The Facts on MERS
MERS (Middle East Respiratory Syndrome) is a severe pneumonia-like respiratory disease caused by a virus. It is different from SARS because MERS is caused by another subtype of the virus.
Pneumonia is a general term for an inflammation of the air sacs of the lungs caused by an infection or chemical. With pneumonia, the lungs fill with fluid, which interferes with their ability to transfer oxygen to the blood. MERS is known as an atypical pneumonia because it is not caused by the usual bacteria or viruses.
MERS causes high fever, cough, and severe shortness of breath. The infection is thought to be spread by close contact with an infected person.
Causes of MERS
A virus called coronavirus is the cause of MERS. There are many kinds of coronavirus, some of which cause the common cold. The MERS coronavirus (MERS-CoV) was a new variant that was discovered in 2012 in the Middle East region.
How MERS spreads is not completely understood, but experts believe that the main way it spreads is through close contact with an infected person (by caring for or living with the person, or having direct contact with their respiratory secretions and body fluids). The people who have been infected by MERS have all been in a health care facility or among close family members.
MERS is different from SARS. Most importantly, the MERS virus does not appear to be as easily spread between people, whereas the SARS virus spreads very easily.
Symptoms and Complications of MERS
The main symptoms of MERS are:
cough, shortness of breath and difficulty breathing
- high fever (over 38°C or 100.4°F)
Some people also develop kidney failure.
People with existing medical conditions (e.g., heart problems, diabetes) are more likely to be affected more seriously with the infection. Many of the fatal MERS infections have been in patients who had a history of other medical conditions.
See your doctor if you develop a fever, coughing, or shortness of breath within 14 days of travelling to a country in or near the Middle East (such as Saudi Arabia, Jordan, Qatar, or the United Arab Emirates).
Your doctor will ask you about your travel history, especially to any Middle Eastern countries, and whether you may have come in contact with someone who has MERS.
If your doctor suspects you may have MERS, he or she may recommend that, instead of visiting the doctor’s office, you go straight to a hospital. The hospital will take appropriate precautions to prevent the infection from spreading to others.
To diagnose MERS, a doctor will perform a physical examination and check for fever and swollen glands. He or she will also listen to your lungs with a stethoscope. Buildup of fluid in the lungs can be seen with a chest X-ray, CT scan, or magnetic resonance imaging (MRI) scan. The doctor will send a sample of your sputum (phlegm) to a laboratory to confirm the diagnosis by identifying the exact strain of virus that may be causing your symptoms.
Treating and Preventing MERS
There are currently no vaccines available for MERS. Medical care is provided to support and relieve the signs and symptoms of MERS. However, there are no treatments available to cure the infection.
There are precautions that you can take to protect yourself against infections. Wash your hands often with soap and water for at least 20 seconds, and help your children to do the same. If no soap is available, use an alcohol-based hand sanitizer. Avoid touching your eyes, nose, and mouth with unwashed hands, as they are common ways for a virus to enter your body. You should also avoid close contact (e.g., sharing cups or utensils) with those who are sick. Make sure to frequently disinfect common surfaces such as door knobs and tables with an antibacterial cleanser.
Frequently Asked Questions on Middle East respiratory syndrome coronavirus (MERS-CoV)
What is coronavirus?
Coronaviruses are a large family of viruses that cause illness in humans and animals. In people, coronaviruses can cause illnesses ranging in severity from the common cold to Severe Acute Respiratory Syndrome (SARS).
The novel coronavirus, first detected in April 2012, is a new virus that has not been seen in humans before. In most cases, it has caused severe disease. Death has occurred in about half of cases.
This new coronavirus is now known as Middle East respiratory syndrome coronavirus (MERS-CoV). It was named by the Coronavirus Study Group of the International Committee on Taxonomy of Viruses in May 2013.
Where are MERS-CoV infections occurring?
Nine countries have now reported cases of human infection with MERS-CoV. Cases have been reported in France, Germany, Italy Jordan, Qatar, Saudi Arabia, Tunisia, the United Arab Emirates, and the United Kingdom. All cases have had some connection (whether direct or indirect) with the Middle East. In France, Italy, Tunisia and the United Kingdom, limited local transmission has occurred in people who had not been to the Middle East but who had been in close contact with laboratory-confirmed or probable cases.
How widespread is MERS-CoV?
How widespread this virus may be is still unknown. WHO encourages Member States to continue to closely monitor for severe acute respiratory infections (SARI) and to carefully review any unusual patterns of SARI or pneumonia. WHO will continue to share information as it becomes available.
What are the symptoms of MERS-CoV?
Common symptoms are acute, serious respiratory illness with fever, cough, shortness of breath and breathing difficulties. Most patients have had pneumonia. Many have also had gastrointestinal symptoms, including diarrhoea. Some patients have had kidney failure. About half of people infected with MERS-CoV have died. In people with immune deficiencies, the disease may have an atypical presentation. It is important to note that the current understanding of illness caused by this infection is based on a limited number of cases and may change as we learn more about the virus.
