Middle East respiratory syndrome coronavirus infection overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Middle East Respiratory Syndrome (MERS) is a viral respiratory illness. MERS is caused by a coronavirus called “Middle East Respiratory Syndrome Coronavirus” (MERS-CoV). MERS-CoV is a beta coronavirus. It was first reported in 2012 in Saudi Arabia. MERS-CoV used to be called “novel coronavirus,” or “nCoV”. It is different from other coronaviruses that have been found in people before.
Historical Perspective
The Middle East respiratory syndrome coronavirus (MERS-CoV) was first reported to cause human infection in September 2012. In July 2013, the World Health Organization (WHO) International Health Regulations Emergency Committee determined that MERS-CoV did not meet criteria for a "public health emergency of international concern," but was nevertheless of "serious and great concern".
Pathophysiology
Potential animal reservoirs and mechanism(s) of transmission of MERS-CoV to humans remain unclear. A zoonotic origin for MERS-CoV was initially suggested by high genetic similarity to bat coronaviruses , and some recent reports have described serologic data from camels and the identification of related viruses in bats. However, more epidemiologic data linking cases to infected animals are needed to determine if a particular species is a host, a source of human infection, or both.
The differential diagnosis of the middle east respiratory syndrome coronavirus infection include other respiratory tract infection, such as influenza.
Epidemiology and Demographics
As of September 20, 2013, a total of 130 cases from eight countries have been reported to WHO; 58 (45%) of these cases have been fatal. All cases have been directly or indirectly linked through travel to or residence in four countries: Saudi Arabia, Qatar, Jordan, and the United Arab Emirates (UAE). Most reported cases involved severe respiratory illness requiring hospitalization.
As of May 28, 2014, globally, 636 laboratory-confirmed cases of infection with MERS-CoV have officially been reported to WHO, including 193 deaths. This global total includes all of the cases reported in this update, plus 17 laboratory confirmed cases officially reported to WHO by Saudi Arabia between 16 and 18 May, 2014.
Risk Factors
Traveling to endemic areas is a risk factor for the middle east respiratory syndrome coronavirus infection.
Natural History, Complications and Prognosis
Approximately 30% of patients infected with MERS-CoV died.
History and Symptoms
The symptoms of the middle east respiratory syndrome coronavirus infection include fever, cough, shortness of breath and gatsrointestinal symptoms.
Physical Examination
Persons with symptoms suspicious of the middle east respiratory syndrome coronavirus infection need medical evaluation. Physical examination by a health care provider may reveal fever or sometimes low body temperature, an increased respiratory rate, low blood pressure, a fast heart rate, or a low oxygen saturation, which is the amount of oxygen in the blood as indicated by either pulse oximetry or blood gas analysis. People who are struggling to breathe, who are confused, or who have cyanosis (blue-tinged skin) require immediate attention.
Laboratory Findings
Confirmatory laboratory testing now requires a positive polymerase chain reaction (PCR) of at least two, instead of one, specific genomic targets or a single positive target with sequencing of a second. Lab tests (PCR) for MERS-CoV are available at state health departments, CDC, and some international labs. Otherwise, MERS-CoV tests are not routinely available. There are a limited number of commercial tests available, but these are not FDA-approved. Clinical specimens should be collected, handled and tested appropriately.
Medical Therapy
There are no specific treatments recommended for illnesses caused by MERS-CoV. Medical care is supportive and to help relieve symptoms.
Contact and Airborne Precautions
Standard, contact, and airborne precautions are recommended for management of hospitalized patients with known or suspected MERS-CoV infection. In addition, ill people who are being evaluated for MERS-CoV infection and do not require hospitalization for medical reasons may be cared for and isolated in their home. Isolation at home is defined as the separation or restriction of activities of an ill person with a contagious disease from those who are well.
Primary Prevention
Enhancing infection prevention and control awareness and measures is critical to prevent the possible spread of MERS‐CoV in health care facilities. Health‐care facilities that provide care for patients suspected or confirmed to be infected with MERS‐CoV infection should take appropriate measures to decrease the risk of transmission of the virus from an infected patient to other patients, health‐care workers and visitors. It is not always possible to identify patients with MERS‐CoV early because some have mild or unusual symptoms. For this reason, it is important that health‐care workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices all the time.