td><td align="left">–</td></tr><tr><td align="left">Western region<xref rid="tblfn0035" ref-type="table-fn">c</xref></td><td align="left">1513</td><td align="left">19 (1.3) (0.8–1.9)</td><td align="left"><italic>P</italic> = 0.0113</td><td align="left">0 (0.0) (0.0–0.2)</td><td align="left"><italic>P</italic> = 0.1250</td></tr><tr><td align="left">Nation-wide<xref rid="tblfn0035" ref-type="table-fn">c</xref></td><td align="left">10009</td><td align="left">152 (1.5) (1.3–1.8)</td><td align="left"><italic>P</italic> = 0.0001</td><td align="left">15 (0.2) (0.1–0.2)</td><td align="left"><italic>P</italic> = 0.3128</td></tr></tbody></table><table-wrap-foot><fn id="tblfn0025"><label>a</label><p id="npar0025">Yates corrected Chi<sup>2</sup> test of positive cases in each cohort vs cases this study.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tblfn0030"><label>b</label><p id="npar0030">This study.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tblfn0035"><label>c</label><p id="npar0035">Results from Ref. [<xref rid="bib0025" ref-type="bibr">5</xref>] on samples from 2013.</p></fn></table-wrap-foot></table-wrap></p></sec><sec id="sec0050"><title>Discussion</title><p id="par0070">MERS-CoV is reminiscent of the severe acute respiratory syndrome-coronavirus (SARS-CoV) which emerged in 2002, and thus has a potential to spread globally as seen in 2015 in South Korea. Several epidemiological studies have proven MERS-CoV endemicity in dromedaries, which can be in close contact with humans in the Arabian Peninsula and Africa. While contact with MERS-CoV shedding camels could be the main cause of primary cases in the Arabian Peninsula, such transmission cannot explain all laboratory confirmed infections in humans. Thus, it was proposed that asymptomatic or mild cases in the general population could act as an unrecognized source of infection in these endemic regions [<xref rid="bib0020" ref-type="bibr">[4]</xref>, <xref rid="bib0025" ref-type="bibr">[5]</xref>, <xref rid="bib0030" ref-type="bibr">[6]</xref>,<xref rid="bib0110" ref-type="bibr">22</xref>]. Nonetheless, only limited number of reports have investigated MERS-CoV seroprevalence in the general populations especially in endemic regions [<xref rid="bib0025" ref-type="bibr">5</xref>,<xref rid="bib0125" ref-type="bibr">25</xref>,<xref rid="bib0145" ref-type="bibr">29</xref>]. Therefore, active and enhanced surveillance is pivotal in order to better understand the true burden of MERS-CoV.</p><p id="par0075">In the present study, we investigated MERS-CoV seroprevalence in archived human sera collected in the western region of Saudi Arabia. These samples were collected from healthy individuals from 50 different nationalities who donated blood at a major tertiary hospital between 2011 and 2016. Our data showed an evidence of MERS-CoV S1-specific binding Abs in 2.3% of the tested cohort (174/7461) in which seroprevalence increased over the years. Interestingly, binding Abs were detected in individuals from 18 different countries, suggesting that such individuals could be responsible for MERS-CoV exportation outside the Arabian Peninsula. Consistent with previous reports [<xref rid="bib0020" ref-type="bibr">4</xref>,<xref rid="bib0025" ref-type="bibr">5</xref>,<xref rid="bib0145" ref-type="bibr">29</xref>], nAbs were only confirmed in 9.8% of these rS1-ELISA positive serum samples (17/174) obtained mostly from Saudi men and resulting in a confirmed seroprevalence of 0.23% in the general population in the western region of Saudi Arabia. This confirmed seroprevalence is higher than the previously reported rates in the general Saudi population (0.15%) as well as the population in the western region of the country (0.00%) in 2013, although no statistical significances were observed between the two studies.</p><p id="par0080">It is important to note that the possibility of asymptomatic or mild infections in the remaining non-confirmed rS1-ELISA 157 individuals cannot be overlooked. This is mostly because of the high specificity of ppNT and MNT assays [<xref rid="bib0080" ref-type="bibr">16</xref>,<xref rid="bib0165" ref-type="bibr">33</xref>] that could result in reduced sensitivity in the testing algorithm as well as the high sensitivity of rS1-ELISA (at least 10-fold more sensitive) and so could actually be detecting S1-binding but non-neutralizing Abs. Furthermore, while cross-reactive low-affinity IgG against other coronaviruses cannot be completely excluded in ELISA [<xref rid="bib0145" ref-type="bibr">29</xref>], MERS-CoV S1 has low homology and cross-reactivity with S1 subunit from other known coronaviruses [<xref rid="bib0165" ref-type="bibr">33</xref>,<xref rid="bib0170" ref-type="bibr">34</xref>]. Thus, it could be postulated that some of these young and healthy individuals between the age of 