Summary
Middle East respiratory syndrome coronavirus (MERS-CoV) which was first described in 2012, belongs to the CoV family. Coronaviruses may cause global outbreaks with high mortality. Although there is no definite evidence, it is thought that bats are reservoir hosts and one-humped camels are intermediate hosts. According to the World Health Organization data, 1,698 MERS-CoV cases were identified as of March, 23th, 2016 with 609 (36%) deaths. Most of the cases were seen in Saudi Arabia. South Korea is the country following Saudi Arabia where most of the cases developed through in-hospital spread. There is no reported case from Turkey except a Turkish patient returning from Saudi Arabia. In Saudi Arabia, there was a marked peak in new cases during April 2014 and May 2014. Although there was no spesific symptom or laboratory finding that belongs to MERS-CoV, pneumonia, acute respiratory distress syndrome and acute renal failure were the most common clinical conditions. Diabetes mellitus, hypertension, congestive hearth failure and chronic renal failure were usually the main predisposing diseases. Real-time polymerase chain reaction is the gold standard for diagnosis and lower respiratory samples are preferred because of high viral load. There is no spesific treatment for MERS-CoV but there are reports showing decreased viral load with ribavirin-interferon combination. Strict and correct personal protective equipment use is the most important factor for preventing the spread of the disease.
References
1Mcintosh K, Mandell GL, Douglas RG, Bennett JE. Coronaviruses, Including Severe Acute Respiratory Syndrome [SARS] and Middle East Respiratory Syndrome [MERS] eds. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases 6. New York: Churchill Livingstone, 2015;1928-36.
2Tyrrell DA, Almeida JD, Cunningham CH, Dowdle WR, Hofstad MS, Mcintosh K, Tajima M, Zakstelskaya LY, Easterday BC, Kapikian A, Bingham RW. Coronaviridae. Intervirology. 1975;5:76-82.
3Zumla A, Hui DS, Perlman S. Middle East respiratory syndrome. Lancet. 2015;386:995-1007.
4King AM, MJ A, Lefkowitz EJ. Virus taxonomy: classification and nomenclature of viruses: Ninth report of the international committee on taxonomy of viruses. San Diego CA: Elsevier Academic Press, 2012.
5Microbiology and Immunology Online, 27.06.2013 available from http:// www.microbiologybook.org/virol/coronaviruses.htm
6Corti D, Zhao J, Pedotti M, Simonelli L, Agnihothram S, Fett C, Fernandez- Rodriguez B, Foglierini M, Agatic G, Vanzetta F, Gopal R, Langrish CJ, Barrett NA, Sallusto F, Baric RS, Varani L, Zambon M, Perlman S, Lanzavecchia A. Prophylactic and postexposure efficacy of a potent human monoclonal antibody against MERS coronavirus. Proc Natl Acad Sci USA. 2015;112:10473-8.
7Raj VS, Mou H, Smits SL, Dekkers DH, Muller MA, Dijkman R, Muth D, Demmers JA, Zaki A, Fouchier RA, Thiel V, Drosten C, Rottier PJ, Osterhaus AD, Bosch BJ, Haagmans BL. Dipeptidyl peptidase 4 is a functional receptor for the emerging human coronavirus-EMC. Nature. 2013;495:251-4.
8Lu L, Liu Q, Du L, Jiang S. Middle East respiratory syndrome coronavirus [MERS-CoV]: challenges in identifying its source and controlling its spread. Microbes Infect. 2013;15:625-9.
9Chan JF, Chan KH, Choi GK, To KK, Tse H, Cai JP, Yeung ML, Cheng VC, Chen H, Che XY, Lau SK, Woo PC, Yuen KY. Differential cell line susceptibility to the emerging novel human betacoronavirus 2c EMC/2012: implications for disease pathogenesis and clinical manifestation. J Infect Dis. 2013;207:1743-52.
10Memish ZA, Mishra N, Olival KJ, Fagbo SF, Kapoor V, Epstein JH, Alhakeem R, Durosinloun A, Al Asmari M, Islam A, Kapoor A, Briese T, Daszak P, Al Rabeeah AA, Lipkin WI. Middle East respiratory syndrome coronavirus in bats, Saudi Arabia. Emerg Infect Dis. 2013;19:1819-23.
11Azhar EI, El-Kafrawy SA, Farraj SA, Hassan AM, Al-Saeed MS, Hashem AM, Madani TA. Evidence for camel-to-human transmission of MERS coronavirus. N Engl J Med. 2014;370:2499-505.
12Hemida MG, Perera RA, Al Jassim RA, Kayali G, Siu LY, Wang P, Chu KW, Perlman S, Ali MA, Alnaeem A, Guan Y, Poon LL, Saif L, Peiris M. Seroepidemiology of Middle East respiratory syndrome [MERS] coronavirus in Saudi Arabia [1993] and Australia [2014] and characterisation of assay specificity. Euro Surveill. 2014;19.
