Disease

MERS-CoV

Overview / History

Middle East respiratory syndrome (MERS) is a viral respiratory illness caused by the Middle East respiratory syndrome coronavirus (MERS-CoV).

MERS-CoV was first reported in 2012 in Saudi Arabia. Since then, approximately 80% of cases have been reported in Saudi Arabia. The virus can cause severe respiratory illness or pneumonia and kills up to 30 to 40% of those infected.

MERS-CoV is a zoonotic virus or a virus transmitted between humans and animals. The virus has been identified in dromedary camels, and human infections have been linked to direct or indirect contact with infected camels. Human-to-human transmission can also occur among close contacts and in healthcare settings.

In May 2015, a very large outbreak occurred in South Korea, sparked by an infected traveller from the Middle East. The outbreak resulted in rapid person-to-person transmission throughout more than 80 healthcare facilities, making it the largest outbreak outside the Middle East.

MERS-CoV is listed as a notifiable disease under the International Health Regulations. Public health authorities are likely to be involved in the management of any suspected and confirmed cases. Any action must be per those required or recommended by local national and regional authorities.

Geographic Risk

MERS-CoV is endemic in dromedary camels from the Middle East and Africa. Since 2012, at least 27 countries have reported human infections of MERS-CoV. Over 80% of all human cases have been from Saudi Arabia. Other countries that have reported MERS-CoV cases include Algeria, Austria, Bahrain, China, Egypt, France, Germany, Greece, the Islamic Republic of Iran, Italy, Jordan, Kuwait, Lebanon, Malaysia, the Netherlands, Oman, Philippines, Qatar, Republic of Korea, Thailand, Tunisia, Türkiye, United Arab Emirates, United Kingdom, United States of America, and Yemen.

The bulk of cases reported outside the Middle East has been from infected people travelling from the Middle East to countries in Asia, Europe, Africa and the United States of America, where the disease has been contained. In some instances, imported cases from travellers have spread to a limited number of close contacts.

Mode of spread

Animals
Coughing / Sneezing
Food and water

Transmission

MERS-CoV spreads to people in two ways:

Animals and their environment-to-human

Transmission to people can occur from direct contact with infected dromedary camels, or indirect contact (via contaminated objects). The virus may be transmitted via respiratory secretions, droplets or through consuming undercooked camel meat or drinking raw camel products (i.e., milk, urine).

Human-to-human

Generally, coronaviruses spread from one person to another through infected respiratory secretions. A sick person expels these when they cough, sneeze, or talk. Others can get the disease via contact with these contaminated droplets.

MERS-CoV typically does not spread easily between humans. People who are in close contact, such as relatives looking after a family member or healthcare workers are at the highest risk. If proper infection control is in place, spread between humans can be prevented. Outbreaks can occur in healthcare settings before special infection control measures have been implemented or before the illness is suspected or diagnosed.

Symptoms

Some people appear to have no symptoms. If symptoms do develop, it takes between 2 to 14 days after someone is exposed to the virus for them to become ill.

Common signs and symptoms of MERS-CoV include:

Fever
Chills
Dry cough
Headache
Shortness of breath
Muscle pain

Other less common signs and symptoms may include:

Sore throat
Runny nose
Nausea
Vomiting
Abdominal pain
Diarrhoea
Dizziness

Some progress to pneumonia with severe breathing difficulty, requiring mechanical ventilation, kidney and other organ failure. People with underlying health problems, such as diabetes, cancer, lung disease, chronic kidney failure or a weakened immune system, are more likely to develop severe illness.

People at a higher risk for severe disease include older people, and people with underlying health problems, such as diabetes, hypertension, heart diseases, lung diseases, cancer, chronic kidney failure or a weakened immune system

About 30-40% of all known cases have been fatal.

Diagnosis

A diagnosis of MERS-CoV may be suspected based on exposure / travel history and symptoms. A definitive diagnosis is confirmed in a laboratory using specimens collected from the upper and lower respiratory tracts.

Treatment

No specific medication is currently available to treat MERS-CoV. Anybody suspected of infection would be managed in isolation in the hospital. Severe MERS-CoV cases may require intensive care support with mechanical ventilation and dialysis.

Vaccination

Although there are vaccines against MERS-CoV in development, there is no vaccine commercially available.

Prevention

To prevent infection:

Follow general hygiene measures
- Washing hands often and well. Carry a hand sanitizer to use when hand washing facilities are not easily available.
- Refrain from touching your face. If you must touch your face, only do so with clean hands.
- Keep a distance (three to six feet/one to two metres) from people who are obviously sick (coughing, sneezing).
- Cover coughs and sneezes with a tissue or your upper sleeve.
- Ensure any food or drink for consumption is safe - thoroughly washed, peeled, boiled, cooked through etc.
Avoiding unprotected contact with sick people
Avoid contact with animals
- In particular, avoid contact with camels, their waste products and environment
- Do not consume any raw camel products – do not drink raw (unpasteurized) milk or eat raw meat.

In outbreak areas:

Avoid affected healthcare facilities.
If medical attention is required, ensure you contact International SOS for the latest recommendation.

Risk to travellers

"Primary" infections with MERS-CoV, where people have been infected from an environmental source (probably dromedary camels), have only occurred in the Middle East.

In other countries, a traveller with MERS can spread the virus to other people but so far this only poses a risk to those in close contact, such as relatives and healthcare workers.

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