What is the significance of the recent finding of MERS-CoV in a Camel?
On 11 November, the Ministry of Health of Saudi Arabia announced that MERS-CoV had been detected in a camel linked to a human case in Saudi Arabia. This finding is consistent with previously published reports of MERS-CoV reactive antibodies in camels, and adds another important piece of information to our understanding of MERS-CoV ecology. However, this finding does not necessarily implicate camels directly in the chain of transmission to humans. The critical question that remains about this virus is the route by which humans are infected, and the way in which they are exposed. Most patients who have tested positive for MERS-CoV had neither a human source of infection nor direct exposure to animals, including camels. It is still unclear whether camels, even if infected with MERS-CoV, play a role in transmission to humans. Further genetic sequencing and epidemiologic data are needed to understand the role, if any, of camels in the transmission of MERS CoV to humans.
How do people become infected with this virus?
We do not yet know how people become infected with this virus. Investigations are underway to determine the source of the virus, the types of exposure that lead to infection, the mode of transmission, and the clinical pattern and course of disease.
How is the virus being transmitted to humans?
We still do not know the answer to this question. It is unlikely that transmission of the MERs-CoV to people occurs through direct exposure to an infected camel, as very few of the cases have reported a camel exposure. More investigations are needed to look at the recent exposures and activities of infected humans. WHO is working with partner agencies with expertise in animal health and food safety, including FAO, OIE and national authorities, to facilitate these investigations. Many technical organizations are offering their expertise to assist ministries responsible for human health, animal health, food, and agriculture. Investigation protocols and guidelines for dealing with new cases are available on the WHO website.
- Latest information on MERS-CoV infections
Should people avoid contact with animals or animal products?
Because neither the source of the virus nor the mode of transmission is known, it is not possible to give specific advice on prevention of infection. Contact with any obviously sick animals (including birds) should be avoided, and basic hygiene measures taken, especially frequent hand washing and changing of clothes and shoes or boots, after handling animals or animal products. Sick animals should never be slaughtered for consumption. 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 processed appropriately through cooking or pasteurization are safe for consumption but should also be handled with care, to avoid cross-contamination with uncooked foods. Other hygiene measures include avoiding unwashed fruits or vegetables, and drinks made without safe water.
Are bats the source of the virus?
MERS-CoV has recently been found to be genetically related to a virus identified in bats from Southern Africa. But there is no definitive evidence that MERS-CoV originates in bats.
Can the MERS-CoV persist in the environment?
We do not yet know the answer to this question. Some types of environment are better suited for persistence of certain viruses but we still do not know exactly how well and under what conditions MERS-CoV may persist in the environment.
Can the virus be transmitted from person to person?
Yes. We have now seen multiple clusters of cases in which human-to-human transmission has occurred. These clusters have been observed in health-care facilities, among family members and between co-workers. However, the mechanism by which transmission occurred in all of these cases, whether respiratory (e.g. coughing, sneezing) or direct physical contact with the patient or contamination of the environment by the patient, is unknown. Thus far, no sustained community transmission has been observed.
Is there a vaccine or treatment for MERS-CoV?
No. No vaccine is currently available. Treatment is largely supportive and should be based on the patient’s clinical condition.
How many people have been infected by MERS-CoV?
Middle East Respiratory Syndrome Coronavirus (MERS-CoV) – Update By WHO
Disease Outbreak News
1 May 2014 – On 26 April 2014, the Ministry of Health of Egypt reported the first laboratory-confirmed case of infection with Middle East respiratory syndrome coronavirus (MERS-CoV) in the country.
“The patient is a 27 year-old man who has been living in Riyadh, Saudi Arabia for the past 4 years. The patient had contact with a previously laboratory-confirmed case (his uncle) who died on 19 April, and another laboratory-confirmed case (neighbour of his uncle) who is still under treatment in a hospital in Jeddah, Saudi Arabia. The patient became ill on 22 April, returned to Egypt on 25 April and was laboratory-confirmed with MERS-CoV on 26 April. The patient is currently in a stable condition.
WHO has mobilized a team to support Saudi Arabia to review the current situation, identify information gaps to better understand the public health risk associated with the current upsurge in cases, particularly in health-care settings, and to determine the type of further investigations to be conducted, in order to understand the transmission chain and health care associated transmission.
Saudi Arabia has provided information on 138 cases identified between 11 to 26 April 2014 in the country, including preliminary details of cases and deaths associated with the outbreak in Jeddah. WHO will update the global total of laboratory-confirmed cases of infections with MERS-CoV, including deaths, based on official information provided by Saudi Arabia as quickly as possible.”
26 April 2014 – On 26 April 2014, the Ministry of Health of the United Arab Emirates (UAE) reported seven additional laboratory-confirmed cases of infection with Middle East Respiratory Syndrome coronavirus (MERS-CoV).