15–44 years might have been indeed exposed to MERS-CoV but only suffered from subclinical infections and mounted transient and weak nAb responses that might wane quickly resulting in false negative results by neutralization assays. This is partially true as it was recently demonstrated that not all individuals with history of MERS infection including high-risk groups could elicit detectable nAbs [<xref rid="bib0105" ref-type="bibr">21</xref>,<xref rid="bib0110" ref-type="bibr">22</xref>]. Another possibility is that antigenically diverse MERS-CoV strains are circulating and thus not all binding Abs are cross-neutralizing. Therefore, prospective seroepidemiological studies should combine serological and immunological methods in order to determine the actual disease burden caused by asymptomatic or subclinical cases acting as an unidentified intermediate source for virus transmission in the population.</p><p id="par0085">By simple comparison to the previously published nation-wide seroprevalence study in Saudi Arabia [<xref rid="bib0025" ref-type="bibr">5</xref>], it is clear that the seroprevalence of S1-binding Abs from the 2013 cohort in this current study (1.5%; 95% CI 0.9–2.4) is comparable to that reported by Müller et al. in the cohort collected from the same region in 2013 (1.3%; 95% CI 0.8–1.9) in which no nAbs were detected in both reports. Nonetheless, we observed higher overall rate of confirmed seropositivity (0.23; 95% CI 0.1–0.4) compared to the previously reported nation-wide seroprevalence rate (0.15; 95% CI 0.1–0.2) in which cases seem to increase over the years [<xref rid="bib0025" ref-type="bibr">5</xref>]. Similarly, extrapolation of our results also indicates that there could be around 19,000 seropositive individuals out of the total population of 8,325,304 in the western region alone in 2016. Such number is of huge concern especially that this region hosts one of the largest mass gathering events (Hajj and Umrah), where the continuous travel of people and movement of livestock to and from the western part of Saudi Arabia could represent a possible way for MERS-CoV infection and exportation by human-to-human or zoonotic transmission.</p></sec><sec id="sec0055"><title>Summary</title><p id="par0090">Screening of 7461 serum samples collected from healthy blood donors from 50 different nationalities residing in western Saudi Arabia showed an increased seropositivity rate (0.23%) in young and healthy individuals aged between 15–44 years from 7 different countries.</p></sec><sec id="sec0060"><title>Contributors</title><p id="par0095">AAD did the laboratory tests, analyzed data, and generated figures. SSA, AMHass, and MM did the laboratory tests and coordinated sample collection and data retrieval. AA did the laboratory tests. SA and RYA searched the published work. AAM analyzed data. SIH arranged sample collection and data retrieval. NKA did the laboratory tests and analyzed data. EIA organized and supervised sample logistics and the study. AMHash designed and coordinated the study, searched the published work, wrote the manuscript, analyzed data, and generated figures. All authors revised and approved the final version of the manuscript.</p></sec><sec id="sec0065"><title>Funding</title><p id="par0100">This work was supported by <funding-source id="gs0005">King Abdulaziz City for Science and Technology</funding-source> (KACST), Riyadh, Saudi Arabia [grant number 09-1 to A.M.H.].</p></sec><sec id="sec0070"><title>Competing interest</title><p id="par0105">None declared. The sponsors had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.</p></sec></body><back><ref-list id="bibl0005"><title>References</title><ref id="bib0005"><label>1</label><element-citation publication-type="journal" id="sbref0005"><person-group person-group-type="author"><name><surname>Zaki</surname><given-names>A.M.</given-names></name><name><surname>van Boheemen</surname><given-names>S.</given-names></name><name><surname>Bestebroer</surname><given-names>T.M.</given-names></name><name><surname>Osterhaus</surname><given-names>A.D.</given-names></name><name><surname>Fouchier</surname><given-names>R.A.</given-names></name></person-group><article-title>Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia</article-title><source>N Engl J Med</source><volume>367</volume><year>2012</year><fpage>1814</fpage><lpage>1820</lpage><pub-id pub-id-type="pmid">23075143</pub-id></element-citation></ref><ref id="bib0010"><label>2</label><element-citation publication-type="journal" id="sbref0010"><person-group person-group-type="author"><name><surname>Al-Abdallat</surname><given-names>M.M.</given-names></name><name><surname>Payne</surname><given-names>D.C.</given-names></name><name><surname>Alqasrawi</surname><given-names>S.</given-names></name><name><surname>Rha</surname><given-names>B.</given-names></name><name><surname>Tohme</surname><given-names>R.A.</given-names></name><name><surname>Abedi</surname><given-names>G.R.</given-names></name></person-group><article-title>Hospital-associated outbreak of Middle East respiratory syndrome coronavirus: a serologic, epidemiologic, and clinical description</article-title><source>Clin Infect Dis</source><volume>59</volume><year>2014</year><fpage>1225</fpage><lpage>1233</lpage><pub-id pub-id-type="pmid">24829216</pub-id></element-citation></ref><ref id="bib0015"><label>3</label><element-citation publication-type="journal" id="sbref0015"><person-group person-group-type="author"><name><surname>Assiri</surname><given-names>A.</given-names></name><name><surname>Al-Tawfiq</surname><given-names>J.A.</given-names></name><name><surname>Al-Rabeeah</surname><given-names>A.A.</given-names></name><name><surname>Al-Rabiah</surname><given-names>F.A.</given-names></name><name><surname>Al-Hajjar</surname><given-names>S.</given-names></name><name><surname>Al-Barrak</surname><given-names>A.</given-names></name></person-group><article-title>Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study</article-title><source>Lancet Infect Dis</source><volume>13</volume><year>2013</year><fpage>752</fpage><lpage>761</lpage><pub-id pub-id-type="pmid">23891402</pub-id></element-citation></ref><ref id="bib0020"><label>4</label><element-citation publication-type="journal" id="sbref0020"><person-group person-group-type="author"><name><surname>Song</surname><given-names>Y.J.</given-names></name><name><surname>Yang</surname><given-names>J.S.</given-names></name><name><surname>Yoon</surname><given-names>H.J.</given-names></name><name><surname>Nam</surname><given-names>H.S.</given-names></name><name><surname>Lee</surname><given-names>S.Y.</given-names></name><name><surname>Cheong</surname><given-names>H.K.</given-names></name></person-group><article-title>Asymptomatic Middle East respiratory syndrome coronavirus infection using a serologic survey in Korea</article-title><source>Epidemiol Health</source><volume>40</volume><year>2018</year><fpage>e2018014</fpage><pub-id pub-id-type="pmid">29656631</pub-id></element-citation></ref><ref id="bib0025"><label>5</label><element-citation publication-type="journal" id="sbref0025"><person-group person-group-type="author"><name><surname>Müller</surname><given-names>M.A.</given-names></name><name><surname>Meyer</surname><given-names>B.</given-names></name><name><surname>Corman</surname><given-names>V.M.</given-names></name><name><surname>Al-Masri</surname><given-names>M.</given-names></name><name><surname>Turkestani</surname><given-names>A.</given-names></name><name><surname>Ritz</surname><given-names>D.</given-names></name></person-group><article-title>Presence of Middle East respiratory syndrome coronavirus antibodies in Saudi Arabia: a nationwide, cross-sectional, serological study</article-title><source>Lancet Infect Dis</source><volume>15</volume><year>2015</year><fpage>559</fpage><lpage>564</lpage><pub-id pub-id-type="pmid">25863564</pub-id></element-citation></ref><ref id="bib0030"><label>6</label><element-citation publication-type="journal" id="sbref0030"><person-group person-group-type="author"><name><surname>Al Hammadi</surname><given-names>Z.M.</given-names></name><name><surname>Chu</surname><given-names>D.K.</given-names></name><name><surname>Eltahir</surname><given-names>Y.M.</given-names></name><name><surname>Al Hosani</surname><given-names>F.</given-names></name><name><surname>Al Mulla</surname><given-names>M.</given-names></name><name><surname>Tarnini</surname><given-names>W.</given-names></name></person-group><article-title>Asymptomatic MERS-CoV infection in humans possibly linked to infected dromedaries imported from Oman to United Arab Emirates, May 2015</article-title><source>Emerg Infect Dis</source><volume>21</volume><year>2015</year><fpage>2197</fpage><lpage>2200</lpage><pub-id pub-id-type="pmid">26584223</pub-id></element-citation></ref><ref id="bib0035"><label>7</label><element-citation publication-type="journal" id="sbref0035"><person-group person-group-type="author"><name><surname>Alagaili</surname><given-names>A.N.</given-names></name><name><surname>Briese</surname><given-names>T.</given-names></name><name><surname>Mishra</surname><given-names>N.</given-names></name><name><surname>Kapoor</surname><given-names>V.</given-names></name><name><surname>Sameroff</surname><given-names>S.C.</given-names></name><name><surname>Burbelo</surname><given-names>P.D.</given-names></name></person-group><article-title>Middle East respiratory syndrome coronavirus infection in dromedary camels in Saudi Arabia</article-title><source>mBio</source><volume>5</volume><year>2014</year><fpage>e00884</fpage><lpage>14</lpage><pub-id pub-id-type="pmid">24570370</pub-id></element-citation></ref><ref id="bib0040"><label>8</label><element-citation publication-type="journal" id="sbref0040"><person-group person-group-type="author"><name><surname>Miguel</surname><given-names>E.