Middle East respiratory syndrome (MERS) - including symptoms, treatment and prevention

Middle East respiratory syndrome (MERS) was first recognised in Saudi Arabia in 2012. It is caused by infection with Middle East respiratory syndrome coronavirus (MERS-CoV). It was formerly called ‘novel coronavirus’. Initially it was confined to travellers in the Middle East, or contacts of travellers to the Middle East, however in 2015, there was a health care associated outbreak in the Republic of Korea resulting in 185 secondary and tertiary cases and 36 deaths. For up to date information on MERS-CoV see:

Middle Eastern respiratory syndrome coronavirus (MERS-CoV) is a notifiable condition1

Clinical Presentation

MERS-CoV infection can cause severe respiratory disease (pneumonia and pneumonitis) and death. However, in some people infection causes a mild influenza-like illness or is asymptomatic. Symptoms may include:

  • fever and chills
  • cough
  • shortness of breath
  • breathing difficulties
  • muscles and joint aches. 

Less common symptoms include: 

  • diarrhoea
  • nausea
  • vomiting.

Severe disease and death is more common in older males and patients with underlying medical conditions. These underlying conditions have included diabetes, kidney disease, high blood pressure, asthma and lung diseases, cardiovascular disease and people with weakened immune systems such as people with cancer or taking certain medications.

Incubation Period

From 2 to 14 days, most commonly 5 days.

Infectious period

Uncertain, cases are likely not infectious during the incubation period.

Transmission

MERS-CoV infection has spread from person to person particularly amongst family members and in health care settings, although the exact mode of transmission is unknown. Some cases have a strong history of exposure to camels or camel products.

Infection control

In the health care setting, airborne and contact precautions, in addition to standard precautions, are recommended.

For further details please see the Australian Guidelines for the Prevention and Control of Infection in Healthcare.  

Diagnosis

Doctors should consider the possibility of MERS-CoV infection in patients with:

  • an illness consistent with an acute febrile respiratory infection and a history of:
    • travel to, or residence in, the Middle East* in the 14 days before illness onset (excluding transiting through an international airport for instance, less than 24 hours stay, remaining within the airport) or
  • an illness consistent with an acute respiratory infection and contact with a suspected or confirmed MERS-CoV case in the 14 days before illness onset.

 Request real time reverse-transcriptase polymerase chain reaction (rRT-PCR) for MERS-CoV on respiratory specimens, preferably lower respiratory tract specimens. If initial tests are negative and MERS-CoV infection is still suspected, repeat testing is recommended. Use appropriate infection control precautions when taking specimens.

* Countries of the Middle East include: Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE) and Yemen.

Treatment 

There is no specific treatment for MERS-CoV infection.

Notify

MERS-CoV infection is a notifiable condition under the South Australian Public Health Act 2011.  Notify any suspected or confirmed cases to the South Australian Communicable Disease Control Branch on 1300 232 272
 (24 hours /7 days).

Prevention

There is no vaccine available against MERS-CoV infection.

Resources and Useful links

Further information for health professionals on MERS-CoV infection is available from the following resources:


1 – In South Australia the law requires doctors and laboratories to report some infections or diseases to SA Health. These infections or diseases are commonly referred to as 'notifiable conditions'.