Middle East Respiratory Syndrome (MERS)
Middle East respiratory syndrome (MERS) is a
respiratory disease caused by a coronavirus (MERS CoV)
What is the source of this virus (MERS-CoV)?
The exact source of MERS–CoV is not known. It was
first reported in Saudi Arabia in 2012. MERS-CoV has
been found in camels in Qatar, Oman, Egypt and Saudi
Arabia, and a bat in Saudi Arabia. Camels in few other
countries have also been tested positive for
antibodies to MERS-CoV, indicating that the camels
were previously infected with this virus . Humans
possibly got infected from camels.
Which countries are affected so far?
The following countries have reported cases of MERS:
Jordan, Kuwait, Oman, Qatar, Saudi Arabia, the United
Arab Emirates, and Yemen (Middle East); France,
Germany, Greece, Italy, and the United Kingdom
(Europe); Tunisia and Egypt (Africa); Malaysia and the
Philippines (Asia); and the United States of America .
Yes, But virus does not pass easily from one person to
another unless there is close contact and infection
prevention and control measures are inadequate.
What is Incubation Period:?
incubation period is between 9 and 12-days. In
majority of cases it is less than a week although it
may exceed one week but is less than two weeks.
How can people get infected with MERS?
Infected person can spread virus to close contacts
which includes health care workers , family members
and any other person who was exposed to that patient
during incubation period. In few cases source of
infection was not found.
Who are at
Disease is mostly affecting old age as the median age
of cases is 51 years (Range 14 months to 94
years).Males are predominant among reported cases
(65%) as well as deaths. Persons with co-morbidities
like liver ,heart or kidney diseases , Diabetics and
immune - compromised patients are more at risk as
compare to health individuals.
What are the symptoms of MERS?
It can present as fever, cough, shortness of breath
and Pneumonia. Gastrointestinal symptoms, like
diarrhea, have also been reported. The virus appears
to cause more severe disease in people with weakened
immune systems, older people, and those with such
chronic diseases as diabetes, cancer, and chronic lung
disease. Severe illness can cause ARDS
&respiratory failure that might need mechanical
What is the treatment?
Treatment is supportive and based on the patient’s
clinical condition. Steroids should be avoided.
Currently no vaccine or anti Viral therapy is
What is Mortality rate of MERS?
It is around 27 – 30%. In some people, infection did
not cause any symptoms. Such persons have been found
because they were tested for MERS-CoV during follow‐up
studies of contacts of people with MERS infection.
should I do if I had close contact with someone who
has recently travelled to Arabian Peninsula.?
you have had close contact within 14 days of person’s
travel from a country in the Arabian Peninsula and the
traveler is confirmed or suspected case of MERS, you
should monitor your health for 14 days, starting from
the day you were last exposed to the ill person. If
you develop respiratory illness, you should see your
doctor. While sick, try to stay at home to reduce the
possibility of spreading illness to others.
should be tested for MERS?
one who develops fever, cough or shortness of breath,
days after travel from a
country in or near the Arabian Peninsula or if have
had close contact with suspected or confirmed case of
MERS, or has respiratory illness like pneumonia or
ARDS which is not explained by any other cause should
be tested for MERS-CoV
kind of Tests are available?
• Two types of tests are
time polymerase chain reaction)–Detects
If it detects viral RNA it means person has active
infection with MERS-CoV. Lower respiratory specimens
(sputum, bronchoalveolar lavage, endotracheal
aspirates) are a preferred respiratory specimen for
RT-PCR testing. Nasopharyngeal and Oropharyngeal
specimens can be collected. If initial testing of a
nasopharyngeal swab is negative in a patient who is
strongly suspected to have MERS-CoV infection,
patients should be retested using a lower respiratory
specimen or a repeat nasopharyngeal specimen
Serology –Detects antibodies against virus
Blood samples are collected to detect antibodies
against MERS-CoV that would indicate a person had been
previously infected with the virus and developed an
Sample Collection and Transportation in Pakistan
According to ministry of health Pakistan
Specimens being sent for MERS-CoV testing should
preferably be tested at local facility to exclude
the presence of other known respiratory pathogens
Exercising standard, contact, droplet and airborne
precautions, samples must be transported to NIH;
duly labeled / packed in triple packaging to the
Department of Virology, Public Health Laboratories
Division, National Institute of Health, Islamabad
along with detailed clinical information and travel
/ contact history.
For any likely delay in reaching referral
laboratory, the respiratory tract specimens or serum
may be frozen on dry ice.
it safe to travel to the Middle East / perform Umerah
or Hajj ?
WHO does not recommend the application of any travel
or trade restrictions or entry screening related to
Kingdom Saudi Arabia on 13thJul 2013,
recommended to postpone the Umrah and Hajj last year
for elderly and those suffering from chronic
illnesses, like heart, kidney, respiratory diseases,
diabetes and people with immune deficiency, as well as
children and pregnant women.
Precautions are recommended ?
Although the source
of the virus and the mechanism of transmission is not
clearly understood , we should try to reduce the
general risk of infection by:
contact with ill persons, and wear masks in crowded
locations, maintaining personal hygiene as a
whole.N95 masks are recommended for health workers.
thoroughly with soap and water or disinfectant,
especially after coughing and sneezing, and cover
while coughing or sneezing; dispose of the waste in
a basket; do not touch your eyes, nose, or mouth
with your hands
Adhering to food
safety and hygiene rules such as avoiding
undercooked meats, raw fruits and vegetables unless
they have been peeled, or unsafe water.
Clean and disinfect
frequently touched surfaces such as toys and
contact with live farm or wild animals.
medical attention in case of sickness