A new study finds that a camel owner died from MERS after putting medicine on the camel’s runny nose, reinforcing a long-suspected link between these animals and human cases of the deadly virus.

According to the study, published in The New England Journal of Medicine, a 44-year-old man in Saudi Arabia, who owned nine camels, died in Jeddah in November of Middle East Respiratory Syndrome (MERS). Using repeated tests, researchers were able to show that the man and one camel were infected with the same virus.

MERS is a respiratory illness that starts with a flu-like fever and cough. It can result in shortness of breath, pneumonia, and death.

MERS first appeared two years ago. Globally, 681 laboratory-confirmed cases of infection with MERS, including 204 related deaths, have been reported to the World Health Organization (WHO). Most cases have been in Saudi Arabia and neighboring nations. The two cases in the U.S. were people who had traveled from the Middle East.

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Eight days before admission to the hospital, the man had developed fever, rhinorrhea, cough, and malaise. Five days later he had shortness of breath, which gradually worsened. The patient and three of his friends had been visiting the camels daily until three days before his admission. The patient’s friends reported that four of the animals had been ill with nasal discharge during the week before the onset of the patient’s illness. They also mentioned that the man had applied a topical medicine in the nose of one of the ill camels seven days before the patient’s onset of illness.

None of the patient’s friends had had direct contact with the camels’ secretions or mucous membranes. They all remained well during the 60 days that followed the onset of illness in the patient.

Five days after the patient’s hospitalization, symptoms of upper respiratory tract infection developed in his 18-year-old daughter and resolved spontaneously within three days, without any complications. After admission, the patient’s condition continued to deteriorate, and he died.

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Following publication of the report, Saudi Arabia Minister of Agriculture Fahd Balghuneim was quoted in Arab News, stating that Saudi Arabia had started testing camels in the country for MERS. Balghuneim also said that the ministry would begin testing all livestock in the Kingdom starting next week to make sure they do not have MERS, and that there would be coordination with the Saudi Wildlife Authority to take samples from wild animals kept in nature reserves to determine the level of coronavirus infection in the Kingdom.

“Earlier work had different pieces of the puzzle that made this story likely. But in this small episode, all the pieces came together” to offer definitive evidence, Dr. William Schaffner, an infectious disease expert at Vanderbilt University in Nashville, told the Associated Press.

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The researchers concluded that their data also suggest the camels were transiently infected, since the virus seemed to be cleared after the acute infection. “Camels may act as intermediate hosts that transmit the virus from its reservoir to humans. The exact reservoir that maintains the virus in its ecologic niche has yet to be identified,” said the researchers.

MERS can also spread from person to person. Healthcare workers and family members have gotten the disease after close contact with MERS patients.