Low-Level Zoonotic Transmission of Clade C MERS-CoV in Africa: Insights from a Scoping Review and Cohort Studies in Hospital and Community Settings

Human outbreaks of Middle east respiratory syndrome coronavirus (MERS-CoV) are more common in middle Eastern and Asian human populations, associated with clades A and B. In Africa, where clade C is dominant in camels, human cases are minimal. We reviewed 16 studies (n= 6198) published across seven African countries between 2012-2024 to assess human MERS-CoV cases. We also analyzed data from four cohort studies conducted in camel-keeping communities between 2018- 2024 involving camel keepers, camel slaughterhouse workers, and hospital patients with acute respiratory illness (ARI). The analysis showed a pooled MERS-CoV prevalence of 2.4% (IQR: 0.6,11.4) from 16 publications, and 1.14% from four cohort studies (n=2353). Symptomatic cases were rarely reported, with most individuals reporting camel contact, and only 12% had travel history to the middle East. There was one travel associated reported death, resulting in a mortality rate of 0.013%. The findings suggest low camel – to – human transmission of clade C MERS-CoV in Africa. Ongoing research focuses on genomic comparisons between clade C and the more virulent clades A and B, alongside surveillance of viral evolution. This study highlights the need for continuous monitoring but indicates that MERS-CoV clade C currently poses a minimum public health threat in Africa.