Modeling the Potential Spread of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and Evaluating Strategic Preparedness Measures in Thailand
DOI:
https://doi.org/10.59096/osir.v18i3.277189Keywords:
spreading, preparedness, Middle East Respiratory Syndrome, MERS, MERS-CoV, Thailand, SEIR ModelingAbstract
Middle East respiratory syndrome (MERS) remains a public health threat due to its severity and potential for nosocomial and international transmission. Thailand remains at risk of a MERS outbreak due to ongoing travel, pilgrimage, and trade with the Middle East, despite having no confirmed case since 2016. This study aimed to assess the potential spread of MERS-CoV and evaluate national preparedness for MERS outbreaks by using a mixed-methods study. A quantitative study employed Susceptible-Exposed-Infectious-Recovered models to simulate the dynamics of MERS outbreaks under various scenarios in Yala, Pattani, and Narathiwat provinces. The qualitative component included documentary reviews and in-depth interviews with 21 key policymakers, experts, and relevant officers from provincial, sub-national, national, and international levels. The modeling revealed a low likelihood of widespread outbreaks, and combined interventions and early detection resulted in decreased peak and cumulative outcomes across various basic reproductive number values. Documentary reviews revealed that in Thailand, MERS surveillance was integrated into the national communicable disease surveillance, and its priority has diminished since 2016. In-depth interviews showed strengths in strategic plans, human resources, and cross-sector coordination, although gaps were identified in MERS-specific surveillance systems, laboratory surge capacity, insufficient community-level preparedness, and fragmented data systems. The results showed that Thailand has foundational capacity for MERS, supported by enhanced public health infrastructure following the COVID-19 pandemic. Recommendations include strengthening combined intervention and early detection measures, MERS-specific surveillance protocols, laboratory capacities, health literacy among high-risk groups such as pilgrims and caregivers, preparing sufficient resources, and enhancing digital health systems.
References
World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV) [Internet]. Geneva: World Health Organization; 2024 [cited 2025 Jan 12]. <https://www.who.int/health-topics/middle-east-respiratory-syndrome-coronavirus-mers#tab=tab_1>
World Health Organization. Disease outbreak news: Middle East respiratory syndrome coronavirus – Kingdom of Saudi Arabia [Internet]. Geneva: World Health Organization; 2025 May 12 [cited 2025 May 20]. <https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON569>
Kim KH, Tandi TE, Choi JW, Moon JM, and Kim MS. MERS outbreak in South Korea, 2015: Epidemiology, characteristics and public health implications. J Hosp Infect. 2017;95(2), 207–13. doi:10.1016/j.jhin.2016.10.008.
Division of International Disease Control, Ports and Quarantine, Department of Disease Control. Predictive and risk assessment for international concern news [Internet]. 2022 [cited 2025 Jan 12]. 10 p. <https://ddc.moph.go.th/uploads/ckeditor2//files/Predictive%20and%20Risk%20Assessment%20%E0%B8%89%E0%B8%9A%E0%B8%B1%E0%B8%9A%E0%B8%97%E0%B8%B5%E0%B9%88%203%20MERS.pdf>. Thai.
World Health Organization. International Health Regulations (2005) – third edition [Internet]. Geneva: World Health Organization; 2016 [cited 2025 Feb 18]. 91 p. <https://www.who.int/publications/i/item/9789241580496>
World Health Organization. Joint external evaluation tool: International Health Regulations (2005) [Internet]. Geneva: World Health Organization; 2022 [cited 2025 Feb 18]. 132 p. <https://www.who.int/publications/i/item/9789240051980>
Government Gazette. Communicable Disease Act, B.E. 2558 (2015) [Internet]. Phasee A, translator. Nonthaburi: Department of Disease Control, Ministry of Public Health; [cited 2025 Feb 18] 24 p. <https://ddc.moph.go.th/uploads/ckeditor/c74d97b01eae257e44aa9d5bade97baf/files/001_2gcd.pdf>
National Statistical Office of Thailand. Thailand monthly statistics [Internet]. Bangkok: Department of Provincial Administration; [cited 2025 Feb 25]. <https://stat.bora.dopa.go.th/stat/statnew/statMONTH/statmonth/#/view>. Thai.
Thai Health Promotion Foundation. The proportion of the Muslim population living in Thailand [Internet]. Menlo Park (CA): Facebook; 2019 Jun 11 [cited 2025 Feb 23]. <https://www.facebook.com/photo.php?fbid=10156374524663106&id=144490368105&set=a.181206533105&locale=th_TH>. Thai.