The following details were provided to WHO on 24 April 2014:
- A 45 year-old woman from Abu Dhabi who is a daughter of a previously laboratory-confirmed case reported on 22 April. She became ill on 15 April. She is reported to have an underlying medical condition, and has no history of recent travel or contact with animals.
- A 4 year-old boy from Abu Dhabi. He developed mild illness on 19 April. He is reported to have no underlying medical condition, and does not have a history of recent travel or contact with animals. His mother returned from a visit to Saudi Arabia 10 days prior to his illness.
- A 37 year-old man from Abu Dhabi who was screened following exposure to a previously laboratory-confirmed case reported on 10 April. He is reported to have underlying medical conditions. He has no history of recent travel, but frequently visits the two farms he owns.
- A 32 year-old man from Abu Dhabi who was screened, following exposure to a previously laboratory-confirmed case reported on 10 April. He did not become ill and does not have any underlying medical condition. He has no history of recent travel and did not have contact with animals.
- A 33 year-old man from Abu Dhabi who was screened following exposure to a previously laboratory-confirmed case reported on 10 April. He did not become ill and is reported to have no underlying medical condition. He has no history of recent travel. He owns two farms and is reported to have contact with camels.
- A 30 year-old man from Abu Dhabi. He was screened following exposure with a previously laboratory-confirmed case reported on 10 April. He does not have any underlying medical condition. He has no history of recent travel and did not have contact with animals.
- A 42 year-old man from Abu Dhabi. He was screened following exposure to a previously laboratory-confirmed case reported on 10 April. He had mild illness. He is reported to have no underlying medical condition. He has no history of recent travel and had no contact with animals.
To date, all the abovementioned cases are in isolation in a hospital and are well. Screening of other contacts within the health care setting and families are ongoing.
24 April 2014 – On 22 April 2014, the Ministry of Health of Jordan reported an additional laboratory-confirmed case of infection with Middle East respiratory syndrome coronavirus (MERS-CoV).
“The patient is a 25 year-old man from Al Grayat City, Saudi Arabia. He became ill on 9 April, was admitted to a hospital in Saudi Arabia on 10 April and discharged from the hospital on 15 April, against medical advice. As his condition did not improve, he sought medical care at another hospital in Zarka City, Jordan on 19 April, where he was tested positive for MERS-CoV. The patient has underlying medical conditions and has a history of travel to Abha Mecca and Jeddah, Saudi Arabia from 3 to 8 April. He has history of contact with camels and is also reported to have consumed camel milk.”
Globally, from September 2012 to date, WHO has been informed of a total of 254 laboratory-confirmed cases of infection with MERS-CoV, including 93 deaths.
Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.
Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. Health-care facilities that provide 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. Health care workers should be educated, trained and refreshed with skills on infection prevention and control.
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.
Droplet precautions should be added to the standard precautions when providing care to all patients with symptoms of acute respiratory infection. Contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection. Airborne precautions should be applied when performing aerosol generating procedures.
Patients should be managed as potentially infected when the clinical and epidemiological clues strongly suggest MERS-CoV, even if an initial test on a nasopharyngeal swab is negative. Repeat testing should be done when the initial testing is negative, preferably on specimens from the lower respiratory tract.
Health-care providers are advised to maintain vigilance. Recent travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations. All Member States are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.
People at high risk of severe disease due to MERS-CoV should avoid close contact with animals when visiting farms or barn areas where the virus is known to be potentially circulating. For the general public, when visiting a farm or a barn, general hygiene measures, such as regular hand washing before and after touching animals, avoiding contact with sick animals, and following food hygiene practices, should be adhered to.
WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.
Are health workers at risk from MERS-CoV?
Yes. Transmission has occurred in health-care facilities, including spread from patients to health-care providers. WHO recommends that health-care workers consistently apply appropriate infection prevention and control measures.
How is WHO responding to the emergence of MERS-CoV?
Since the emergence of this virus, WHO has been working under the International Health Regulations to gather scientific evidence to better understand this virus and provide information to Member States. For this purpose, WHO convened the first international meeting on MERS-CoV in Cairo in January 2013.
On 19-22 June, WHO convened a second meeting in Cairo to discuss advances in scientific research and the international response to MERS-CoV. On 5 July, WHO announced it would convene an Emergency Committee under the International Health Regulations (2005). This Committee will advise the Director-General as to whether this event constitutes a Public Health Emergency of International Concern (PHEIC). The Committee may also offer advice to the Director-General on public health measures that should be taken.
WHO is also working with affected countries and international partners to coordinate the global health response, including the provision of updated information on the situation, guidance to health authorities and technical health agencies on interim surveillance recommendations, laboratory testing of cases, infection control, and clinical management.
What is WHO recommending that countries do?
WHO encourages all Member States to enhance their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns of SARI or pneumonia cases. WHO urges Member States to notify or verify to WHO any probable or confirmed case of infection with MERS-CoV.
Has WHO recommended any travel or trade restrictions related to this new virus?
No. WHO does not recommend any travel or trade restrictions with respect to MERS-CoV. WHO will continue to review all recommendations as more information becomes available.