Evidence map›Paper›PMID 24239323›Full record

ArticleThe Lancet. Infectious diseases2014

Middle East respiratory syndrome coronavirus: quantification of the extent of the epidemic, surveillance biases, and transmissibility.

Simon Cauchemez, Christophe Fraser, Maria D Van Kerkhove, Christl A Donnelly, Steven Riley, Andrew Rambaut, Vincent Enouf, Sylvie van der Werf, Neil M Ferguson

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet. Infectious diseases, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 205 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
205citing papers in PubMed, 11 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

205 citing papers in PubMed, 11 syntheses or guidelines pooled it.

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  15. Variable DPP4 expression in multiciliated cells of the human nasal epithelium as a determinant for MERS-CoV tropism.Proceedings of the National Academy of Sciences of the United States of America · 2025
    Article
  16. Flexible Bayesian estimation of incubation times.American journal of epidemiology · 2025
    Article
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  18. AnHeliyon · 2024
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145 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Simon CauchemezMRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
Christophe FraserMRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
Maria D Van KerkhoveMRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
Christl A DonnellyMRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
Steven RileyMRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
Andrew RambautInstitute of Evolutionary Biology, Ashworth Laboratories, University of Edinburgh, Edinburgh, UK.
Vincent EnoufInstitut Pasteur, Unit of Molecular Genetics of RNA Viruses, UMR3569 CNRS, Université Paris Diderot Sorbonne Paris Cité, Paris, France.
Sylvie van der WerfInstitut Pasteur, Unit of Molecular Genetics of RNA Viruses, UMR3569 CNRS, Université Paris Diderot Sorbonne Paris Cité, Paris, France.
Neil M FergusonMRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. Electronic address: neil.ferguson@imperial.ac.uk.

Funding

Medical Research Council G0800596Medical Research Council MR/J008761/1Medical Research Council MR/K010174/1Wellcome Trust 095831
6 · The paper itself

Abstract

backgroundThe novel Middle East respiratory syndrome coronavirus (MERS-CoV) had, as of Aug 8, 2013, caused 111 virologically confirmed or probable human cases of infection worldwide. We analysed epidemiological and genetic data to assess the extent of human infection, the performance of case detection, and the transmission potential of MERS-CoV with and without control measures.

methodsWe assembled a comprehensive database of all confirmed and probable cases from public sources and estimated the incubation period and generation time from case cluster data. Using data of numbers of visitors to the Middle East and their duration of stay, we estimated the number of symptomatic cases in the Middle East. We did independent analyses, looking at the growth in incident clusters, the growth in viral population, the reproduction number of cluster index cases, and cluster sizes to characterise the dynamical properties of the epidemic and the transmission scenario.

findingsThe estimated number of symptomatic cases up to Aug 8, 2013, is 940 (95% CI 290-2200), indicating that at least 62% of human symptomatic cases have not been detected. We find that the case-fatality ratio of primary cases detected via routine surveillance (74%; 95% CI 49-91) is biased upwards because of detection bias; the case-fatality ratio of secondary cases was 20% (7-42). Detection of milder cases (or clinical management) seemed to have improved in recent months. Analysis of human clusters indicated that chains of transmission were not self-sustaining when infection control was implemented, but that R in the absence of controls was in the range 0·8-1·3. Three independent data sources provide evidence that R cannot be much above 1, with an upper bound of 1·2-1·5.

interpretationBy showing that a slowly growing epidemic is underway either in human beings or in an animal reservoir, quantification of uncertainty in transmissibility estimates, and provision of the first estimates of the scale of the epidemic and extent of case detection biases, we provide valuable information for more informed risk assessment.

fundingMedical Research Council, Bill & Melinda Gates Foundation, EU FP7, and National Institute of General Medical Sciences.

Indexed as

EpidemicsAdolescentAdultAgedAged, 80 and overBasic Reproduction NumberChildChild, PreschoolCluster AnalysisCoronavirusCoronavirus InfectionsEpidemiological MonitoringFemaleHumansMaleMiddle Aged

Identifiers

PMID24239323
PMCPMC3895322

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.