Office of International Religious Freedom, U.S. Department of State. Thailand 2022 International religious freedom report [Internet]. Washington: U.S. Department of State; [cited 2025 Feb 24]. 15 p. <https://www.state.gov/wp-content/uploads/2023/05/441219-THAILAND-2022-INTERNATIONAL-RELIGIOUS-FREEDOM-REPORT.pdf>
Killerby ME, Biggs HM, Midgley CM, Gerber SI, Watson JT. Middle East Respiratory Syndrome Coronavirus Transmission. Emerg Infect Dis. 2020 Feb;26(2):191–8. doi:10.3201/eid2602.
Division of Epidemiology, Department of Disease Control. Surveillance and investigation guidelines for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Thailand (Issued in June 2015) [Internet]. Nonthaburi: Ministry of Public Health; 2015 Jun 6 [cited 2025 Apr 15]. 20 p. <https://wwwnno.moph.go.th/epidnan/mypage/MERS/2_command/7_MersCoV-InvestigationGuidelines.pdf>. Thai.
Division of Epidemiology, Department of Disease Control. Case definition for communicable disease surveillance, Thailand, 2020 [Internet]. Nonthaburi: Division of Epidemiology, Department of Disease Control, Ministry of Public Health; 2020 [cited 2025 May 23]. <https://ddc.moph.go.th/uploads/publish/1142920210518092542.pdf>. Thai.
Chantutanon S, and Sangsawang C. Development of a new model of surveillance, prevention, and control of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) among pilgrims in southern Thailand [Internet]. The Southern College Network Journal of Nursing and Public Health: 2023;10(3):e265232. <https://he01.tci-thaijo.org/index.php/scnet/article/view/265232>
U.S. Centers for Disease Control and Prevention. Clinical overview of MERS [Internet]. Atlanta: U.S. Centers for Disease Control and Prevention; 2024 Dec 4 [cited 2025 Feb 18]. <https://www.cdc.gov/mers/hcp/clinical-overview/index.html>
World Health Organization. Disease outbreak news: Middle East respiratory syndrome coronavirus - Kingdom of Saudi Arabia [Internet]. Geneva: World Health Organization; 2025 Mar 13 [cited 2025 Apr 15]. <https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON560>
U.S. Centers for Disease Control and Prevention. About Middle East Respiratory Syndrome (MERS) [Internet]. Atlanta: U.S. Centers for Disease Control and Prevention; 2024 Dec 4 [cited 2025 Apr 16]. <https://www.cdc.gov/mers/about/index.html>
Department of Disease Control, Ministry of Public Health (TH). The 20-year national strategic plan on disease prevention, control, and health threats (2017–2036) [Internet]. Nonthaburi: Department of Disease Control; 2017 [cited 2025 May 18]. 103 p. <https://ddc.moph.go.th/uploads/publish/989620200310142003.pdf>. Thai.
Division of General Communicable Disease, Department of Disease Control. Action plan for preparedness, prevention, and response to emerging infectious diseases, 2023–2027 [Internet]. Nonthaburi: Department of Disease Control; 2023 [cited 2025 May 21]. 168 p. <https://ddc.moph.go.th/uploads/publish/1573220240517100947.pdf>. Thai.
Division of Disease Control in Emergency, Department of Disease Control. Hazard specific plans: HSP, Department of Disease Control, 2023 [Internet]. Nonthaburi: Division of Disease Control in Emergency, Department of Disease Control; 2023 [cited 2025 May 10]. 148 p. <https://ddc.moph.go.th/uploads/ckeditor2/ddce/files/Hazard%20Specific%20Plans%20HSP%20(1)%20(1).pdf>. Thai.
Department of Disease Control, Ministry of Public Health. Communicable Disease Act B.E. 2558 (A.D. 2015) [Internet]. Nonthaburi: Department of Disease Control; [cited 2025 May 12]. <https://www.ddc.moph.go.th/law_gcd_eng.php>
World Health Organization. Emergency response framework: second edition [Internet]. Geneva: World Health Organization; 2017 [cited 2025 Apr 4]. 68 p. <https://iris.who.int/bitstream/handle/10665/258604/9789241512299-eng.pdf>
Park C. MERS-CoV infection in South Korea and strategies for possible future outbreak: narrative review. Journal of Global Health Reports [Internet]. 2019 [cited 2025 Apr 4];3:e2019088. <https://www.joghr.org/article/12122-mers-cov-infection-in-south-korea-and-strategies-for-possible-future-outbreak-narrative-review>. doi:10.29392/joghr.3.e2019088.
