MERS-CoV - MERS Virus

MERS stands for Middle East Respiratory Syndrome. It is an infectious disease caused by a Coronavirus  called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). MERS as a disease affects the respiratory system (lungs and its branches). Often times MERS patients easily come down with severe acute respiratory illness with symptoms of fever, cough and shortness of breath. About 3-4 out of every 10 patients reported with MERS have died. MERS is considered a deadlier but less infectious sister of severe acute respiratory syndrome (Sars), which killed more than 200 people in Hong Kong in 2003.

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Epidemiology of MERS and MERS-CoV

MERS was first reported in Saudi Arabia in September 2012 by Health Officials. Health officials, through retrospective investigations, later identified that the first known cases of MERS occurred in Jordan in April 2012. Up to this point, all cases of MERS have been linked to countries around the Arabian Peninsula.

MERS-CoV has spread from ill people to others through close contact, such as caring for or living with an infected person.

MERS can affect anyone irrespective of age. MERS virus has been known to affect people ranged in age from younger than 1 to 99 years old.

CDC continues to closely monitor the MERS situation globally and work with partners to better understand the risks of this virus, including the source, how it spreads, and how infections might be prevented. CDC recognizes the potential for MERS-CoV to spread further and cause more cases globally and in the U.S. We have provided information for travelers and are working with health departments, hospitals, and other partners to prepare for this.

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Clinical Features of MERS- (Symptoms & Complications)

Most people confirmed to have MERS-CoV infection have had severe acute respiratory disease with symptoms of:

• fever


• cough


• shortness of breath

Some people also had gastrointestinal (GIT) symptoms including diarrhea, nausea, and vomiting. For many people with MERS, more severe complications followed, such as pneumonia and kidney failure. About 3-4 out of every 10 people reported with MERS have died- that's about 40% mortality rate. Most of the people who died had an underlying medical condition. Some infected people had mild symptoms (such as cold-like symptoms) or no symptoms at all; they recovered.

Based on what researchers know so far, people with pre-existing medical conditions (comorbidities) may be more likely to become infected with MERS-CoV, or have a severe case. Pre-existing conditions from reported cases for which we have information have included diabetes; cancer; and chronic lung, heart, and kidney disease. Individuals with weakened immune systems are also at higher risk for getting MERS or having a severe case.

Based on information we have to date, the incubation period for MERS (time between when a person is exposed to MERS-CoV and when they start to have symptoms) is usually about 5 or 6 days, but can range from 2-14 days.

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How MERS-CoV Spread - (Transmission)

MERS-CoV, like other coronaviruses, is thought to spread from an infected person’s respiratory secretions, such as through coughing. However, the precise ways the virus spreads are not currently well understood.

MERS-CoV has spread from ill people to others through close contact, such as caring for or living with an infected person. Infected people have spread MERS-CoV to others in healthcare settings, such as hospitals. Researchers studying MERS have not seen any ongoing spreading of MERS-CoV in the community.

All reported cases have been linked to countries in and near the Arabian Peninsula. Most infected people either lived in the Arabian Peninsula or recently traveled from the Arabian Peninsula before they became ill. A few people became infected with MERS-CoV after having close contact with an infected person who had recently traveled from the Arabian Peninsula.

Public health agencies continue to investigate clusters of cases in several countries to better understand how MERS-CoV spreads from person to person.

 Predisposing Factors - People Who May Be at Increased Risk for MERS

Those that Recently Visited from the Arabian Peninsula

If you develop a fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after traveling from countries in or near the Arabian Peninsula you should call ahead to a healthcare provider and mention your recent travel. While sick, stay home from work or school and delay future travel to reduce the possibility of spreading illness to others.

Close Contacts of an Ill Traveler from the Arabian Peninsula

If you have had close contact with someone within 14 days after they traveled from a country in or near the Arabian Peninsula and the traveler has/had fever and symptoms of respiratory illness, such as cough or shortness of breath, you should monitor your health for 14 days, starting from the day you were last exposed to the ill person.

If you develop fever and symptoms of respiratory illness, such as cough or shortness of breath, you should call ahead to a healthcare provider and mention your recent contact with the traveler. While sick, stay home from work or school and delay future travel to reduce the possibility of spreading illness to others.

Those who Recently were in a healthcare facility in the Republic of Korea

If you develop a fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after being in a healthcare facility (as a patient, worker, or visitor) in the Republic of Korea, you should call ahead to a healthcare provider and mention your recent presence in the healthcare facility. While sick, stay home from work or school and delay future travel to reduce the possibility of spreading illness to others.

 Close Contacts of a Confirmed Case of MERS

If you have had close contact with someone who has a confirmed MERS-CoV infection, you should contact a healthcare provider for an evaluation. Your healthcare provider may request laboratory testing and outline additional recommendations, depending on the findings of your evaluation and whether you have symptoms. You most likely will be asked to monitor your health for 14 days, starting from the day you were last exposed to the ill person. Watch for these symptoms:

• Fever. Take your temperature twice a day.


