A proposal for the eradication of Middle East respiratory syndrome.

To the Editor:

Recently, we came across the recent report, “Outcome of strict implementation of infection prevention control measures during an outbreak of Middle East respiratory syndrome,” by El Bushra et al, and the related letter by Yasri and Wiwanitkit. Middle East respiratory syndrome (MERS) is known to be a zoonosis from camels to humans.3, 4 In this letter, we present the idea about the possibilities of eradicating MERS through the experience of brucellosis control in South Korea. In South Korea, since 2005, the Korea Center for Disease Control and Prevention has conducted a survey annually on targeted high-risk groups for brucellosis, such as livestock farmers. Through these surveys, the seroprevalence of brucellosis among the high-risk groups has been reduced to zero steadily in 10 years. With these activities, in the animal sector, premarketing and annual tests have been implemented for all cattle >1 year of age since 2004 and 2007, respectively. Through these efforts, the incidence of both bovine and human brucellosis has decreased since 2006.5, 6 Unfortunately, these control activities for camels are supposed to be insufficient in the Middle East region. Both cows and camels are linked to humans in terms of providing labor and food. For this reason, when these animals are infected, humans are easily exposed to the diseases, and both animals may not be easily culled. In particular, Koreans usually enjoy eating raw beef (Yukhoe). Similarly, Middle Easterners enjoy drinking raw camel milk. The test and slaughter with compensation policy has been very effective to control brucellosis in both humans and cattle in Korea. Of course, we do not think that the test and slaughter policy is the ultimate solution. However, development of a vaccine is now at a standstill, and currently, >1,500 patients are infected worldwide, with a mortality rate of 40%. MERS itself causes fear among us. We wonder why the aforementioned policies have not been formulated in the Middle East region. The successful control of brucellosis in South Korea was achieved from cooperation between the veterinary and medical sectors. For the control of MERS, more extensive activities in the Middle East region must be implemented. In particular, avoidance of eating unpasteurized dairy products and culling of infected camels, along with surveillance and a compensation policy, will help to eradicate MERS in the region.