Middle East respiratory syndrome (MERS) is a viral respiratory disease caused by the Middle East respiratory syndrome coronavirus (MERS‐CoV). We have covered this disease earlier (see links below) when it first emerged in 2012. Let’s take a quick recap of the disease today.

1. Coronaviruses are common viruses that cause diseases ranging from the common cold to severe acute respiratory syndrome (SARS).
2. MERS-CoV is a zoonotic virus. A lineage C betacoronavirus, MERS-CoV is different from any other known coronaviruses (SARS coronavirus) but is closely related to several bat coronaviruses.
3. MERS first emerged in Saudi Arabia in 2012. Since then, cases have also been reported from North Africa, Europe, Asia and North America.
4. Dromedary camels are a major reservoir host for the virus and a source of infection in humans.
5. Human to human transmission may follow inadequate infection control practices and has been mainly reported in healthcare settings.
6. The incubation period is 5.2 days.
7. MERS-CoV infection may be asymptomatic or present with mild respiratory symptoms progressing to severe acute respiratory disease and death. A typical presentation of MERS-CoV disease is fever, cough and shortness of breath. Pneumonia, GI symptoms (anorexia, nausea, vomiting, abdominal pain and diarrhea) may also occur in some patients. Frequency and severity of symptoms are directly proportional to the age of the patient.
8. Aggressive contact tracing may reveal laboratory-confirmed cases of MERS-CoV even though they have no symptoms of the disease.  
9. People with diabetes, renal failure, chronic lung disease and those who are immunocompromised are at high risk of severe disease from MERS-CoV infection.
10. Diagnosis is confirmed by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) test, which detects viral RNA. Lower respiratory tract, upper respiratory tract andserum samples should be tested. Serological tests like enzyme-linked immunosorbent assay (ELISA) and immunofluorescence assay (IFA) are used to detect antibodies to MERS-CoV in people who may have been exposed to the virus.
11. Individuals with an acute respiratory infection who have an epidemiologic link to MERS-CoV or who have had an unusual or unexpected clinical course (especially sudden deterioration despite appropriate treatment) should be tested for MERS-CoV.
12. All probable and confirmed cases should be reported within 24 hours of classification through the Regional Contact Point for International Health Regulations at the appropriate WHO Regional Office.
13. Treatment is supportive as there is no specific treatment for MERS.
14. Currently, there is no vaccine for MERS. Preventive methods include practicing hygiene measures (hand washing before and after touching animals), avoiding contact with sick animals and those who are sick and consumption of raw or undercooked animal products, including milk and meat.

Links to earlier published stories on MERS

1. http://emedinews.blogspot.com/2013/06/breaking-news-new-sars-like-illness-in.html
2. http://issue.emedinews.in/archive/22_06_13.html
3. http://emedinews.blogspot.com/2013/07/coronavirus-is-not-global-emergency.html
4. http://issue.emedinews.in/archive/25_7_13.html

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA