What is MERS?

Human coronaviruses usually cause mild to moderate upper-respiratory tract illnesses of short duration. Symptoms may include runny nose, cough, sore throat, and fever. Lower respiratory tract infections tend to occur in people with underlying medical conditions. Fall and winter are typical times of the year for infections to occur.
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.
After the initial surge of human cases in 2013, the rate of human cases slowed until March 2014 when a surge in cases was seen most notably in Saudi Arabia. Globally, from September 2012 to date, WHO has been informed of a total of 496 laboratory-confirmed cases of infection with MERS-CoV. This total includes 229 cases reported between 11 April and 4 May by Saudi Arabia, and the recent reports of 3 cases from Jordan, and one case each from Egypt, the United States, and Yemen
May 2, 2014 the first human case of MERS in the United States was reported by Indiana health officials. The patient is in his 60’s and is a citizen of the US but lives and works in Saudi Arabia. The man is a healthcare worker but has had no known contact with MERS patients in his place of work. The man traveled to the US to visit relatives in Indiana. To date no cases have been confirmed in his family, travel, or healthcare contacts. The man is expected to leave the hospital soon.
May 12, 2014 the second human MERS case has been reported in the US. This case though not epidemiologically related to the first case there are similarities in that the second case is in a patient travelling to the US from the Middle East and the onset and clinical symptoms are very similar to the first case. The healthcare workers for the second patient hospitalized in Orlando are being tested for the virus.
The US posted a travel advisory today at major US airports for folks coming from the Middle East and/or traveling to the Middle East. While a concern, this second case is not unexpected and US officials are taking precautions, nit unlike with 2009H1N1, but they also indicate thus far the risk of transmission is low.
May 17, 2014 US officials have confirmed the first secondary human infection as a man who had face-to-face contact with the Indiana man (US first confirmed case) has been infected with the virus. The man has shown no signs of illness, the virus was confirmed from blood tests.
However, sustained human-to-human transmission has not been confirmed to date even with the surge in cases in Saudi Arabia.

May 29, 2013 – the World Health Organization has warned MERS could be the next pandemic as the virus is spreading faster than information is being gained as to source and mode of transmission.
June 4, 2013 – The Obama administration declared Mideast flu a public health emergency

MERS has been determined to be a threat to public health and national security leading to the public health emergency declaration which allows for rapid development of diagnostic tools. For more information see – article.

What is a Coronavirus?
Coronaviruses are grouped as alpha, beta, gamma, and a provisional grouping delta. The new virus, MERS-CoV or MERS is a beta coronavirus and it is different than other coronaviruses that have been found in people before. As such this novel coronavirus is not the same virus that caused severe acute respiratory syndrome (SARS) in 2003.
Symptoms of novel coronavirus infection have included fever, cough, and shortness of breath. At this time the novel coronavirus appears to have a high mortality rate.
Initial research has suggested the new coronavirus is of bat origin, as was the SARS 2003 virus. And in fact it has been confirmed the virus is 100% of tomb bat origin, however the intermediate hosts remain unknown. The use of bat guano as fertilizer may be providing the mode of transmission of adaptation of the virus to infect humans.
Recent research suggests the virus is of camel origin as human isolates of the virus have been found in camels, some of whom showed no symptoms of the disease.


Has there been human-to-human transmission of MERS?
As 2013 ended there had been reports of transmission of the virus from infected patients to healthcare workers, but no sustained human-to-human transmission and no transmission of the virus outside a healthcare setting was confirmed.
The announcement May 17, 2014 of a secondary infection in an Illinois man who had face-to-face business contacts with the Indiana man confirmed as the first US case confirms human-to-human transmission outside a healthcare setting, However this is not evidence of sustained human-to-human transmission.
It was reported May 7, 2013 that the recent cluster cases are in not one but several hospitals raising concern about human-to-human transmission. There have been 13 cases reported in Saudi Arabia; five of these people died the last week of April, two the first week of May and two this past week.
A British citizen became ill after returning home from a trip to Saudi Arabia and Pakistan and infected two family members.
May 7, 2013 French officials released a statement a Frenchman fell ill after returning from a trip to the United Arab Emirates. The man is under isolation and medical surveillance at a hospital. May 9 French officials reported 3 suspected cases of the virus in a nurse, doctor and roommate all of whom had contact with the ill man. Tests are pending.
May 13, WHO officials suggested the new virus is transmissible human-to-human upon prolonged contact with an infected individual.
May 21, 2013 officials in Tunisia reported the death of a 66 year-old-man and illness of his 2 children from MERS. All three had traveled to Saudi Arabia. The 66 year old was diabetic and had other health related issues.
WHO officials have now as of May 22, 2013 shared concern the virus may be easily spread to India and the Philippines due to workers from these countries traveling back and forth to home.. Australia has issued a travel alert.


How to protect yourself from MERS
To date there have not been any infections of the novel coronavirus in the United States. If traveling to the Arabian Peninsula, the Centers for Disease Control Recommends:
Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer.
Avoid touching your eyes, nose, and mouth. Germs spread this way.
Avoid close contact with sick people.
Be sure you are up-to-date with all of your shots, and if possible, see your healthcare provider at least 4–6 weeks before travel to get any additional shots. Visit CDC’s Travelers’ Health website for more information on healthy travel.
If you are sick
Cover your mouth with a tissue when you cough or sneeze, and throw the tissue in the trash.
Avoid contact with other people to keep from infecting them.


Centers for Disease Control
Center for Infectious Disease Research and Policy
World Health Organization