Hong Kong Centre for Health Prevention, Department of Health. Preparedness plan for the Middle East respiratory syndrome (MERS): the government of the Hong Kong special administrative region [Internet]. Hong Kong: Centre for Health Protection, Depart of Health; 2024 Jul [cited 2025 Apr 4]. 20 p. <https://www.chp.gov.hk/files/pdf/erib_preparedness_plan_for_mers_2014_eng.pdf>
World Health Organization. A coordinated global research roadmap: 2019 novel coronavirus [Internet]. Geneva: World Health Organization; 2020 [cited 2025 Apr 7]. 66 p. <https://www.who.int/publications/i/item/mers-cov-global-research-roadmap>
World Health Organization. Community-based health care, including outreach and campaigns, in the context of the COVID-19 pandemic: Interim guidance [Internet]. Geneva: World Health Organization; 2020 May 5 [cited 2025 May 23]. <https://www.who.int/publications/i/item/WHO-2019-nCoV-Comm_health_care-2020.1>
World Health Organization Regional Office for Africa. Integrated disease surveillance and response in the African Region: a guide for establishing community-based surveillance [Internet]. Brazzaville: World Health Organization Regional Office for Africa; 2014 Aug [cited 2025 Apr 7]. 12 p. <https://www.afro.who.int/publications/community-based-surveillance>
Byrne A. Halting Epidemics at the Outset: Community-Based Surveillance (CBS) in an Epidemic Preparedness Model for Early Detection and Early Action. Int J Infect Dis [Internet]. 2022 [cited 2025 Apr 7];116(Suppl):S98. <https://doi.org/10.1016/j.ijid.2021.12.231>
World Health Organization. Communicating risk in public health emergencies: a WHO guideline for emergency risk communication (ERC) policy and practice [Internet]. Geneva: World Health Organization; 2017 [cited 2025 Apr 5]. 57 p. <https://iris.who.int/bitstream/handle/10665/259807/9789241550208-eng.pdf?sequence=2>
U.S. Centers for Disease Control and Prevention. Crisis and emergency risk communication (CERC) manual [Internet]. Atlanta: U.S. Centers for Disease Control and Prevention; 2024 [cited 2025 Apr 5]. <https://www.cdc.gov/cerc/php/cerc-manual/index.html>
World Health Organization. Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection: Interim guidance [Internet]. Geneva: World Health Organization; 2019 Oct 15 [cited 2025 Apr 20]. <https://www.who.int/publications/i/item/10665-174652>
U.S. Centers for Disease Control and Prevention. Prevention and control for hospitalized MERS patients: health care providers [Internet]. Atlanta: U.S. Centers for Disease Control and Prevention; 2024 May 30 [cited 2025 Apr 25] <https://www.cdc.gov/mers/hcp/infection-control/index.html>
World Health Organization. International Health Regulations (2005); core capacity workbook: a series of exercises to assist the validation of core capacity implementation levels [Internet]. Geneva: World Health Organization; 2015 [cited 2025 Apr 15]. 65 p. <https://www.who.int/publications/i/item/WHO-HSE-GCR-2015.13>
World Health Organization. Surveillance for human infection with Middle East respiratory Syndrome coronavirus (MERS-CoV): interim guidance [Internet]. Geneva: World Health Organization; 2018 [cited 2025 Apr 15]. 3 p. <https://iris.who.int/bitstream/handle/10665/177869/WHO_MERS_SUR_15.1_eng.pdf>
World Health Organization. Global strategy on digital health 2020–2025 [Internet]. Geneva: World Health Organization; 2021 [cited 2025 May 21]. 50 p. <https://www.who.int/publications/i/item/9789240020924>
U.S. Centers for Disease Control and Prevention. Data modernization initiative (DMI) [Internet]. Atlanta: U.S. Centers for Disease Control and Prevention; 2024 May 15 [cited 2025 Apr 10] <https://www.cdc.gov/data-modernization/php/about/dmi.html>
Office of Public Health Scientific Services, U.S. Centers for Disease Control and Prevention. Public health surveillance: preparing for the future [Internet]. Atlanta: U.S. Centers for Disease Control and Prevention; 2018 [cited 2025 Apr 10]. 37 p. <https://stacks.cdc.gov/view/cdc/58736>
World Health Organization. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies [Internet]. Geneva: World Health Organization; 2010 [cited May 26]. 93 p. <https://iris.who.int/bitstream/handle/10665/258734/9789241564052-eng.pdf>
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Outbreak, Surveillance, Investigation & Response (OSIR) Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
