Serological and virological evidence of MERS-CoV infection among dromedary camels in Africa: a systematic review and Meta-analysis

Abstract

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a zoonotic pathogen of major public health concern due to its pandemic potential. Dromedary camels are the principal reservoir, and Africa harbors over 60% of the global dromedary population. This systematic review and meta-analysis assessed the serological, molecular, and geographical distribution of MERS-CoV infection and associated risk factors among African dromedary camels over the past decade. A systematic search of Web of Science, PubMed, Scopus, and African Journals Online (AJOL) was conducted for studies published between 2012 and 2025, following PRISMA 2020 guidelines. Thirty-nine eligible studies from 13 African countries were included, predominantly from East Africa, followed by North and West Africa. The pooled seroprevalence and viral RNA prevalence of MERS-CoV among dromedaries were 75.1% (95% CI: 68.2%-82.0%; I2 = 99.4) and 6.2% (95% CI: 3.5%-8.9%; I2 = 99.7), respectively, indicating extensive exposure history. Subgroup analysis showed regional variation, with the highest pooled seroprevalence in North Africa and highest viral RNA prevalence in West Africa (5.5%). Adult camels had higher seroprevalence (78.5%) than juvenile camels (42.5%), while viral RNA detection was slightly higher in young (5.5%). Female camels showed slightly higher (descriptive) pooled seroprevalence (69.7%) than males (65.8%), whereas males had slightly higher pooled viral RNA prevalence (5.1%) compared to females (4.0%). Nine studies examined human infection among camel handlers, yielding a pooled prevalence of 12.3% (95% CI: 1.4%-25.9%; I2 = 99.9). These findings highlight widespread MERS-CoV circulation in African camels and the urgent need for coordinated One Health surveillance to mitigate zoonotic risks.