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:
- World Health Organisation website for a current list of involved countries.
- Department of Foreign Affairs and Trade Smart Traveller website for travel advice.
Middle Eastern respiratory syndrome coronavirus (MERS-CoV) is a notifiable condition1
How MERS is spread
MERS-CoV has been found in camels, but it is not yet known whether the virus can spread from camels to humans, and if so, how that occurs. MERS-CoV can spread between people through close contact such as living with or caring for a person infected with MERS, and spread within healthcare settings has also been described. Transiting through an international airport (less than 24 hours stay and remaining within the airport) in the Middle East* is currently not considered to be a risk factor for infection. Spread of MERS in the Republic of Korea has occurred only within health care settings. No community spread of MERS-CoV infection has been reported in the Republic of Korea.
* 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.
Signs and symptoms
MERS usually presents with severe acute respiratory illness, most commonly in adult males with underlying medical conditions such as diabetes, kidney disease, high blood pressure, asthma and lung diseases, cancer and heart disease and weakened immune systems such as people with cancer or taking certain medications. Symptoms of MERS may include:
- breathing difficulties
- muscles aches
- nausea and vomiting.
To date, about 30% of diagnosed cases have died. However some people, particularly those infected in healthcare settings, have only mild influenza-like symptoms or no symptoms at all.
A person with an acute febrile respiratory infection in Australia is very unlikely to have MERS.
Individuals with fever and other symptoms of an acute respiratory infection who have a history of travel to or residence in the Middle East within the past 14 days, or contact with someone with respiratory symptoms who has recently been in the Middle East, should be investigated. Individuals with an acute respiratory infection and contact with a suspected or confirmed case of MERS within the past 14 days should be investigated.
Samples from the lower respiratory tract preferably (e.g. sputum), but otherwise from the nose or throat, are tested by PCR for the presence of MERS-CoV. Samples should be collected using respiratory precautions. Antibody tests for MERS are not currently available in Australia.
(time between becoming infected and developing symptoms)
Between 2 to 14 days, most commonly 5 days
(time during which an infected person can infect others)
The infectious period is unknown, but is unlikely to start until symptoms are present.
There is no specific treatment for MERS.
There is no vaccine available to prevent MERS.
The particular conditions or procedures that lead to transmission in healthcare settings are not well understood. To minimise transmission in hospitals the following precautions should be taken:
- confirmed and probable cases placed in a negative pressure room or single room with the door closed
- appropriate personal protective equipment
- regular careful hand-washing
- cough etiquette (when sneezing or coughing, nose and mouth should be covered with a tissue which is then disposed of appropriately).
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'.