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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

MERS and the camel connection – to kiss or cull?

The World Health Organization recently reported two Middle East respiratory syndrome (MERS) coronavirus infections in Qatar, with both men reporting exposure to camels.

A 71-year-old man from Doha, Qatar, who remains hospitalized in critical condition after acquiring MERS, “owns a camel barn and is known to have consumed raw camel milk,” the WHO reported. The other case, a 43-year-old man from Doha, developed symptoms and was admitted to a hospital with MERS infection after frequently visiting a camel barn in the 14 days that preceded his onset of symptoms.

“There is no history of exposure to other known risk factors,” the WHO reported.

As evidence mounts that camels are serving as a reservoir for the emerging coronavirus -- including the presence of MERS antibodies in some camel populations -- the question of culling camels has inevitably arisen.

When H5N1 avian flu emerged as a major public health threat in 1997, officials in Hong Kong eliminated its suspected animal reservoir by killing more than 1 million chickens. Similarly, when SARS hit China in 2002-2003, more than 10,000 masked palm civets – cat-like animals sold at public markets – were culled. Bats were found to be the ultimate source of the virus, with civets apparently serving as an intermediate host that provided access to human populations.

We may have a similar situation with emerging MERS coronavirus, which appears to be of bat origin but has found a safe haven in camels. However, the camel is such an integral part of culture in Saudi Arabia and other countries in the region that any suggestion of slaughtering the beasts is likely to be met with strong resistance.

Indeed, when officials in Saudi Arabia began warning of the link between camels and human MERS infections, kissing camels became a bizarre act of defiance. As National Geographic described it, “Camels in the Kingdom [of Saudi Arabia] are like dairy cows, beef cows, racehorses, pulling horses, beloved Labradors, and living daily reminders of holy scripture, all in one. (Camels appear, honorably, in the Quran.)”

Globally, the WHO reports 885 laboratory-confirmed cases of MERS, including 319 deaths.