Middle East Respiratory Syndrome (MERS)

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This website was last updated June 12, 2013 3:00 PM EDT

Updates:


A novel coronavirus called “Middle East Respiratory Syndrome Coronavirus” (MERS-CoV) was identified in 2012 as the cause of respiratory illness in people. Investigations are being done to figure out the source of MERS-CoV and how it spreads.
jvi.asm.org/content/early/2013/05/08/JVI.01244-13.full.pdf


So far, there are no reports of anyone in the U.S. getting infected with MERS-CoV.

The Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses (ICTV) decided in May 2013 to call the novel coronavirus “Middle East Respiratory Syndrome Coronavirus” (MERS-CoV) Adobe PDF file [1.7 MB, 5 pages]External Web Site Icon.
Update: Severe Respiratory Illness Associated with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) — Worldwide, 2012–2013

Update: Severe Respiratory Illness Associated with Middle East Respiratory Syndrome Coronavirus (MERS-CoV)—Worldwide, 2012–2013.MMWR. June 7, 2013
For Healthcare Professionals:
Update, Case Definitions, & Guidance
Infection Control RecommendationsJune 11, 2013
Travel Notice:
A Novel Coronavirus Called "MERS-CoV" in the Arabian Peninsula

www.cdc.gov/coronavirus/mers/index.html

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MERS-CoV Photos

Coronaviruses derive their name from the fact that under electron microscopic examination, each virion is surrounded by a "corona," or halo. This is due to the presence of viral spike peplomers emanating from each proteinaceous envelope.

www.cdc.gov/coronavirus/mers/photos.html

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Update, Case Definitions, and Guidance

MERS Update

CDC continues to work closely with the World Health Organization (WHO) and other partners to better understand the public health risk presented by Middle East Respiratory Syndrome Coronavirus (MERS-CoV). MERS-CoV used to be called “novel coronavirus,” or “nCoV”.

MERS Clusters Under Investigation

The first cluster of two cases, both fatal, occurred near Amman, Jordan, in April 2012. Stored samples from these two cases tested positive retrospectively for MERS-CoV. This cluster was temporally associated with cases of illness among workers in a hospital (2).

•A second cluster occurred in October 2012, in Saudi Arabia. Of the four individuals in the household, three were laboratory-confirmed cases, two of them died.
•In February 2013, a third cluster of three family members was identified in the United Kingdom. All three people tested positive for MERS-CoV. Among them, two died, and one recovered after experiencing a mild respiratory illness. This cluster provides evidence of person-to-person transmission of novel coronavirus. It also provides the first example of mild illness being associated with MERS-CoV infection.
•A fourth cluster among two family contacts occurred in Saudi Arabia in February 2013. One of the individuals died, and one recovered after experiencing a mild respiratory illness.
•Beginning April 2013, a fifth geographic cluster was reported in the Al-Ahsa region of eastern Saudi Arabia, with most cases linked to one healthcare facility. A total of 25 cases have been reported in the cluster, of which 14 have died. At least one of the cases was a family member contact. At least three of the cases were reported as not linked to the healthcare facility. Two healthcare providers in this cluster were infected after caring for patients who had MERS-CoV infection.
•A sixth cluster of two cases was reported in France in May 2013. One person became infected after sharing a hospital room with the country’s first infected person. The initial case died. He had a history of recent travel from the United Arab Emirates prior to becoming ill.
•A seventh family cluster among two laboratory-confirmed cases and one probable case was reported in Tunisia in May 2013. These were the first laboratory-confirmed cases in Africa.
•An eighth cluster of three cases was reported in Italy in May 2013. The index case had recently traveled from Jordan after a 40-day visit. Two more people were infected after having close contact with the index case.

These eight clusters, which occurred among close contacts or in healthcare settings, provide clear evidence of human-to-human transmission of MERS-CoV, possibly involving different modes, such as droplet and contact transmission. But further studies are required to better understand the risks. The efficiency of person-to-person transmission of MERS-CoV is not well characterized. So far, there is no reported evidence of sustained community transmission in any country.

The original source of MERS-CoV, routes of transmission to humans, and mode of human-to-human transmission have not been determined. Genetic sequencing to date has determined the virus is most closely related to coronaviruses detected in bats. CDC is continuing to collaborate with WHO and affected countries to better characterize the epidemiology of MERS-CoV infection in humans.