</given-names></name><name><surname>Chevalier</surname><given-names>V.</given-names></name><name><surname>Ayelet</surname><given-names>G.</given-names></name><name><surname>Ben Bencheikh</surname><given-names>M.N.</given-names></name><name><surname>Boussini</surname><given-names>H.</given-names></name><name><surname>Chu</surname><given-names>D.K.</given-names></name></person-group><article-title>Risk factors for MERS coronavirus infection in dromedary camels in Burkina Faso, Ethiopia, and Morocco, 2015</article-title><source>Euro Surveill</source><volume>22</volume><year>2017</year><fpage>30498</fpage><pub-id pub-id-type="pmid">28382915</pub-id></element-citation></ref><ref id="bib0045"><label>9</label><element-citation publication-type="journal" id="sbref0045"><person-group person-group-type="author"><name><surname>Reusken</surname><given-names>C.B.</given-names></name><name><surname>Ababneh</surname><given-names>M.</given-names></name><name><surname>Raj</surname><given-names>V.S.</given-names></name><name><surname>Meyer</surname><given-names>B.</given-names></name><name><surname>Eljarah</surname><given-names>A.</given-names></name><name><surname>Abutarbush</surname><given-names>S.</given-names></name></person-group><article-title>Middle east respiratory syndrome coronavirus (MERS-CoV) serology in major livestock species in an affected region in Jordan, June to September 2013</article-title><source>Euro Surveill</source><volume>18</volume><year>2013</year><fpage>20662</fpage><pub-id pub-id-type="pmid">24342516</pub-id></element-citation></ref><ref id="bib0050"><label>10</label><element-citation publication-type="journal" id="sbref0050"><person-group person-group-type="author"><name><surname>Munyua</surname><given-names>P.</given-names></name><name><surname>Corman</surname><given-names>V.M.</given-names></name><name><surname>Bitek</surname><given-names>A.</given-names></name><name><surname>Osoro</surname><given-names>E.</given-names></name><name><surname>Meyer</surname><given-names>B.</given-names></name><name><surname>Müller</surname><given-names>M.A.</given-names></name></person-group><article-title>No serologic evidence of Middle East respiratory syndrome coronavirus infection among camel farmers exposed to highly seropositive camel herds: a household linked study, Kenya, 2013</article-title><source>Am J Trop Med Hyg</source><volume>96</volume><year>2017</year><fpage>1318</fpage><lpage>1324</lpage><pub-id pub-id-type="pmid">28719257</pub-id></element-citation></ref><ref id="bib0055"><label>11</label><element-citation publication-type="journal" id="sbref0055"><person-group person-group-type="author"><name><surname>Ommeh</surname><given-names>S.</given-names></name><name><surname>Zhang</surname><given-names>W.</given-names></name><name><surname>Zohaib</surname><given-names>A.</given-names></name><name><surname>Chen</surname><given-names>J.</given-names></name><name><surname>Zhang</surname><given-names>H.</given-names></name><name><surname>Hu</surname><given-names>B.</given-names></name></person-group><article-title>Genetic evidence of Middle East respiratory syndrome coronavirus (MERS-Cov) and widespread seroprevalence among camels in Kenya</article-title><source>Virol Sin</source><volume>33</volume><year>2018</year><fpage>484</fpage><lpage>492</lpage><pub-id pub-id-type="pmid">30570714</pub-id></element-citation></ref><ref id="bib0060"><label>12</label><element-citation publication-type="journal" id="sbref0060"><person-group person-group-type="author"><name><surname>Zohaib</surname><given-names>A.</given-names></name><name><surname>Saqib</surname><given-names>M.</given-names></name><name><surname>Athar</surname><given-names>M.A.</given-names></name><name><surname>Chen</surname><given-names>J.</given-names></name><name><surname>Sial</surname><given-names>A.U.</given-names></name><name><surname>Khan</surname><given-names>S.</given-names></name></person-group><article-title>Countrywide survey for MERS-coronavirus antibodies in dromedaries and humans in Pakistan</article-title><source>Virol Sin</source><volume>33</volume><year>2018</year><fpage>410</fpage><lpage>417</lpage><pub-id pub-id-type="pmid">30311100</pub-id></element-citation></ref><ref id="bib0065"><label>13</label><element-citation publication-type="journal" id="sbref0065"><person-group person-group-type="author"><name><surname>So</surname><given-names>R.T.</given-names></name><name><surname>Perera</surname><given-names>R.A.</given-names></name><name><surname>Oladipo</surname><given-names>J.O.</given-names></name><name><surname>Chu</surname><given-names>D.K.