MERS

Dr. Zainab A. Hussein

 What is coronavirus?
 Coronaviruses are a family of viruses that
cause illness in humans and animals. Seven
different types have been found in people,
including those responsible for the SARS,
MERS and COVID-19 epidemics.

 Coronaviruses (CoVs) are viruses that

cause respiratory and intestinal illnesses in
humans and animals..
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 there are several types for coronavirus, the emergence of the severe acute

respiratory syndrome (SARS) epidemic in China in 2002–2003 and the Middle

East respiratory syndrome (MERS) on the Arabian Peninsula in 2012 show they

can also cause severe disease and (COVID-19), which was first identified in

Wuhan, China in December 2019.

Middle East respiratory syndrome (MERS‐CoV)

MERS : is a viral respiratory disease

caused by Middle East respiratory
syndrome coronavirus (MERS‐CoV)
that was first identified in Saudi
Arabia in 2012. (WHO)
 MERS‐CoV

 The incubation period is the amount of time between when a person is

exposed to the virus and when symptoms occur. The average incubation period
is about 4 to 5 days, but there are cases that occurred between 2 to 14 days
after exposure.

MERS can affect anyone. MERS patients have ranged in age from younger than
1 to 99 years old.
 Source of the virus

 MERS-CoV is a zoonotic virus that has been transmitted from animals to humans.

The origins of the virus are not fully understood but, according to the analysis of

different virus genomes, it is believed that it originated in bats and was transmitted

to Camels sometime in the distant past.

 Statistics and Incidences

 Approximately 35% of MERS cases reported to WHO have died.

 About 3 or 4 out of every 10 patients reported with MERS have died.

 Since 2012, 2,374 laboratory-confirmed cases of infection with MERS-CoV

have been reported to the World Health Organization (WHO), including at least
823 related deaths.

 Twenty-seven countries have reported MERS cases.

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 On the Arabian Peninsula, countries include Bahrain, Iran, Jordan, Kuwait,
Lebanon, Oman, Qatar, Saudi Arabia, United Arab Emirates (UAE), and Yemen.

Other countries reporting travel-associated MERS include Algeria, Austria,

China, Egypt, France, Germany, Greece, Italy, Malaysia, Netherlands,
Philippines, Republic of Korea.

 The vast majority of these cases have so far occurred in the Kingdom of Saudi
Arabia.
 The largest MERS outbreak outside of Saudi Arabia occurred in 2015 in the Republic of Korea;

the outbreak involved 186 confirmed cases and caused 36 deaths.

 MERS in the Middle East and Iraq

• MERS in camels: 73.7% overall seroprevalence of MERS-CoV antibodies in

dromedary camels from the seven countries (Egypt, Uganda, Senegal, Tunisia,
Jordan, Saudi Arabia, Iraq) - thousands of samples collected from 2015-2018 .

• 43.7% of dromedary camels from the Najaf and Muthanna provinces of Iraq
had MERS antibodies.

• MERS in humans: In a 2018 study in Diyala Province, 51.1% of human subjects

were positive for anti-MERS-CoV immunoglobulin.
 Transmission

1- Transmission from animals to humans

Zoonotic transmission: MERS-CoV is a zoonotic virus, which means that is

transmitted between animals and people. Studies have shown that humans are
infected through direct or indirect contact with infected dromedary camels.
 2- Transmission from humans to humans

 Human-to-human transmission is possible and has occurred among close

contacts and in health care settings.

Transmission of the virus has occurred in health care facilities in several

countries, including transmission from patients to health care providers and
transmission between patients before MERS-CoV was diagnosed.

The largest outbreaks have occurred in health care facilities in Saudi Arabia,
the United Arab Emirates, and the Republic of Korea.
 Symptoms

 MERS-CoV infection ranges from no symptoms (asymptomatic) or mild

respiratory symptoms to severe acute respiratory disease and death.

Clinical Features of MERS is fever, cough , shortness of breath and Pneumonia

is a common finding.

 Gastrointestinal symptoms, including diarrhea and nausea/vomiting.

 laboratory testing

1- PCR Assay (NCV-12 rRT-PCR Assay) is used to conform MERS-CoV in

respiratory (Nasal or throat swab) , blood and stool samples.

2- Chest X-ray : A chest X-ray is done to check for problems in lungs , chest
imaging findings are abnormal in more than 80% of MERS cases.

3-Sputum culture : A small sample of mucus coughed from lungs is

collected. It is checked for the virus.
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4- Stool culture.

5- Blood tests : Laboratory findings at presentation may include leukopenia,

lymphopenia, thrombocytopenia, and elevated lactate dehydrogenase levels;
these are most likely with increasing severity of illness .
 Treatment
 No vaccine or specific treatment is currently available.

Individuals with MERS can seek medical care to help relieve symptoms.

 Management of the Middle East respiratory syndrome (MERS) coronavirus

(MERS-CoV) infection is supportive; this includes hydration, antipyretic,
analgesics, respiratory support, and antibiotics if needed for bacterial
superinfection.
 Prevention
CDC routinely advises that people help protect themselves from respiratory
illnesses by taking everyday preventive actions:

1- Wash hands often with soap and water for 20 seconds.

2- If soap and water are not available, use an alcohol-based hand sanitizer.

3- Cover nose and mouth with a tissue when cough or sneeze, then throw the
tissue in the trash.

4- Avoid touching eyes, nose and mouth with unwashed hands.

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5- Avoid personal contact, such as kissing, or sharing cups or eating utensils,
with sick people.
6- Avoid close contact with people who are sick.
7- Clean and disinfect surfaces frequently.
8- Wash your hands after touching camels and avoid contact with sick camels.
9- Do not consume unpasteurized camel milk or uncooked camel meat.
10- Avoid contact with camels if you have a chronic health condition or
compromised immune system.