WHO updates fact sheet on MERS-CoV (23 January 2019)

The World Health Organization (WHO) has updated its fact sheet on Middle East Respiratory Syndrome Coronavirus (MERS-CoV).

Background Information:

Coronaviruses are a large family of viruses that can cause diseases ranging from the common cold to Severe Acute Respiratory Syndrome (SARS).

MERS-CoV is a zoonotic virus, which means it is a virus that is transmitted between animals and people. Studies have shown that humans are infected through direct or indirect contact with infected dromedary camels. MERS-CoV has been identified in dromedaries in several countries in the Middle East, Africa and South Asia.

The origins of the virus are not fully understood but, according to the analysis of different virus genomes, it is believed that it may have originated in bats and was transmitted to camels sometime in the distant past.

Key Messages:

Middle East respiratory syndrome (MERS) is a viral respiratory disease caused by a novel coronavirus (Middle East respiratory syndrome coronavirus, or MERS‐CoV) that was first identified in Saudi Arabia in 2012.

Clinical features

The clinical spectrum of MERS-CoV infection ranges from no symptoms (asymptomatic) or mild respiratory symptoms to severe acute respiratory disease and death.

Typical MERS symptoms include fever, cough and shortness of breath. Pneumonia is common, but not always present. Gastrointestinal symptoms, including diarrhoea, have also been reported.

Severe illness can cause respiratory failure that requires mechanical ventilation and support in an intensive care unit. The virus appears to cause more severe disease in older people, people with weakened immune systems, and those with chronic diseases such as renal disease, cancer, chronic lung disease, and diabetes.

Some laboratory-confirmed cases of MERS-CoV infection are reported as asymptomatic, meaning that they do not have any clinical symptoms, yet they are positive for MERS-CoV infection following a laboratory test. Most of these asymptomatic cases have been detected following aggressive contact tracing of a laboratory-confirmed case.

Approximately 35% of patients with MERS have died, but this may be an overestimate of the true mortality rate, as mild cases of MERS may be missed by existing surveillance systems and until more is known about the disease, the case fatality rates are counted only amongst the laboratory-confirmed cases.

Transmission

Non-human to human transmission: The route of transmission from animals to humans is not fully understood, but dromedary camels are the major reservoir host for MERS-CoV and an animal source of infection in humans. Strains of MERS-CoV that are identical to human strains have been isolated from dromedaries in several countries, including Egypt, Oman, Qatar, and Saudi Arabia.

Human-to-human transmission: The virus does not pass easily from person to person unless there is close contact, such as providing unprotected care to an infected patient. There have been clusters of cases in healthcare facilities, where human-to-human transmission appears to have occurred, especially when infection prevention and control practices are inadequate or inappropriate. Human to human transmission has been limited to date, and has been identified among family members, patients, and health care workers. While the majority of MERS cases have occurred in health care settings, thus far, no sustained human to human transmission has been documented anywhere in the world.

Health care associated outbreaks have occurred in several countries, with the largest outbreaks seen in Saudi Arabia, United Arab Emirates, and the Republic of Korea.

Approximately 80% of human cases have been reported by Saudi Arabia.

Prevention and Control

No vaccine or specific treatment is currently available, however several MERS-CoV specific vaccines and treatments are in development. Treatment is supportive and based on the patient’s clinical condition.

As a general precaution, anyone visiting farms, markets, barns, or other places where dromedary camels and other animals are present should practice general hygiene measures, including regular hand washing before and after touching animals, and should avoid contact with sick animals.

The consumption of raw or undercooked animal products, including milk and meat, carries a high risk of infection from a variety of organisms that might cause disease in humans. Animal products that are processed appropriately through cooking or pasteurization are safe for consumption, but should also be handled with care to avoid cross contamination with uncooked foods. Camel meat and camel milk are nutritious products that can continue to be consumed after pasteurization, cooking, or other heat treatments.

People with

  • diabetes,
  • renal failure,
  • chronic lung disease, and
  • immunocompromised persons

are considered to be at high risk of severe disease from MERS-CoV infection. These people should avoid contact with camels, drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

Health-care facilities

Infection prevention and control measures are critical to prevent the possible spread of MERS‐CoV in health‐care facilities. Facilities that provide care for patients suspected or confirmed to be infected with MERS‐CoV should take appropriate measures to decrease the risk of transmission of the virus from an infected patient to other patients, health‐care workers, or visitors.

Useful Links:

Link to the updated WHO fact sheet:

https://www.who.int/news-room/fact-sheets/detail/middle-east-respiratory-syndrome-coronavirus-(mers-cov)

Link to WHO Frequently Asked Questions (FAQs) on MERS-CoV:

https://www.who.int/csr/disease/coronavirus_infections/faq/en/

Link to WHO page containing resources on MERS-CoV:

https://www.who.int/emergencies/mers-cov/en/

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