Table 2.

List of prioritized research and progress on MERS-CoV research, as discussed at the September 2017 meeting. *Based on an enhanced understanding of the virus, the Doha Declaration (FAO, 2015) is undergoing revision with a focus on guiding surveillance techniques, management of dromedary camels shedding the virus, research, regional and inter-sectoral coordination, risk communication, food and environmental safety practices, and biosecurity measures. The update includes explicit guidance on import testing, quarantine procedures, and management of shedding animals. These recommendations and priority actions in the Doha Declaration will be delivered as a separate document after validation by stakeholders in affected and at risk countries.

Population focus	Prioritized research*	Progress since the September, 2017 Meeting
In dromedary camel populations*	•Conduct natural history studies and evaluate evidence of re-infection •Conduct value chain and production system analyses •Improve surveillance to evaluate seasonal/temporal variation, if any, in camel viral shedding •Identify critical points for interventions and interruption of within species and zoonotic transmission •Accelerate the development of vaccine candidates	•The report “MERS-CoV at the Animal-Human Interface – An Update of the 2015 Doha Declaration” published outlining priority actions in surveillance, testing of animals at quarantine and entry points, management of PCR positive dromedary camels, coordinated outbreak investigation of community acquired cases with dromedary exposure, food safety and environmental contamination, risk communication and awareness raising for MERS-CoV among animal owners and intersectoral collaboration and coordination •Repeat cross-sectional and cohort surveillance studies ongoing in dromedary camels in Jordan, Egypt, Ethiopia, Kenya. •FAO protocol on repeat cross-sectional and cohort surveillance studies dromedary camels available upon request. •Camel value chain analysis ongoing in Jordan, Egypt, Ethiopia, Kenya. •WHO-IVI Joint Workshop on MERS-CoV human and dromedary vaccines, 26–27 June 2018 Seoul, Korea
At the animal-human interface	•Map virus circulation and geographic range of MERS-CoV in humans and dromedary camels •Evaluate geographic extent of spillover to humans in Africa, the Middle East and South Asia •Conduct animal/human serological and virological studies in specific locations to evaluate risk factors for human infection and exact routes of zoonotic transmission, including food/oral routes, if any •Conduct social science and anthropological studies to describe and quantify exposures to dromedary camels and identify opportunities for risk-mitigating interventions	•Revision of camel/human field study methodology (WHO-Protocol and questionnaires available: Cross-sectional seroepidemiologic study of MERS-CoV infection in high-risk population sin contact with dromedary camels) published •Camel/human field studies are ongoing/or planned in Algeria, Egypt, Ethiopia, Kenya, Mauritania, Niger, Pakistan and Sudan. •Protocol developed: Anthropological study to describe and general population contact patterns with dromedary camels (WHO protocol available upon request: Multi-site study to describe frequency and patterns of contact with dromedary camels, and assess other potential and known risk factors for MERS-CoV infection •National and sub-national Rapid-response team training involving human and animal health sectors developed and implemented in several at risk countries in the Middle East and Africa •MERS-CoV Situational Updates provided by FAO and WHO monthly
In human populations	•Accelerate the research, development, implementation and evaluation of medical countermeasures to reduce morbidity and mortality associated with MERS •Identify the risk factors for healthcare workers in hospital settings and role of administrative and environmental control for transmission of infection •Understand the role of silent/asymptomatic cases in transmission of infections in humans and whether any specific behaviors may result in human infection form non-human sources; •Conduct targeted epidemiological studies in clinical settings to better understand immune response and duration of infectiousness •Integrate testing for MERS-CoV into existing respiratory disease surveillance systems to identify extent and spectrum of mild infection in the community	•WHO-IVI Joint Workshop on MERS-CoV human and dromedary vaccines, 26–27 June 2018 Seoul, Korea •Funding for development of clinical trial protocols for MERS treatment and vaccines received and protocols in development in consultation with WHO R&D Blueprint and affected member states. •Country workshops held to integrated MERS-CoV preparedness and response plans into larger national respiratory disease preparedness and response plans •MERS-CoV virus persistence studies ongoing under experimental conditions •Protocol developed (available upon request) to provide guidance on the collection of surface samples to evaluate MERS-CoV persistence in hospital settings where MERS patients are treated