The emerging threat of the Middle East respiratory syndrome-coronavirus (MERS-CoV)

Middle East respiratory syndrome (MERS) is a viral respiratory disease caused by a novel coronavirus (MERS-CoV) which was first identified in Saudi Arabia in 2012. The virus appears to be circulating throughout the Arabian Peninsula, primarily in Saudi Arabia, where the majority of cases (>85%) have been reported. Several cases have been reported in many different countries outside the Middle East. MERS-CoV is a zoonotic virus that is transmitted from animals to humans. The origins of the virus are not fully understood, but it is believed to have originated in bats, to have been transmitted to camels sometime in the distant past. The route of transmission from animals to humans is not fully known, but camels are likely to be a major reservoir host for MERS-CoV and an animal source of infection for humans. The virus does not appear to pass easily from person to person unless there is close contact. Clusters of cases have been reported in healthcare facilities, where human-to-human transmission appears to be more probable, especially when infection prevention and control practices are inadequate, but so far, no sustained community transmission has been documented. Typical MERS symptoms include high fever, cough and shortness of breath. Pneumonia is common and gastrointestinal symptoms, including diarrhea, have also been reported. The fatality rate is high (30-40%). So far, neither a vaccine nor effective therapy against the virus is available. Enhancing infection prevention and control awareness and implementation of preventive measures is critical to avoiding spread of the virus. Breaking the human-to-human transmission cycle remains the cornerstone of infection control during MERS-CoV outbreaks. In order to succeed, this requires the effective identification and isolation of cases, and promotion of the necessary trust between the community and infection control team.