</given-names></name><name><surname>Kuranga</surname><given-names>S.A.</given-names></name><name><surname>Chan</surname><given-names>K.H.</given-names></name></person-group><article-title>Lack of serological evidence of Middle East respiratory syndrome coronavirus infection in virus exposed camel abattoir workers in Nigeria, 2016</article-title><source>Euro Surveill</source><volume>23</volume><issue>32</issue><year>2018</year></element-citation></ref><ref id="bib0070"><label>14</label><element-citation publication-type="journal" id="sbref0070"><person-group person-group-type="author"><name><surname>Chu</surname><given-names>D.K.</given-names></name><name><surname>Poon</surname><given-names>L.L.</given-names></name><name><surname>Gomaa</surname><given-names>M.M.</given-names></name><name><surname>Shehata</surname><given-names>M.M.</given-names></name><name><surname>Perera</surname><given-names>R.A.</given-names></name><name><surname>Abu Zeid</surname><given-names>D.</given-names></name></person-group><article-title>MERS coronaviruses in dromedary camels, Egypt</article-title><source>Emerg Infect Dis</source><volume>20</volume><year>2014</year><fpage>1049</fpage><lpage>1053</lpage><pub-id pub-id-type="pmid">24856660</pub-id></element-citation></ref><ref id="bib0075"><label>15</label><element-citation publication-type="journal" id="sbref0075"><person-group person-group-type="author"><name><surname>Hemida</surname><given-names>M.G.</given-names></name><name><surname>Al-Naeem</surname><given-names>A.</given-names></name><name><surname>Perera</surname><given-names>R.A.P.M.</given-names></name><name><surname>Chin</surname><given-names>A.W.H.</given-names></name><name><surname>Poon</surname><given-names>L.L.M.</given-names></name><name><surname>Peiris</surname><given-names>M.</given-names></name></person-group><article-title>Lack of Middle East respiratory syndrome coronavirus transmission from infected camels</article-title><source>Emerg Infect Dis</source><volume>21</volume><year>2015</year><fpage>699</fpage><lpage>701</lpage><pub-id pub-id-type="pmid">25811546</pub-id></element-citation></ref><ref id="bib0080"><label>16</label><element-citation publication-type="journal" id="sbref0080"><person-group person-group-type="author"><name><surname>Perera</surname><given-names>R.A.</given-names></name><name><surname>Wang</surname><given-names>P.</given-names></name><name><surname>Gomaa</surname><given-names>M.R.</given-names></name><name><surname>El-Shesheny</surname><given-names>R.</given-names></name><name><surname>Kandeil</surname><given-names>A.</given-names></name><name><surname>Bagato</surname><given-names>O.</given-names></name></person-group><article-title>Seroepidemiology for MERS coronavirus using microneutralisation and pseudoparticle virus neutralisation assays reveal a high prevalence of antibody in dromedary camels in Egypt, June 2013</article-title><source>Euro Surveill</source><volume>18</volume><year>2013</year><fpage>20574</fpage><pub-id pub-id-type="pmid">24079378</pub-id></element-citation></ref><ref id="bib0085"><label>17</label><element-citation publication-type="journal" id="sbref0085"><person-group person-group-type="author"><name><surname>Kandeil</surname><given-names>A.</given-names></name><name><surname>Gomaa</surname><given-names>M.</given-names></name><name><surname>Shehata</surname><given-names>M.</given-names></name><name><surname>El-Taweel</surname><given-names>A.</given-names></name><name><surname>Kayed</surname><given-names>A.E.</given-names></name><name><surname>Abiadh</surname><given-names>A.</given-names></name></person-group><article-title>Middle East respiratory syndrome coronavirus infection in non-camelid domestic mammals</article-title><source>Emerg Microbes Infect</source><volume>8</volume><year>2019</year><fpage>103</fpage><lpage>108</lpage><pub-id pub-id-type="pmid">30866764</pub-id></element-citation></ref><ref id="bib0090"><label>18</label><element-citation publication-type="journal" id="sbref0090"><person-group person-group-type="author"><name><surname>Breban</surname><given-names>R.</given-names></name><name><surname>Riou</surname><given-names>J.</given-names></name><name><surname>Fontanet</surname><given-names>A.</given-names></name></person-group><article-title>Interhuman transmissibility of Middle East respiratory syndrome coronavirus: estimation of pandemic risk</article-title><source>Lancet</source><volume>382</volume><year>2013</year><fpage>694</fpage><lpage>699</lpage><pub-id pub-id-type="pmid">23831141</pub-id></element-citation></ref><ref id="bib0095"><label>19</label><element-citation publication-type="journal" id="sbref0095"><person-group person-group-type="author"><name><surname>Cauchemez</surname><given-names>S.</given-names></name><name><surname>Fraser</surname><given-names>C.</given-names></name><name><surname>Van Kerkhove</surname><given-names>M.D.