Middle East respiratory syndrome coronavirus (MERS-CoV). It is a new, emerging virus that is distantly related to the virus that caused SARS.
The first documented cases of MERS occurred in Jordan in early 2012. Globally, to date there has been a total of 55 cases confirmed by laboratory testing. Of these, 40 have occurred in KSA, and the rest have been reported from other countries in the Middle East (Qatar and the United Arab Emirates), from Tunisia in North Africa, and from France, Germany, Italy and the United Kingdom of Great Britain and Northern Ireland in Europe.
The overall number of cases is limited, but the virus causes death in about 60% of patients. So far, about 75% of the cases in KSA have been in men and most have occurred in people with one or more major chronic conditions.
There appears to be three main epidemiological patterns.
In the first pattern, sporadic cases occur in communities. At present, we do not know the source or how these people became infected.
In the second pattern, clusters of infections occur in families. In most of these clusters, there appears to be person-to-person transmission, but it seems that this transmission is limited to people who are in close contact with a sick family member.
The third pattern comprises clusters of infections in health care facilities. Such events have been reported in France, Jordan and KSA. In these clusters, the sequence seems to be that an infected person is admitted to hospital where that person then transmits the virus to other people in the health care facility.
Two important points need to be stressed.
First, there is no evidence of widespread person-to-person transmission of MERS-CoV. Where it has been suspected that the virus has been transmitted from person to person, it appears that there had been close contact between somebody who was sick and another person: a family member, a fellow patient or a health care worker.
Secondly, many fewer infections with MERS-CoV have been reported in health care workers in KSA than might have been expected on the basis of the previous experience of SARS. During the SARS epidemic, health care workers were at high risk of infection. The MERS-CoV is different from the SARS virus. Although the reason why fewer health care workers have been infected with MERS-CoV is not clear, it could be that improvements in infection control that were made after the outbreak of SARS have made a significant difference. In this context, infection control measures in KSA appear to be effective.
Currently, the diagnosis of MERS CoV relies heavily on clinical awareness combined with confirmatory testing for the presence of MERS-CoV by the polymerase chain reaction. No bedside test exists.
Treatment is primarily supportive and there are no convincing data that the use of potent antiviral agents, such as ribavirin and interferon, brings any benefit. The use of steroids in high doses should be avoided.
The first documented cases of MERS occurred in Jordan in early 2012. Globally, to date there has been a total of 55 cases confirmed by laboratory testing. Of these, 40 have occurred in KSA, and the rest have been reported from other countries in the Middle East (Qatar and the United Arab Emirates), from Tunisia in North Africa, and from France, Germany, Italy and the United Kingdom of Great Britain and Northern Ireland in Europe.
The overall number of cases is limited, but the virus causes death in about 60% of patients. So far, about 75% of the cases in KSA have been in men and most have occurred in people with one or more major chronic conditions.
There appears to be three main epidemiological patterns.
In the first pattern, sporadic cases occur in communities. At present, we do not know the source or how these people became infected.
In the second pattern, clusters of infections occur in families. In most of these clusters, there appears to be person-to-person transmission, but it seems that this transmission is limited to people who are in close contact with a sick family member.
The third pattern comprises clusters of infections in health care facilities. Such events have been reported in France, Jordan and KSA. In these clusters, the sequence seems to be that an infected person is admitted to hospital where that person then transmits the virus to other people in the health care facility.
Two important points need to be stressed.
First, there is no evidence of widespread person-to-person transmission of MERS-CoV. Where it has been suspected that the virus has been transmitted from person to person, it appears that there had been close contact between somebody who was sick and another person: a family member, a fellow patient or a health care worker.
Secondly, many fewer infections with MERS-CoV have been reported in health care workers in KSA than might have been expected on the basis of the previous experience of SARS. During the SARS epidemic, health care workers were at high risk of infection. The MERS-CoV is different from the SARS virus. Although the reason why fewer health care workers have been infected with MERS-CoV is not clear, it could be that improvements in infection control that were made after the outbreak of SARS have made a significant difference. In this context, infection control measures in KSA appear to be effective.
Currently, the diagnosis of MERS CoV relies heavily on clinical awareness combined with confirmatory testing for the presence of MERS-CoV by the polymerase chain reaction. No bedside test exists.
Treatment is primarily supportive and there are no convincing data that the use of potent antiviral agents, such as ribavirin and interferon, brings any benefit. The use of steroids in high doses should be avoided.
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