13Corman VM, Jores J, Meyer B, Younan M, Liljander A, Said MY, Gluecks I, Lattwein E, Bosch BJ, Drexler JF, Bornstein S, Drosten C, Muller MA. Antibodies against MERS coronavirus in dromedary camels, Kenya, 1992- 2013. Emerg Infect Dis. 2014;20:1319-22.
14Aburizaiza AS, Mattes FM, Azhar EI, Hassan AM, Memish ZA, Muth D, Meyer B, Lattwein E, Muller MA, Drosten C. Investigation of anti-middle East respiratory syndrome antibodies in blood donors and slaughterhouse workers in Jeddah and Makkah, Saudi Arabia, fall 2012. J Infect Dis. 2014;209:243-6.
15Kupferschmidt K. Infectious diseases. MERS surges again, but pandemic jitters ease. Science. 2015;347:1296-7.
16World Health Organization [WHO], Investigation of cases of human infection with Middle East respiratory syndrome coronavirus [MERSCoV], Updated 3 July 2015. Available from: http://apps.who.int/iris/ bitstream/10665/178252/1/WHO_MERS_SUR_15.2_eng.pdf.
17Drosten C, Meyer B, Muller MA, Corman VM, Al-Masri M, Hossain R, Madani H, Sieberg A, Bosch BJ, Lattwein E, Alhakeem RF, Assiri AM, Hajomar W, Albarrak AM, Al-Tawfiq JA, Zumla AI, Memish ZA. Transmission of MERScoronavirus in household contacts. N Engl J Med. 2014;371:828-35.
18Oboho IK, Tomczyk SM, Al-Asmari AM, Banjar AA, Al-Mugti H, Aloraini MS, Alkhaldi KZ, Almohammadi EL, Alraddadi BM, Gerber SI, Swerdlow DL, Watson JT, Madani TA. 2014 Mers-Cov outbreak in Jeddah a link to health care facilities. N Engl J Med. 2015;372:846-54.
19Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med. 2012;367:1814-20.
20Bermingham A, Chand MA, Brown CS, Aarons E, Tong C, Langrish C, Hoschler K, Brown K, Galiano M, Myers R, Pebody RG, Green HK, Boddington NL, Gopal R, Price N, Newsholme W, Drosten C, Fouchier RA, Zambon M. Severe respiratory illness caused by a novel coronavirus, in a patient transferred to the United Kingdom from the Middle East, September 2012. Euro Surveill. 2012;17:20290.
21World Health Organization [WHO], Middle East respiratory syndrome coronavirus [MERS-CoV] - Saudi Arabia, Available from: http://www.who. int/csr/don/23-march-2016-mers-saudi-arabia/en/
22Kingdom of Saudi Arabia, Ministry of Health Portal. Available from: http:// www.moh.gov.sa/en/CCC/PressReleases/Pages/default.aspx
23World Health Organization [WHO], Middle East respiratory syndrome coronavirus [MERS-CoV]. Available from: http://www.who.int/mediacentre/ factsheets/mers-cov/en/
24Kingdom of Saudi Arabia, Ministry of Health Portal, Available from: http:// www.moh.gov.sa/en/CCC/PressReleases/Pages/default.aspx
25World Health Organization [WHO], Middle East respiratory syndrome coronavirus [MERS- CoV] - Republic of Korea Son Erişim tarihi: 25 Ekim 2015. Available from: http://www.who.int/csr/don/25-october-2015-merskorea/ en/
26World Health Organization, Middle East respiratory syndrome coronavirus [MERS-CoV] - Turkey, 24 October 2014. Available from: http://www.who. int/csr/don/24-october-2014-mers/en/
27Sampathkumar P. Middle East respiratory syndrome: what clinicians need to know. Mayo Clin Proc. 2014;89:1153-8.
28TC Sağlık Bakanlığı, Türkiye Kamu Hastaneleri Kurumu, MERS-Cov Hastalığı. Available from: http://www.tkhk.gov.tr/DB/9/1668_merscov--hastaligi-v
29Saad M, Omrani AS, Baig K, Bahloul A, Elzein F, Matin MA, Selim MA, Al Mutairi M, Al Nakhli D, Al Aidaroos AY, Al Sherbeeni N, Al-Khashan HI, Memish ZA, Albarrak AM. Clinical aspects and outcomes of 70 patients with Middle East respiratory syndrome coronavirus infection: a single-center experience in Saudi Arabia. Int J Infect Dis. 2014;29:301-6.
30World Health Organization [WHO]. Available from: http://www.who.int/ csr/disease/coronavirus_infections/WHO_interim_recommendations_lab_ detection_MERSCoV_092014.pdf?ua=1.
