UK - Department for Business, Energy and Industrial Strategy
Responding to the challenge of MERS-CoV: Development and testing of interventions to reduce risk among Bedouin populations in Southern Jordan
Programme Data Last Updated: 23/03/2022
IATI Identifier: GB-GOV-13-FUND--GCRF-MR_T02996X_1
Middle Eastern Respiratory Syndrome coronavirus (MERS-CoV) is a recently identified 'emerging infectious disease' first seen in Jordan and Saudi Arabia in 2012. Clinical cases can present as a sudden acute respiratory infection, with rapid onset pneumonia and death, although milder infections also occur (in some cases without any symptoms at all). Since the initial outbreaks in 2012, there have been almost 2500 confirmed cases, with over a third of those infected subsequently dying from the disease (848 people to date). Confirmed cases have been reported across 27 countries, although the majority have been in the Arabian Peninsula, with Saudi Arabia the disease epicentre (over 80% of all confirmed cases). Primary infection in humans occurs through contact with infected dromedary camels (or camel products) and camel populations act as the host reservoir for the virus, however infection in camels causes only mild symptoms, similar to a common cold (and may cause no symptoms at all). Once someone becomes infected in this way secondary human-to-human transmission of the virus can then occur (often in a hospital setting) with the potential to cause large scale outbreaks such as those seen in South Korea and Saudi Arabia in recent years. Jordan's strategic location at the centre of current Middle Eastern crises means that its stability within the region is of global significance. Enormous influxes of displaced peoples into Jordan from the conflicts in Syria, Iraq and Yemen among others (accounting for over 30% of the population) have placed unprecedented demands on Jordan's national disease surveillance, response and health-care services and increased the risk of catastrophic disease outbreaks occurring in the future, including MERS-CoV. Jordan's long, porous border with Saudi Arabia, across which frequent movements of people and livestock occur (particularly among rural Bedouin populations in the south of the country) and large camel populations, mean that the risks posed by MERS-CoV remain high. The World Health Organization (WHO) have designated MERS-CoV to be a Blueprint Priority Disease for Research and Development, alongside other 'emerging infectious diseases' that represent a potential global threat, including Ebola, Lassa and Nipah viruses. The development of vaccines against MERS-CoV, for use in both camels and humans, is already at an advanced stage, however knowledge regarding the diseases epidemiology and cultural context (which are essential for effective vaccine deployment) is currently lacking. A similar lack of knowledge has delayed the deployment of other vaccines in the past (e.g. recently the Lassa virus vaccine in West Africa) and so it is important that deployment of future MERS-CoV vaccines is not delayed for the same reasons. It is crucial therefore that appropriate research be conducted among high-risk populations. With this in mind, and building on the findings of successful GRCF Foundation Award research, we aim to conduct state-of-the-art interdisciplinary research to determine the biological and sociocultural contexts of the disease among at-risk Bedouin populations in southern Jordan. In particular, we are seeking to understand which individuals, or camels, should be targeted for future vaccination, the correct seasons for the deployment of such vaccines and the sociocultural issues that are driving the infection, with consideration of these sociocultural issues vital when looking at potential control measures for the disease, including vaccination. Through this project we thus aim to develop appropriate, community based behavioural interventions that will reduce the risk of infection among these communities (as well as considering the potential role of vaccines in the future). We are also aiming to build Jordan's capacity for strategic research, surveillance and control activities to confront the challenge posed by MERS-CoV (as well as by other 'emerging infectious diseases').Objectives
Building on a successful GCRF Foundation Award, our overall aims in this project are to: 1. Address, through state-of-the-art interdisciplinary research in Jordan, critical knowledge gaps urgently required to inform future effective vaccination strategies for Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV), identified through the GCRF Foundation Award. In particular i) who (or which, in the case of camels) should be targeted for vaccination, ii) the correct seasonality for deployment of vaccines and iii) the sociocultural issues, including vaccine acceptability, that are likely to be faced. 2. Engage, develop and implement appropriate community-informed, contextualized behavioural public health interventions to mitigate risk among rural communities at high risk of MERS-CoV infection. 3. Further build capacity for strategic research, surveillance and control activities targeted at MERS-CoV. To achieve these three overall aims, our specific objectives are: 1. Provide epidemiological evidence on the risks and drivers of MersCoV in community dwelling populations in contact with camel herds. We will: (i) estimate the incidence rates of infection among high-risk individuals (camel workers / shepherds), (ii) assess and estimate secondary attack rates in household members with no direct camel contact, (iii) assess likely transmission pathways, (iv) determine whether natural infection is protective. 2. Assess prevalence of and potential impact of co-morbidities such as diabetes and smoking related illnesses on risk of MERS-CoV infection. Co-morbidities will be considered in this study as those associated with the probability of infection being symptomatic, representing potential clinical risk groups to be offered future vaccines. 3. Identify viral shedding patterns and immunological responses to infection in camels in terms of: (i) patterns of viral shedding by age and season, (ii) role of prior infection on viral shedding. 4. Develop an in-depth understanding of the social, cultural and religious factors that shape perceptions of MERS-CoV (and camel zoonoses in general) and attitudes towards control measures, particularly the deployment of potential future vaccines among these communities. Specifically, we will investigate: i) the role of camels in Bedouin identity and the social imaginary, ii) social, cultural and religious influences on risk-related behaviours, iii) the roles and perspectives of other household members including women in relation to zoonotic disease risks and household hygiene practices, iv) the likely influences of the above factors on acceptability and uptake of risk-reduction interventions, including vaccination. 5. Design, implement and evaluate community-based, contextualized behavioural public health interventions to mitigate risk among rural communities at high risk of infection including appropriate health promotion messages for possible non-communicable disease co-factors increasing the risk of severe MERS-CoV disease. A randomised pilot feasibility trial will be carried out in order to assess the ability to scale up for wider evaluation in future trials. Effectiveness of such behavioural interventions using surrogate outcomes will be examined. 6. Engage with cultural, social and religious beliefs and practices to identify, understand and mitigate potentially limiting factors to the above health promotion and health protection interventions and support women and children's perspectives and roles within such interventions. 7. Build capacity for strategic research, surveillance and control activities for emerging infectious diseases (with particular reference to the continuing threat posed by MERS-CoV) through the promotion of interdisciplinary research, advocacy for integrated delivery of livestock and public health programs and provision of opportunity, support and mentorship for early career researchers to participate in the achieving of project goals.
|Extending:||UK Research & Innovation|
|Funding:||UK - Department for Business, Energy and Industrial Strategy|
|Implementing:||Royal Veterinary College|
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