Middle East Respiratory Syndrome (MERS) – An update

Middle East Respiratory Syndrome (MERS) is a viral respiratory illness, caused by coronavirus called “Middle East Respiratory Syndrome Coronavirus” (MERS-CoV). It was first reported on 24 September 2012 by an Egyptian virologist, Dr. Ali Mohamed Zaki in Jeddah, Saudi Arabia. ⁽¹⁾ The symptoms of MERS-CoV infection are fever, cough, and shortness of breath and later on development of severe acute respiratory illness. Gastrointestinal symptoms as diarrhea and vomiting have also reported among the patients. About half of the patients of MERS die. Severe complications include renal failure and acute respiratory distress syndrome (ARDS) with shock. Severely immunocompromised patients can present with atypical signs and symptoms. ⁽²⁾

MERS-CoV is a beta coronavirus. The virus spreads from person to person who are in close contact. Transmission from infected patients to healthcare personnel has also been observed. Persons at risk are elderly people age 65 years or above, children, pregnant women, persons with chronic diseases and weakened immune system. ⁽³⁾

Bats and camels were considered as zoonotic reservoir, but world organization for Animal Health (OIE) announced that “currently there is no strong evidence that camels are source of infection for human cases of MERS. ^{(4, 5)}

Lab tests (polymerase chain reaction or PCR) for MERS-CoV is available. There is no specific treatment for MERS-CoV, only supportive and symptomatic treatment is offered to the patient.

The Centers for Disease Control and Prevention (CDC) is working with partners in countries having epidemic of MERS-CoV to better understand the risk factor of this virus, its mode of spread and possible preventive measures against it. ⁽⁶⁾

Latest situation of MERS, from April 2012 to 15 November 2013 is as:-

MERS Cases and Deaths, April 2012 to November 15, 2013

Countries	Cases (Deaths)
France	2 (1)
Italy	1(0)
Jordan	2 (2)
Oman	1 (0)
Qatar	8 (3)
Saudi Arabia	127 (53)
Tunisia	3 (1)
United Kingdom(UK)	3 (2)
United Arab Emirates (UAE)	6 (2)
Total	153 (64)

Source: http://www.cdc.gov/coronavirus/mers/

The Ministry of Health, Kingdom of Saudi Arabia has launched awareness campaign against the disease, ⁽⁷⁾ which includes:-

1. Continuous communication with the local and international community through conferences and scientific meetings.

2. Launching a webpage on MOH website with the aim to identify the disease, its updates and the preventive strategies.

3. Using the social networking sites, especially Tweeter and Face book.

4. A toll free number by the MOH for questions and inquiries related to the disease

5. Using awareness videos, illustrated news reports and advertising in newspapers and on TV.

6. Using SMS and health educational material as brochures to identify the disease and the ways of prevention

The CDC, Ministry of Health, Kingdom of Saudi Arabia has advised the following measures for the people to prevent respiratory illnesses:

1. Wash hands well with water and soap, or with other disinfectants used for hand washing, especially after coughing, sneezing, and help young children do the same.

2. Covering of nose and mouth with a tissue paper when coughing or sneezing then throwing the tissue in the trash for safe disposal.

3. Try as much as possible to avoid touching the eyes, nose and mouth with your hands, because it can transmit the virus after touching surfaces contaminated with the virus.

4. Avoid as much as possible contacting with infected people and to put on face-mask in overcrowded places.

5. Avoid close contact, such as kissing, sharing drinking and eating utensils, with sick people.

6. Pay attention to other healthy habits as the use balanced diet and physical activity, as well as taking enough sleep, as it helps to increase the body’s immunity.

7. Clean and disinfect frequently touched surfaces, such as toys and doorknobs.