Case Definitions(2)

Patient Under Investigation (PUI)

CDC requests that state and local health departments immediately report PUIs for MERS-CoV infection to CDC.

A Patient Under Investigation (PUI) is a person with-
•an acute respiratory infection, which may include fever (≥ 38°C , 100.4°F) and cough; AND
•suspicion of pulmonary parenchymal disease (e.g., pneumonia or acute respiratory distress syndrome based on clinical or radiological evidence of consolidation); AND
•history of travel from the Arabian Peninsula or neighboring countries* within 14 days; AND
•not already explained by any other infection or etiology, including all clinically indicated tests for community-acquired pneumonia** according to local management guidelines.

In addition, the following people may be considered for evaluation for MERS-CoV infection:
•People who develop severe acute lower respiratory illness of known etiology within 14 days after travel from the Arabian Peninsula or neighboring countries* but do not respond to appropriate therapy; OR
•People who develop severe acute lower respiratory illness who are close contacts of a symptomatic traveler who developed fever and acute respiratory illness within 14 days after travel from the Arabian Peninsula or neighboring countries*.

Close contact is defined as:
•Any person who provided care for the patient, including a healthcare worker or family member, or had similarly close physical contact.
•Any person who stayed at the same place (e.g. lived with, visited) as the patient while the patient was ill.

For more information, see Interim Guidance for State and Local Health Departments.

Footnotes

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* Countries considered in the Arabian Peninsula and neighboring include: Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen.

** Examples of respiratory pathogens causing community-acquired pneumonia include influenza A and B, respiratory syncytial virus, Streptococcus pneumoniae, and Legionella pneumophila.

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CONTINUED:

Probable Case

Any person who-
•meets the criteria above for “Patient Under Investigation” and has clinical, radiological, or histopathological evidence of pulmonary parenchyma disease (e.g. pneumonia or ARDS), but no possibility of laboratory confirmation exists, either because the patient or samples are not available or there is no testing available for other respiratory infections, AND
•is a close contact with a laboratory-confirmed case, AND
•has illness not already explained by any other infection or etiology, including all clinically indicated tests for community-acquired pneumonia according to local management guidelines.

OR any person with-
•severe acute respiratory illness with no known etiology, AND
•an epidemiologic link to a confirmed MERS case.

Confirmed Case
•A person with laboratory confirmation of infection with MERS-CoV.

Clusters of Severe Acute Respiratory Illness

Any clusters of severe acute respiratory illness (SARI) in healthcare workers in the United States should be thoroughly investigated (3,4). Clusters of SARI of unknown etiology in the community should also be thoroughly investigated, and if no etiology is identified, this should prompt immediate notification of local public health officials, and testing for MERS-CoV should be conducted if indicated.

Also see WHO case definitions in the WHO interim surveillance recommendations for human infection with novel coronavirus Adobe PDF fileExternal Web Site Icon [4 pages, May 18, 2013].

Top of Page

Guidance

For Healthcare Providers
•Infection control recommendations for healthcare settings
Standard, contact, and airborne precautions are recommended for management of hospitalized patients with known or suspected MERS-CoV infection. These recommendations are consistent with those recommended for the coronavirus that caused severe acute respiratory syndrome (SARS) in 2003. The recommendations are based on available information (as of June 10, 2013) and will be re-evaluated and updated as needed when new information becomes available. See 2013 Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) New June 11, 2013

Infection prevention recommendations may be updated as information about transmission and the severity of clinical illness caused by MERS-CoV becomes available.
•Respirator Trusted-Source Information
•Respirator Fact Sheet

For Health Departments
•Interim Guidance for State and Local Health Departments
•Interim Local Health Departments MERS-CoV Investigation Short Form Adobe PDF file [1 page] Revised Jun 2013
•Interim Local Health Departments MERS-CoV Investigation Short Form Microsoft Word file [1 page] Revised Jun 2013

Lab Guidance
•Interim Guidelines for Collection, Processing and Transport of Clinical Specimens from Patients Under Investigation for MERS Adobe PDF file [3 pages] Revised Jun 2013
•Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with MERS Adobe PDF file [2 pages] Reviewed Jun 2013

References
1.Coronavirus infectionsExternal Web Site Icon. Global Alert and Response (GAR) 2013 [cited June 5, 2013].
2.Interim surveillance recommendations for human infection with MERS-CoV - update Adobe PDF file [4 pages]External Web Site Icon. May 18, 2013 [cited May 29, 2013].
3.Technical Guidelines for Integrated Disease Surveillance and Response in the African Region October 2010 Adobe PDF file [3.1 MB, 416 pages]. 2010 [cited December 2, 2012].
4.CDC. How to Investigate Unexplained Respiratory Disease Outbreaks (URDO) [cited December 7, 2012].