31World Health Organization, Laboratory Testing for Middle East Respiratory Syndrome Coronavirus, June 2015. Kingdom of Saudi Arabia, Ministry of Health Portal, Case Definition and Surveillance Guidance- Updated June 2015. Available from: http://apps.who.int/iris/bitstream/10665/176982/1/ WHO_MERS_LAB_15.1_eng.pdf
32MERS Interim patient under investigation [PUI] Guidance and Case Definitions. Available from: http://www.cdc.gov/coronavirus/mers/case-def. html
33Al-Dorzi H M, Alsolamy S, Arabi YM. Critically ill patients with Middle East respiratory syndrome coronavirus infection. Critical Care. 2016;20:1.
34Kindler E, Jonsdottir HR, Muth D, Hamming OJ, Hartmann R, Rodriguez R, Geffers R, Fouchier RA, Drosten C, Muller MA, Dijkman R, Thiel V. Efficient replication of the novel human betacoronavirus EMC on primary human epithelium highlights its zoonotic potential. MBio. 2013;4:e00611-12.
35Zielecki F, Weber M, Eickmann M, Spiegelberg L, Zaki AM, Matrosovich M, Becker S, Weber F. Human cell tropism and innate immune system interactions of human respiratory coronavirus EMC compared to those of severe acute respiratory syndrome coronavirus. J Virol. 2013;87:5300-4.
36Falzarano D, de Wit E, Rasmussen AL, Feldmann F, Okumura A, Scott DP, Brining D, Bushmaker T, Martellaro C, Baseler L, Benecke AG, Katze MG, Munster VJ, Feldmann H. Treatment with interferon-alpha2b and ribavirin improves outcome in MERS-CoV-infected rhesus macaques. Nat Med. 2013;19:1313-7.
37Omrani AS, Saad MM, Baig K, Bahloul A, Abdul-Matin M, Alaidaroos AY, Almakhlafi GA, Albarrak MM, Memish ZA, Albarrak AM. Ribavirin and interferon alfa-2a for severe Middle East respiratory syndrome coronavirus infection: a retrospective cohort study. Lancet Infect Dis. 2014;14:1090-5.
38Hart BJ, Dyall J, Postnikova E, Zhou H, Kindrachuk J, Johnson RF, Olinger GG, Jr., Frieman MB, Holbrook MR, Jahrling PB, Hensley L. Interferon-beta and mycophenolic acid are potent inhibitors of Middle East respiratory syndrome coronavirus in cell-based assays. J Gen Virol. 2014;95:571-7.
39Falzarano D, de Wit E, Martellaro C, Callison J, Munster VJ, Feldmann H. Inhibition of novel beta coronavirus replication by a combination of interferon-alpha 2b and ribavirin. Sci Rep. 2013;3:1686.
40Chong YP, Song JY, Seo YB, Choi JP, Shin HS, Rapid Response T. Antiviral Treatment Guidelines for Middle East Respiratory Syndrome. Infect Chemother. 2015;47:212-22.
41Chan JF, Yao Y, Yeung ML, Deng W, Bao L, Jia L, Li F, Xiao C, Gao H, Yu P, Cai JP, Chu H, Zhou J, Chen H, Qin C, Yuen KY. Treatment With Lopinavir/ Ritonavir or Interferon-beta1b Improves Outcome of MERS-CoV Infection in a Nonhuman Primate Model of Common Marmoset. J Infect Dis. 2015;212:1904-13.
42World Health Organization, Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus [MERS-CoV] infection, June 2015. Available from: http://www. who.int/csr/disease/coronavirus_infections/ipc-mers-cov/en/
43World Health Organization World - Travel advice on MERS-CoV for pilgrimages, June 2014. Available from: http://www.who.int/ith/ updates/20140603/en/.
44CDC. Interim infection prevention and control recommendations for hospitalized patients with Middle East respiratory syndrome coronavirus [MERS-CoV]. Uptaded May 15, 2014. Available from: http://www.cdc.gov/ coronavirus/mers/infection-prevention-control.html
45Trajman A, Menzies D. Occupational respiratory infections. Curr Opin Pulm Med. 2010;16:226-34.
46Wang L, Shi W, Joyce MG, Modjarrad K, Zhang Y, Leung K, Lees CR, Zhou T, Yassine HM, Kanekiyo M, Yang ZY, Chen X, Becker MM, Freeman M, Vogel L, Johnson JC, Olinger G, Todd JP, Bagci U, Solomon J, Mollura DJ, Hensley L, Jahrling P, Denison MR, Rao SS, Subbarao K, Kwong PD, Mascola JR, Kong WP, Graham BS. Evaluation of candidate vaccine approaches for MERS-CoV. Nat Commun. 2015;6:7712.
