MERS: The ongoing threat of a viral respiratory disease

MERS – Middle East Respiratory Syndrome – was first identified in Saudi Arabia in 2012 and is still an active viral respiratory disease. At the outbreak’s peak, approximately 80% of human cases were reported in Saudi Arabia, the remainder being in 27 other countries. 

As of January 2020, there was a total of 2519 confirmed cases of MERS, including 866 associated deaths: the global fatality rate is 34.3%. However, the number of MERS cases reported in Saudi Arabia was 2121, including a fatality rate of 37.1%. 

According to the World Health Organization (WHO), dromedary camels are a host for Middle East Respiratory Syndrome and, therefore, a potential source of MERS infection in humans.  However, the vast majority of coronavirus infections are caused by human-to-human transmission. 

During MERS transmission, some people will show no symptoms; others will have mild respiratory symptoms, whereas some will suffer severe acute respiratory disease resulting in death. The most common symptoms include cough, fever and shortness of breath.

The most severe cases will lead to respiratory failure that will require ventilation.  Currently, the R0 of MERS is below one, identifying it as a mildly contagious disease.  However, in 2017 a MERS patient in Riyadh was responsible for infecting 16 patients resulting in an outbreak that infected further 44 people over two weeks.

The structure of the MERS coronavirus consists of an envelope containing a positive-sense RNA virus. This virus has a 30-kilobase genome capable of coding for structural proteins and RNA polymerase, typical of the Coronaviridae family.

The most immunogenic of these proteins is the glycoprotein spike on the envelope that facilitates the viral attachment to the host cells. However, the mechanisms of MERS pathogenesis remain to be understood, but unfortunately, no vaccine has yet been approved.

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