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About Coronavirus

Q:What are coronaviruses?


A: Coronaviruses are common viruses that most people get some time in their life. Human coronaviruses usually cause mild to moderate upper-respiratory tract illnesses.

Coronaviruses are named for the crown-like spikes on their surface. There are three main sub-groupings of coronaviruses, known as alpha, beta and gamma, and a fourth provisionally-assigned new group called delta coronaviruses.

Human coronaviruses were first identified in the mid 1960s. The five coronaviruses that can infect people are: alpha coronaviruses 229E and NL63 and beta coronaviruses OC43, HKU1, and SARS-CoV, the coronavirus that causes severe acute respiratory syndrome.

Coronaviruses may also infect animals. Most of these coronaviruses usually infect only one animal species or, at most, a small number of closely related species. However, SARS-CoV can infect people and animals, including monkeys, Himalayan palm civets, raccoon dogs, cats, dogs, and rodents.

Q: How common are human coronavirus infections?


A: People around the world commonly get infected with human coronaviruses. However, one exception is SARS-CoV. Since 2004, there have not been any known cases of SARS-CoV infection reported anywhere in the world.

Q: Who can get infected?


A: Most people will get infected with human coronaviruses in their life time. Young children are most likely to get infected. However, you can have multiple infections in your life time.

Q: How do I get infected?


A: The ways that human coronaviruses spread have not been studied very much, except for SARS. However, it is likely that human coronaviruses spread from an infected person to others through—
•the air by coughing and sneezing, and
•close personal contact, such as touching or shaking hands.

These viruses may also spread by touching contaminated objects or surfaces then touching your mouth, nose, or eyes.

In one case, the SARS virus was though to spread through infected stool that got into the air; people breathed this in and got infected.

Q: When can I get infected?


A: In the United States, people usually get infected with human coronaviruses in the fall and winter. However, you can get infected at any time of the year.

Q: What are the symptoms?


A: Human coronaviruses usually cause mild to moderate upper-respiratory tract illnesses of short duration. Symptoms may include runny nose, cough, sore throat, and fever. These viruses can sometimes cause lower-respiratory tract illnesses, such as pneumonia. This is more common in people with cardiopulmonary disease or compromised immune systems, or the elderly.

SARS-CoV can cause severe illness. To learn more, see Symptoms of SARS.

Q: How can I protect myself?


A: There are currently no vaccines available to protect you against human coronavirus infection. You may be able to reduce your risk of infection by—
•washing your hands often with soap and water,
•not touching your eyes, nose, or mouth, and
•avoiding close contact with people who are sick.

For information about hand washing, see CDC’s Clean Hands Save Lives!

Q: What should I do if I get sick?


A: If you have an illness caused by human coronaviruses, you can help protect others by—
•staying home while you are sick,
•avoiding close contact with others,
•covering your mouth and nose when you cough or sneeze, and
•keeping objects and surfaces clean and disinfected.

Q: How do I get diagnosed?


A: Laboratory tests can be done to confirm whether your illness may be caused by human coronaviruses. However, these tests are not used very often because people usually have mild illness. Also, testing may be limited to a few specialized laboratories.

Specific laboratory tests may include:
•virus isolation in cell culture,
•polymerase chain reaction (PCR) assays that are more practical and available commercially, and
•serological testing for antibodies to human coronaviruses.

Nose and throat swabs are the best specimens for detecting common human coronaviruses. Serological testing requires collection of blood specimens.

Q: Are there treatments?


A: There are no specific treatments for illnesses caused by human coronaviruses.

Most people with coronavirus illness will recover on their own. However, some things can be done to relieve your symptoms, such as—
•taking pain and fever medications (Caution: Aspirin should not be given to children), and
•using a room humidifier or taking a hot shower to help ease a sore throat and cough.

If you are sick, you should —
•drink plenty of liquids, and
•stay home and rest.

If you are concerned about your symptoms, you should see you healthcare provider.



Related Pages
Coronaviruses, including SARS-CoV (Red Book, American Academy of Pediatrics, 2012)External Web Site Icon