</given-names></name><name><surname>Donnelly</surname><given-names>C.A.</given-names></name><name><surname>Riley</surname><given-names>S.</given-names></name><name><surname>Rambaut</surname><given-names>A.</given-names></name></person-group><article-title>Middle East respiratory syndrome coronavirus: quantification of the extent of the epidemic, surveillance biases, and transmissibility</article-title><source>Lancet Infect Dis</source><volume>14</volume><year>2014</year><fpage>50</fpage><lpage>56</lpage><pub-id pub-id-type="pmid">24239323</pub-id></element-citation></ref><ref id="bib0100"><label>20</label><mixed-citation publication-type="other" id="oref0100">World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV). <ext-link ext-link-type="uri" xlink:href="https://www.who.int/emergencies/mers-cov/en/" id="intr0010">https://www.who.int/emergencies/mers-cov/en/</ext-link>. [Accessed 28 December 2019].</mixed-citation></ref><ref id="bib0105"><label>21</label><element-citation publication-type="journal" id="sbref0105"><person-group person-group-type="author"><name><surname>Zhao</surname><given-names>J.</given-names></name><name><surname>Alshukairi</surname><given-names>A.N.</given-names></name><name><surname>Baharoon</surname><given-names>S.A.</given-names></name><name><surname>Ahmed</surname><given-names>W.A.</given-names></name><name><surname>Bokhari</surname><given-names>A.A.</given-names></name><name><surname>Nehdi</surname><given-names>A.M.</given-names></name></person-group><article-title>Recovery from the Middle East respiratory syndrome is associated with antibody and T-cell responses</article-title><source>Sci Immunol</source><volume>2</volume><year>2017</year><object-id pub-id-type="publisher-id">eaan5393</object-id></element-citation></ref><ref id="bib0110"><label>22</label><element-citation publication-type="journal" id="sbref0110"><person-group person-group-type="author"><name><surname>Alshukairi</surname><given-names>A.N.</given-names></name><name><surname>Zheng</surname><given-names>J.</given-names></name><name><surname>Zhao</surname><given-names>J.</given-names></name><name><surname>Nehdi</surname><given-names>A.</given-names></name><name><surname>Baharoon</surname><given-names>S.A.</given-names></name><name><surname>Layqah</surname><given-names>L.</given-names></name></person-group><article-title>High prevalence of MERS-CoV infection in camel workers in Saudi Arabia</article-title><source>mBio</source><volume>9</volume><year>2018</year><fpage>e01985</fpage><lpage>18</lpage><pub-id pub-id-type="pmid">30377284</pub-id></element-citation></ref><ref id="bib0115"><label>23</label><element-citation publication-type="journal" id="sbref0115"><person-group person-group-type="author"><name><surname>Kim</surname><given-names>C.J.</given-names></name><name><surname>Choi</surname><given-names>W.S.</given-names></name><name><surname>Jung</surname><given-names>Y.</given-names></name><name><surname>Kiem</surname><given-names>S.</given-names></name><name><surname>Seol</surname><given-names>H.Y.</given-names></name><name><surname>Woo</surname><given-names>H.J.</given-names></name></person-group><article-title>Surveillance of the Middle East respiratory syndrome (MERS) coronavirus (CoV) infection in healthcare workers after contact with confirmed MERS patients: incidence and risk factors of MERS-CoV seropositivity</article-title><source>Clin Microbiol Infect</source><volume>22</volume><year>2016</year><fpage>880</fpage><lpage>886</lpage><pub-id pub-id-type="pmid">27475739</pub-id></element-citation></ref><ref id="bib0120"><label>24</label><element-citation publication-type="journal" id="sbref0120"><person-group person-group-type="author"><name><surname>Khudhair</surname><given-names>A.</given-names></name><name><surname>Killerby</surname><given-names>M.E.</given-names></name><name><surname>Al Mulla</surname><given-names>M.</given-names></name><name><surname>Abou Elkheir</surname><given-names>K.</given-names></name><name><surname>Ternanni</surname><given-names>W.</given-names></name><name><surname>Bandar</surname><given-names>Z.</given-names></name></person-group><article-title>Risk factors for MERS-CoV seropositivity among animal market and slaughterhouse workers, Abu Dhabi, United Arab Emirates, 2014-2017</article-title><source>Emerg Infect Dis</source><volume>25</volume><year>2019</year><fpage>927</fpage><lpage>935</lpage><pub-id pub-id-type="pmid">31002068</pub-id></element-citation></ref><ref id="bib0125"><label>25</label><element-citation publication-type="journal" id="sbref0125"><person-group person-group-type="author"><name><surname>Reusken</surname><given-names>C.B.</given-names></name><name><surname>Farag</surname><given-names>E.A.</given-names></name><name><surname>Haagmans</surname><given-names>B.L.