• Coughing


• Shortness of breath


• Other early symptoms to watch for are chills, body aches, sore throat, headache, diarrhea, nausea/vomiting, and runny nose.

If you develop symptoms, call ahead to your healthcare provider as soon as possible and tell him or her about your possible exposure to MERS-CoV so the office can take steps to keep other people from getting infected. Ask your healthcare provider to call the local or state health department.

Healthcare Personnel Not Using Recommended Infection-Control Precautions

Healthcare personnel should adhere to recommended infection control measures, including standard, contact, and airborne precautions, while managing symptomatic close contacts, patients under investigation, and patients who have probable or confirmed MERS-CoV infections. Recommended infection control precautions should also be utilized when collecting specimens.

Healthcare personnel who had close contact with a confirmed case of MERS while the case was ill, if not using recommended infection control precautions (e.g. appropriate use of personal protective equipment), are at increased risk of developing MERS-CoV infection and should be evaluated and monitored by a healthcare professional with a higher index of suspicion.

People with Exposure to Camels

MERS-CoV has been found in some camels, and some MERS patients have reported contact with camels. However, we do not know exactly how people become infected with MERS-CoV—many people with MERS have had close contact with a person sick with MERS.

The World Health Organization has posted a general precaution for anyone visiting farms, markets, barns, or other places where animals are present. Travelers should practice general hygiene measures, including regular handwashing before and after touching animals, and avoid contact with sick animals. Travelers should also avoid consumption of raw or undercooked animal products. 

The World Health Organization considers certain groups to be at high risk for severe MERS; these groups include people with diabetes, kidney failure, or chronic lung disease and people who have weakened immune systems. The World Health Organization recommends that these groups take additional precautions:

• Avoid contact with camels


• Do not drink raw camel milk or raw camel urine


• Do not eat undercooked meat, particularly camel meat

Prevention

Currently, there is no vaccine to prevent MERS-CoV infection. The U.S. National Institutes of Health is exploring the possibility of developing one.

CDC routinely advises that people help protect themselves from respiratory illnesses by taking everyday preventive actions:

• Wash your hands often with soap and water for 20 seconds, and help young children do the same. If soap and water are not available, use an alcohol-based hand sanitizer.


• Cover your nose and mouth with a tissue when you cough or sneeze, then throw the tissue in the trash.


• Avoid touching your eyes, nose and mouth with unwashed hands.


• Avoid personal contact, such as kissing, or sharing cups or eating utensils, with sick people.


• Clean and disinfect frequently touched surfaces and objects, such as doorknobs.

Preventing MERS-CoV from Spreading to Others in Homes and Communities

The following interim guidance may help prevent Middle East Respiratory Syndrome Coronavirus (MERS-CoV) from spreading among people in homes and in communities. The interim guidance is based on what we currently know about other viral respiratory infections and MERS-CoV. CDC will update this interim guidance as additional information becomes available.

Prevention Steps for People Confirmed to Have, or Being Evaluated for, MERS-CoV Infection

If you are confirmed to have, or being evaluated for, MERS-CoV infection you should follow the prevention steps below until a healthcare provider or local or state health department says you can return to your normal activities.

Stay home
You should restrict activities outside your home, except for getting medical care. Do not go to work, school, or public areas, and do not use public transportation or taxis.

Separate yourself from other people in your home
As much as possible, you should stay in a different room from other people in your home. Also, you should use a separate bathroom, if available.

Call ahead before visiting your doctor
Before your medical appointment, call the healthcare provider and tell him or her that you have, or are being evaluated for, MERS-CoV infection. This will help the healthcare provider’s office take steps to keep other people from getting infected.

Wear a facemask
You should wear a facemask when you are in the same room with other people and when you visit a healthcare provider. If you cannot wear a facemask, the people who live with you should wear one while they are in the same room with you.

Cover your coughs and sneezes
Cover your mouth and nose with a tissue when you cough or sneeze, or you can cough or sneeze into your sleeve. Throw used tissues in a lined trash can, and immediately wash your hands with soap and water.

Wash your hands
Wash your hands often and thoroughly with soap and water. You can use an alcohol-based hand sanitizer if soap and water are not available and if your hands are not visibly dirty. Avoid touching your eyes, nose, and mouth with unwashed hands.

Avoid sharing household items
You should not share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items with other people in your home. After using these items, you should wash them thoroughly with soap and water.

Monitor your symptoms
Seek prompt medical attention if your illness is worsening (e.g., difficulty breathing). Before going to your medical appointment, call the healthcare provider and tell him or her that you have, or are being evaluated for, MERS-CoV infection. This will help the healthcare provider’s office take steps to keep other people from getting infected. Ask your healthcare provider to call the local or state health department.

