Risk of MERS importation and onward transmission: a systematic review and analysis of cases reported to WHO
C Poletto, PY Boelle, V Colizza
BMC Infectious Diseases 16, 448 (2016)
We systematically analysed imported cases of MERS out of Middle East occurring the last 3 years to study the drivers of MERS importation and onward transmission.
We showed that the risk of importation can be quantified based on two ingredients: the incidence profile in the source area, and the international traveling flux connecting the source with country of destination. We thus confirmed that air traffic information is a precious tool for epidemic risk assessment both in the early and long-term spreading regime.
Analysing the risk of local transmission following importation, we recovered two main finding. First, MERS transmission is more efficient in hospital settings than at home or in the community. Second, the duration of hospitalisation prior to isolation shorten when global awareness to the disease, as measured by digital proxies, is high. Through the use of digital proxies (e.g. Google Trends) we were thus able to explicitly measure awareness in time and relate it to a quantifiable change of behaviour, further illustrating its impact on transmission.