</given-names></name><name><surname>Mohran</surname><given-names>K.A.</given-names></name><name><surname>Godeke</surname><given-names>G.J.</given-names><suffix>5th</suffix></name><name><surname>Raj</surname><given-names>S.</given-names></name></person-group><article-title>Occupational exposure to dromedaries and risk for MERS-CoV infection, Qatar, 2013-2014</article-title><source>Emerg Infect Dis</source><volume>21</volume><year>2015</year><fpage>1422</fpage><lpage>1425</lpage><pub-id pub-id-type="pmid">26196891</pub-id></element-citation></ref><ref id="bib0130"><label>26</label><element-citation publication-type="journal" id="sbref0130"><person-group person-group-type="author"><name><surname>Gierer</surname><given-names>S.</given-names></name><name><surname>Hofmann-Winkler</surname><given-names>H.</given-names></name><name><surname>Albuali</surname><given-names>W.H.</given-names></name><name><surname>Bertram</surname><given-names>S.</given-names></name><name><surname>Al-Rubaish</surname><given-names>A.M.</given-names></name><name><surname>Yousef</surname><given-names>A.A.</given-names></name></person-group><article-title>Lack of MERS coronavirus neutralizing antibodies in humans, Eastern province, Saudi Arabia</article-title><source>Emerg Infect Dis</source><volume>19</volume><year>2013</year><fpage>2034</fpage><lpage>2036</lpage><pub-id pub-id-type="pmid">24274664</pub-id></element-citation></ref><ref id="bib0135"><label>27</label><element-citation publication-type="journal" id="sbref0135"><person-group person-group-type="author"><name><surname>Aburizaiza</surname><given-names>A.S.</given-names></name><name><surname>Mattes</surname><given-names>F.M.</given-names></name><name><surname>Azhar</surname><given-names>E.I.</given-names></name><name><surname>Hassan</surname><given-names>A.M.</given-names></name><name><surname>Memish</surname><given-names>Z.A.</given-names></name><name><surname>Muth</surname><given-names>D.</given-names></name></person-group><article-title>Investigation of anti- Middle East respiratory syndrome antibodies in blood donors and slaughterhouse workers in Jeddah and Makkah, Saudi Arabia, Fall 2012</article-title><source>J Infect Dis</source><volume>209</volume><year>2014</year><fpage>243</fpage><lpage>246</lpage><pub-id pub-id-type="pmid">24218504</pub-id></element-citation></ref><ref id="bib0140"><label>28</label><element-citation publication-type="journal" id="sbref0140"><person-group person-group-type="author"><name><surname>Memish</surname><given-names>Z.A.</given-names></name><name><surname>Alsahly</surname><given-names>A.</given-names></name><name><surname>Masri</surname><given-names>M.A.</given-names></name><name><surname>Heil</surname><given-names>G.L.</given-names></name><name><surname>Anderson</surname><given-names>B.D.</given-names></name><name><surname>Peiris</surname><given-names>M.</given-names></name></person-group><article-title>Sparse evidence of MERS-CoV infection among animal workers living in Southern Saudi Arabia during 2012</article-title><source>Influenza Other Respir Viruses</source><volume>9</volume><year>2015</year><fpage>64</fpage><lpage>67</lpage><pub-id pub-id-type="pmid">25470665</pub-id></element-citation></ref><ref id="bib0145"><label>29</label><element-citation publication-type="journal" id="sbref0145"><person-group person-group-type="author"><name><surname>Al Kahlout</surname><given-names>R.A.</given-names></name><name><surname>Nasrallah</surname><given-names>G.K.</given-names></name><name><surname>Farag</surname><given-names>E.A.</given-names></name><name><surname>Wang</surname><given-names>L.</given-names></name><name><surname>Lattwein</surname><given-names>E.</given-names></name><name><surname>Müller</surname><given-names>M.A.</given-names></name></person-group><article-title>Comparative serological study for the prevalence of anti-MERS coronavirus antibodies in high- and low-risk groups in Qatar</article-title><source>J Immunol Res</source><volume>2019</volume><year>2019</year><object-id pub-id-type="publisher-id">1386740</object-id></element-citation></ref><ref id="bib0150"><label>30</label><element-citation publication-type="journal" id="sbref0150"><person-group person-group-type="author"><name><surname>Liljander</surname><given-names>A.</given-names></name><name><surname>Meyer</surname><given-names>B.</given-names></name><name><surname>Jores</surname><given-names>J.</given-names></name><name><surname>Müller</surname><given-names>M.A.</given-names></name><name><surname>Lattwein</surname><given-names>E.</given-names></name><name><surname>Njeru</surname><given-names>I.