Prevention Steps for Caregivers and Household Members

If you live with, or provide care at home for, a person confirmed to have, or being evaluated for, MERS-CoV infection, you should:

• Make sure that you understand and can help the person follow the healthcare provider's instructions for medication and care. You should help the person with basic needs in the home and provide support for getting groceries, prescriptions, and other personal needs.


• Have only people in the home who are essential for providing care for the person.
  
  
  
  • Other household members should stay in another home or place of residence. If this is not possible, they should stay in another room, or be separated from the person as much as possible. Use a separate bathroom, if available.
  
  
  • Restrict visitors who do not have an essential need to be in the home.
  
  
  • Keep elderly people and those who have compromised immune systems or certain health conditions away from the person. This includes people with chronic heart, lung or kidney conditions, and diabetes.


• Make sure that shared spaces in the home have good air flow, such as by an air conditioner or an opened window, weather permitting.


• Wash your hands often and thoroughly with soap and water. You can use an alcohol-based hand sanitizer if soap and water are not available and if your hands are not visibly dirty. Avoid touching your eyes, nose, and mouth with unwashed hands.


• Wear a disposable facemask, gown, and gloves when you touch or have contact with the person’s blood, body fluids and/or secretions, such as sweat, saliva, sputum, nasal mucus, vomit, urine, or diarrhea.
  
  
  
  • Throw out disposable facemasks, gowns, and gloves after using them. Do not reuse.
  
  
  • Wash your hands immediately after removing your facemask, gown, and gloves.


• Avoid sharing household items. You should not share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items with a person who is confirmed to have, or being evaluated for, MERS-CoV infection. After the person uses these items, you should wash them thoroughly (see below “Wash laundry thoroughly”).


• Clean all “high-touch” surfaces, such as counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables, every day. Also, clean any surfaces that may have blood, body fluids and/or secretions or excretions on them.
  
  
  
  • Read label of cleaning products and follow recommendations provided on product labels. Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves or aprons and making sure you have good ventilation during use of the product.
  
  
  • Use a diluted bleach solution or a household disinfectant with a label that says “EPA-approved.” To make a bleach solution at home, add 1 tablespoon of bleach to 1 quart (4 cups) of water. For a larger supply, add ¼ cup of bleach to 1 gallon (16 cups) of water.


• Wash laundry thoroughly.
  
  
  
  • Immediately remove and wash clothes or bedding that have blood, body fluids and/or secretions or excretions on them.
  
  
  • Wear disposable gloves while handling soiled items. Wash your hands immediately after removing your gloves.
  
  
  • Read and follow directions on labels of laundry or clothing items and detergent. In general, wash and dry with the warmest temperatures recommended on the clothing label.


• Place all used gloves, gowns, facemasks, and other contaminated items in a lined container before disposing them with other household waste. Wash your hands immediately after handling these items.


• Monitor the person’s symptoms. If they are getting sicker, call his or her medical provider and tell him or her that the person has, or is being evaluated for, MERS-CoV infection. This will help the healthcare provider’s office take steps to keep other people from getting infected. Ask the healthcare provider to call the local or state health department.


• Caregivers and household members who do not follow precautions when in close contact with a person who is confirmed to have, or being evaluated for, MERS-CoV infection, are considered “close contacts” and should monitor their health. Follow the prevention steps for close contacts below.

Prevention Steps for Close Contacts

If you have had close contact with someone who is confirmed to have, or being evaluated for, MERS-CoV infection, you should:

• Monitor your health starting from the day you were first exposed to the person and continue for 14 days after you were last exposed to the person. Watch for these signs and symptoms:
  
  
  
  • Fever. Take your temperature twice a day.
  
  
  • Coughing.
  
  
  • Shortness of breath.
  
  
  • Other early symptoms to watch for are chills, body aches, sore throat, headache, diarrhea, nausea/vomiting, and runny nose.


• If you develop symptoms, follow the prevention guides described above, and call your healthcare provider as soon as possible. Before going to your medical appointment, call the healthcare provider and tell him or her about your possible exposure to MERS-CoV. This will help the healthcare provider’s office take steps to keep other people from getting infected. Ask your healthcare provider to call the local or state health department.


• If you do not have any symptoms, you can continue with your daily activities, such as going to work, school, or other public areas.

You are not considered to be at risk for MERS-CoV infection if you have not had close contact with someone who is confirmed to have, or being evaluated for, MERS-CoV infection. CDC advises that people follow prevention steps to help reduce their risk of getting infected with respiratory viruses, like MERS-CoV

Treatment

There is no specific antiviral treatment recommended for MERS-CoV infection. Individuals with MERS can seek medical care to help relieve symptoms. For severe cases, current treatment includes care to support vital organ functions.

Read more on WHO update on MERS here.

Read CDC's FAQs on MERS and MERS-CoV

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Curated from CDC
By DR. TONY IWUAFOR
Dept of Medical Microbiology
UCTH, Calabar
Nigeria

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