Coronavirus: Middle East respiratory syndrome coronavirus (MERS. CoV).

Khaled Saad, MD

What are Corona viruses?

• Coronaviruses are believedto cause a significantpercentage of all commoncolds in human.Coronaviruses cause colds inhumans primarily in thewinter and early springseason.• Coronaviruses primarilyinfect the upper respiratoryand gastrointestinal tract ofmammals and birds.

What are Corona viruses?

• Five different currentlyknown strains ofCoronaviruses infecthumans. The most madeknown humanCoronavirus, is SARS.

• A sixth was discoveredlast year, known as NovelCoronavirus 2012.

Origin of Middle East respiratory syndrome coronavirus

The first confirmed casewas reported in a 60-year-old male patientwith acute pneumoniaand acute renal failure,who died in Jeddah,Saudi Arabia on 24 June2012.

Egyptian virologist Dr.Ali Mohamed Zakiisolated and identifieda previously unknowncoronavirus from theman's lungs. Dr. Zakithen posted hisfindings on 24September 2012 onProMED-mail.

A second case found in September 2012. A 49 yold male in Qatar, the sequence of the virus wasidentical to that of the first case. In Nov 2012,similar cases in Qatar and Saudi Arabia.Additional cases were noted, with deathsassociated, and rapid research and monitoringof this novel coronavirus began.

Transmission

•On 13 February 2013, WHO stated"the risk of sustained person-to-persontransmission appears to be very low."The cells MERS-CoV infects in the lungsonly account for 20% of respiratoryepithelial cells, so a large number ofvirions are likely needed to be inhaledto cause infection.

•As of 29 May 2013, the WHO is nowwarning that the MERS-CoV virus is a"threat to entire world.

Early research suggested the virus is related to onefound in the Egyptian bat. In September 2012 RonFouchier speculated that the virus might haveoriginated in bats. Recent work links camels to thevirus. At least one of the people who have fallen sickwith MERS was known to have come into contactwith camels or recently drank camel milk. On 9August 2013, a report in the journal The LancetInfectious Diseases showed that 50 out of 50 (100%)blood serum from Omani camels and 15 of 105 (14%)from Spanish camels had protein-specific antibodiesagainst the MERS-CoV spike protein.

Natural reservoir

Transmission of mErs-Cov

According to the 27 Mar 2014 MERS-CoVsummary update, recent studies support thatcamels serve as the primary source of theMERS-CoV infecting humans, while bats maybe the ultimate reservoir of the virus. Evidenceincludes the frequency with which the virushas been found in camels to which humancases have been exposed, seriological datawhich shows widespread transmission incamels, and the similarity of the camel CoV tothe human CoV.

0n 4-May-2014

Infected: 480 case

Died: 133

Mortality rate: 28%

http://coronamap.com/

How is Novel Coronavirus transmitted?• All the clusters of cases seen so far have been transmitted between family members or in a health care setting, the WHO said in an update .

• Human-to-human transmission occurred in at least some of these clusters, however, the exact mode of transmission is unknown.

Symptoms of MERS-CoV infectioninclude renal failure and severeacute pneumonia, which oftenresult in a fatal outcome. The firstpatient, in June 2012, had a "7-day history of fever, cough,expectoration, and dysnea."MERS has incubation period of 12days. MERS may occasionally leadto pneumonia, either direct viralpneumonia or secondarybacterial pneumonia.

Signs and symptoms

Diagnosis

Several highly sensitive, confirmatory real-time RT_PCR assays exist for rapid identification of MERS-CoV from patient-derived samples (such as BAL or sputum)

Therapeutics

*There are no known treatments. interferon-α2b and Ribavirin combination do affect MERS-coV replication.

*Camels, revealed high titers of neutralizing antibodies to MERS-CoV in the blood serum of these animals, providing an option for passive immunotherapy of patients with MERS.

This option must be thoroughly explored before being considered as reliable.

Prevention Measures

• Keep away from someone with a heavy cough.

• Use a tissue to cover the nose/mouth when coughing, sneezing, wiping and blowing noses.

• If a tissue isn’t available, cough or sneeze into the inner elbow rather than the hand

Prevention Measures

• Wash hands with hot water and soap at least six or seven times a day

• Disinfect common surfaces as frequently as possible.

• Wash hands or use a sanitiser when in contact with common surfaces like door handles.

Thank you!