What is Middle East Respiratory Syndrome (MERS)

Common conditions

Passengers wearing masks to prevent contracting Middle East Respiratory Syndrome (MERS) walk past a thermal imaging camera (unseen) at Incheon International Airport in Incheon, South Korea, June 2, 2015. REUTERS/Kim Hong-Ji

What is MERS?

The Middle East respiratory syndrome is a viral life-threatening infection caused by the coronavirus (MERS-CoV).

Signs and Symptoms of MERS

Although uncommon, these symptoms may be present:

  • Fever
  • Cough
  • Breathlessness

More serious symptoms:

  • Chills
  • Diahorrea
  • Nausea/vomiting
  • Coughing out blood

Complications of MERS

  • Pneumonia
  • Kidney failure
  • worsening of pre – existing diseases like diabetes, cancer, heart problems etc.

Source of MERS-CoV 

The exact source is unknown. However, camels and bats are suspected to be the main host of origin for these viruses. Camels are reported to be able to carry these viruses but it cannot be explained how many of the humans got infected without having any direct contact with camels. Bats can also carry and they often feed on fruit that’s harvested by people, so that is another possible route.

What does the virus do to the human body?

One of the most important cells of the human immune system is the macrophages. These macrophages help to eliminate any infections.

MERS-CoV can establish a productive infection in the macrophages. This induces a release of pro-inflammatory cytokines leading to:

  • Severe inflammation
  • Tissue damage

These manifest clinically as severe pneumonia and respiratory failure. The cells of the lungs are infected the most by MERS-CoV.

Severe acute respiratory syndrome (SARS) and MERS

Both SARS and MERS are relatives and have come from the Coronaviruses. They are a large family of viruses that can cause a range of illnesses in humans, from the common cold to the Severe Acute Respiratory illnesses (SARS). Viruses in this family also cause a number of animal diseases. Compared to SARS, MERS-CoV appears to be more severe and have been reported to be the cause of death to more people (40% versus 10%), more quickly and especially more severe in those with pre-existing medical conditions.

MERS is a global threat

Since the discovery of MERS in 2012, it is considered a pandemic threat to the Gulf region. However, MERS-CoV has now reached about 23 countries affecting thousands of people. 

Although MERS have been reported in US, UK, France, Germany and other countries, strict measures have been taken to stop the spread and since then there has been a decline in the numbers infected.

2015 updates on the Countries with travel-associated MERS cases: Algeria, Austria, China, Egypt, France, Germany, Greece, Italy, Malaysia, Netherlands, Philippines, Republic of Korea, Tunisia, Turkey, United Kingdom (UK), and United States of America (USA) 

However, people in South Korea are still facing the problems of MERS and about 2,300-plus people are quarantined and 1,800 schools closed in South Korea due to the fast spreading of this virus.  

Possible reasons why South Korea has more MERS cases

  • As per reports, the first patient who contracted MERS from a travel visit to the middle east when returned to Korea was left undiagnosed for a week. In that time period, many health professionals and other people who came in contact got infected.
  • There was not enough infection control taken. Bad ventilated hospital rooms may have aided the spread of the virus.
  • South Korea has also been quick to report MERS cases to the World Health Organization as compared to other countries.
  • The worst possibility that the virus may have mutated and become more infectious. Although further research needs to be done to know the exact cause as of now the World Health Organization (WHO) reports, “”There is no evidence to suggest sustained human-to-human transmission in communities and no evidence of airborne transmission. However, MERS-CoV is a relatively new disease and information gaps are considerable.”

The Ministry of Health (MOH) in Singapore continues to closely monitor the recent progress on research regarding MERS-CoV infections. As of now, no cases of MERS-CoV have been detected in Singapore. Nonetheless, given today’s globalised travel patterns. Awareness and strict precautionary measures should be undertaken.

Who is at risk of being infected?

  • Travelers: People who have come in close contact with infected people while travelling to high-risk countries.
  • Consumption of Camel products.
  • Compromised immune system: People who have lung, heart or other conditions or diseases have lower immunity and are more susceptible to the viral infection.
  • Contact with infected person such as health care professionals in hospitals. Also, people who take care of animals like bats and camels may be at increased risk. 

How does MERS-CoV spread? 

The virus can spread between people in close contact. It can spread through the air as the infected person sneezes and releases viral droplet in the air which could spread across to other individuals in close contact. 

The average incubation period has been reported to be 5 days but there are cases that occurred up to 14 days after exposure. Incubation period refers to the amount of time when a person is first exposed to the virus and when the symptoms starts to occur.

How is MERS diagnosed?

There are two main ways to determine if an infection is with MERS-CoV.

  •  Polymerase chain reaction (PCR) analysis: PCR tests are done with respiratory samples and can quickly indicate if a person has an active infection with MERS-CoV.
  • Serology testing: blood samples designed to look for antibodies to MERS-CoV that would indicate a person had previously been infected with the virus hence developed an immune response.

Other tests

  • X-ray to determine the extent of the damage: All patients with MERS have an abnormal chest X-ray. Pneumonia is commonly seen as shown in Fig 1.  The black portion shows the normal air-filled spaces in the lungs and the white portion on the left lung is called infiltrates (filling of air spaces with infectious fluid) that identifies the presence of pneumonia infection. 
image016 (1)

Fig 1: Pneumonia in the Right lung

How to prevent and treat MERS?

There is no known vaccine for MERS and no known medications that have been proved to be effective for the treatment of coronavirus infections. Clinical research is still working on establishing an effective treatment.

Infection prevention and control measures: Especially in healthcare settings, this is important to prevent the possible spread of MERS-CoV.

Early identification of people with MERS-CoV is difficult as like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, standard precautions should be taken with all patients, regardless of diagnosis.

General precautionary measures

  • When in contact with a person with any symptoms of acute respiratory infection, contact precautions and eye protection should be taken. As the infection is airborne, it can spread through the mucosal lining of the eyes and nose. 
  • Even touching contaminated objects or surfaces and then touching the eyes, nose, or mouth can lead to the spread of the infection. 
  • General hygiene measures – regular hand washing before and after touching animals and avoiding contact with sick animals.
  • Food hygiene practices should be observed. People should avoid camel food products.

Until research reveals more about MERS-CoV, people with diabetes, renal failure, chronic lung disease and people with compromised immunity are considered to be at high risk from MERS‐CoV infection. Therefore, these people should avoid close contact with animals, particularly camels when visiting farms, markets or barn areas where the virus is known to be potentially circulating.

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