</given-names></name></person-group><article-title>MERS-CoV antibodies in humans, Africa, 2013-2014</article-title><source>Emerg Infect Dis</source><volume>22</volume><year>2016</year><fpage>1086</fpage><lpage>1089</lpage><pub-id pub-id-type="pmid">27071076</pub-id></element-citation></ref><ref id="bib0155"><label>31</label><element-citation publication-type="journal" id="sbref0155"><person-group person-group-type="author"><name><surname>Hashem</surname><given-names>A.M.</given-names></name><name><surname>Al-Amri</surname><given-names>S.S.</given-names></name><name><surname>Al-Subhi</surname><given-names>T.L.</given-names></name><name><surname>Siddiq</surname><given-names>L.A.</given-names></name><name><surname>Hassan</surname><given-names>A.M.</given-names></name><name><surname>Alawi</surname><given-names>M.M.</given-names></name></person-group><article-title>Development and validation of different indirect ELISAs for MERS-CoV serological testing</article-title><source>J Immunol Methods</source><volume>466</volume><year>2019</year><fpage>41</fpage><lpage>46</lpage><pub-id pub-id-type="pmid">30659836</pub-id></element-citation></ref><ref id="bib0160"><label>32</label><element-citation publication-type="journal" id="sbref0160"><person-group person-group-type="author"><name><surname>Grehan</surname><given-names>K.</given-names></name><name><surname>Ferrara</surname><given-names>F.</given-names></name><name><surname>Temperton</surname><given-names>N.</given-names></name></person-group><article-title>An optimised method for the production of MERS-CoV spike expressing viral pseudotypes</article-title><source>MethodsX</source><volume>2</volume><year>2015</year><fpage>379</fpage><lpage>384</lpage><pub-id pub-id-type="pmid">26587388</pub-id></element-citation></ref><ref id="bib0165"><label>33</label><element-citation publication-type="journal" id="sbref0165"><person-group person-group-type="author"><name><surname>Hemida</surname><given-names>M.G.</given-names></name><name><surname>Perera</surname><given-names>R.A.</given-names></name><name><surname>Al Jassim</surname><given-names>R.A.</given-names></name><name><surname>Kayali</surname><given-names>G.</given-names></name><name><surname>Siu</surname><given-names>L.Y.</given-names></name><name><surname>Wang</surname><given-names>P.</given-names></name></person-group><article-title>Seroepidemiology of Middle East respiratory syndrome (MERS) coronavirus in Saudi Arabia (1993) and Australia (2014) and characterisation of assay specificity</article-title><source>Euro Surveill</source><volume>19</volume><year>2014</year><fpage>20828</fpage><pub-id pub-id-type="pmid">24957744</pub-id></element-citation></ref><ref id="bib0170"><label>34</label><element-citation publication-type="journal" id="sbref0170"><person-group person-group-type="author"><name><surname>Park</surname><given-names>S.W.</given-names></name><name><surname>Perera</surname><given-names>R.A.</given-names></name><name><surname>Choe</surname><given-names>P.G.</given-names></name><name><surname>Lau</surname><given-names>E.H.</given-names></name><name><surname>Choi</surname><given-names>S.J.</given-names></name><name><surname>Chun</surname><given-names>J.Y.</given-names></name></person-group><article-title>Comparison of serological assays in human Middle East respiratory syndrome (MERS)-coronavirus infection</article-title><source>Euro Surveill</source><volume>20</volume><year>2015</year><fpage>30042</fpage></element-citation></ref></ref-list><sec id="sec0080" sec-type="supplementary-material"><label>Appendix A</label><title>Supplementary data</title><p id="par0120">The following is Supplementary data to this article:<supplementary-material content-type="local-data" id="upi0005"><media xlink:href="mmc1.docx"></media></supplementary-material></p></sec><ack id="ack0005"><title>Acknowledgments</title><p>We wish to thank the King Abdulaziz City for Science and Technology (KACST) for their generous funding through the MERS-CoV research grant program (number 09-1), which is a part of the Targeted Research Program (TRP).</p></ack><fn-group><fn id="sec0075" fn-type="supplementary-material"><label>Appendix A</label><p id="par0115">Supplementary material related to this article can be found, in the online version, at doi:<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.1016/j.jiph.2020.01.001" id="intr0005">https://doi.org/10.1016/j.jiph.2020.01.001</ext-link>.</p></fn></fn-group></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Sante/explor/MersV1/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000E55 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 000E55 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Sante
|area= MersV1
|flux= Pmc
|étape= Corpus
|type= RBID
|clé= PMC:7104088
|texte= Seroprevalence of MERS-CoV in healthy adults in western Saudi Arabia, 2011–2016
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i -Sk "pubmed:32005618" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a MersV1
| This area was generated with Dilib version V0.6.33. |  |