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Middle East Respiratory Syndrome (MERS)

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  • Authors: Sonja A. Rasmussen1, Amelia K. Watson2, David L. Swerdlow3
  • Editors: W. Michael Scheld4, James M. Hughes5, Richard J. Whitley6
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: Centers for Disease Control and Prevention, Atlanta, GA 30333; 2: The University of Georgia, Athens, GA 30602; 3: Centers for Disease Control and Prevention, Atlanta, GA 30333; 4: Department of Infectious Diseases, University of Virginia Health System, Charlottesville, VA; 5: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA; 6: Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
  • Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0020-2016
  • Received 02 March 2016 Accepted 15 March 2016 Published 10 June 2016
  • Sonja A. Rasmussen, skr9@cdc.gov
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  • Abstract:

    Since the identification of the first patients with Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, over 1,600 cases have been reported as of February 2016. Most cases have occurred in Saudi Arabia or in other countries on or near the Arabian Peninsula, but travel-associated cases have also been seen in countries outside the Arabian Peninsula. MERS-CoV causes a severe respiratory illness in many patients, with a case fatality rate as high as 40%, although when contacts are investigated, a significant proportion of patients are asymptomatic or only have mild symptoms. At this time, no vaccines or treatments are available. Epidemiological and other data suggest that the source of most primary cases is exposure to camels. Person-to-person transmission occurs in household and health care settings, although sustained and efficient person-to-person transmission has not been observed. Strict adherence to infection control recommendations has been associated with control of previous outbreaks. Vigilance is needed because genomic changes in MERS-CoV could result in increased transmissibility, similar to what was seen in severe acute respiratory syndrome coronavirus (SARS-CoV).

  • Citation: Rasmussen S, Watson A, Swerdlow D. 2016. Middle East Respiratory Syndrome (MERS). Microbiol Spectrum 4(3):EI10-0020-2016. doi:10.1128/microbiolspec.EI10-0020-2016.

Key Concept Ranking

Acute Respiratory Distress Syndrome
0.49074668
Severe Acute Respiratory Syndrome
0.47306213
0.49074668

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/content/journal/microbiolspec/10.1128/microbiolspec.EI10-0020-2016
2016-06-10
2017-08-16

Abstract:

Since the identification of the first patients with Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, over 1,600 cases have been reported as of February 2016. Most cases have occurred in Saudi Arabia or in other countries on or near the Arabian Peninsula, but travel-associated cases have also been seen in countries outside the Arabian Peninsula. MERS-CoV causes a severe respiratory illness in many patients, with a case fatality rate as high as 40%, although when contacts are investigated, a significant proportion of patients are asymptomatic or only have mild symptoms. At this time, no vaccines or treatments are available. Epidemiological and other data suggest that the source of most primary cases is exposure to camels. Person-to-person transmission occurs in household and health care settings, although sustained and efficient person-to-person transmission has not been observed. Strict adherence to infection control recommendations has been associated with control of previous outbreaks. Vigilance is needed because genomic changes in MERS-CoV could result in increased transmissibility, similar to what was seen in severe acute respiratory syndrome coronavirus (SARS-CoV).

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Figures

Image of FIGURE 1
FIGURE 1

Cases of Middle East respiratory syndrome coronavirus, 2012 to 2016, by month and year of onset (total = 1,638 cases), as reported by the World Health Organization (data as of 5 February 2016). The total case counts include 130 cases identified from Saudi Arabia Ministry of Health’s retrospective reviews, but these are not depicted in the epidemic curve due to unknown case onset dates.

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0020-2016
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Image of FIGURE 2
FIGURE 2

Global map of countries with confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV), 2012 to 2016, as reported by the World Health Organization (data as of 5 February 2016) (http://www.who.int/emergencies/mers-cov/en/).

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0020-2016
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FIGURE 3

Depiction of components of the MERS-coronavirus including the membrane, envelope, and spike proteins that make up the viral membrane and nucleocapsid protein, which is associated with the viral RNA. Image source: CDC, Jennifer Oosthuizen.

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0020-2016
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Image of FIGURE 4
FIGURE 4

Middle East respiratory syndrome coronavirus as seen by electron microscopy. The spike proteins protrude from the viral membrane and give the virus a crown-like (corona) appearance. Image source: CDC’s Public Health Image Library (http://www.cdc.gov/coronavirus/mers/photos.html), Cynthia Goldsmith/Maureen Metcalfe/Azaibi Tamin.

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0020-2016
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Tables

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TABLE 1

Comparison of characteristics of SARS and MERS

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0020-2016
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TABLE 2

Chronology of key events

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0020-2016
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TABLE 3

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) definitions from the CDC

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0020-2016
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TABLE 4

Middle East respiratory syndrome coronavirus (MERS-CoV) case definition for reporting to the WHO

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0020-2016

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