Coronaviruses are a family of viruses that cause illnesses ranging from the common cold to more severe diseases. Middle East respiratory syndrome (MERS) is a viral respiratory disease caused by a coronavirus called MERS-CoV. The first case was reported in Saudi Arabia in 2012. Additional cases were found in several Middle Eastern countries. Research indicates that camels are a reservoir for the virus and may transmit it to humans. Transmission between humans occurs through close contact. Symptoms include severe pneumonia and kidney failure. There is no vaccine or specific treatment, though supportive care can be given.

1. Coronavirus: Middle East respiratory
syndrome coronavirus (MERS. CoV).
Khaled Saad, MD

2. What are Corona
viruses?
• Coronaviruses are believed
to cause a significant
percentage of all common
colds in human.
Coronaviruses cause colds in
humans primarily in the
winter and early spring
season.
• Coronaviruses primarily
infect the upper respiratory
and gastrointestinal tract of
mammals and birds.

3. What are Corona
viruses?
• Five different currently
known strains of
Coronaviruses infect
humans. The most made
known human
Coronavirus, is SARS.
• A sixth was discovered
last year, known as Novel
Coronavirus 2012.

4. Origin of Middle East respiratory
syndrome coronavirus
The first confirmed case
was reported in a 60-
year-old male patient
with acute pneumonia
and acute renal failure,
who died in Jeddah,
Saudi Arabia on 24 June
2012.

5. Egyptian virologist Dr.
Ali Mohamed Zaki
isolated and identified
a previously unknown
coronavirus from the
man's lungs. Dr. Zaki
then posted his
findings on 24
September 2012 on
ProMED-mail.

6. A second case found in September 2012. A 49 y
old male in Qatar, the sequence of the virus was
identical to that of the first case. In Nov 2012,
similar cases in Qatar and Saudi Arabia.
Additional cases were noted, with deaths
associated, and rapid research and monitoring
of this novel coronavirus began.

7. Transmission
•On 13 February 2013, WHO stated
"the risk of sustained person-to-person
transmission appears to be very low."
The cells MERS-CoV infects in the lungs
only account for 20% of respiratory
epithelial cells, so a large number of
virions are likely needed to be inhaled
to cause infection.
•As of 29 May 2013, the WHO is now
warning that the MERS-CoV virus is a
"threat to entire world.

8. Early research suggested the virus is related to one
found in the Egyptian bat. In September 2012 Ron
Fouchier speculated that the virus might have
originated in bats. Recent work links camels to the
virus. At least one of the people who have fallen sick
with MERS was known to have come into contact
with camels or recently drank camel milk. On 9
August 2013, a report in the journal The Lancet
Infectious Diseases showed that 50 out of 50 (100%)
blood serum from Omani camels and 15 of 105 (14%)
from Spanish camels had protein-specific antibodies
against the MERS-CoV spike protein.
Natural reservoir

9. Transmission of MERS-Cov

10. According to the 27 Mar 2014 MERS-CoV
summary update, recent studies support that
camels serve as the primary source of the
MERS-CoV infecting humans, while bats may
be the ultimate reservoir of the virus. Evidence
includes the frequency with which the virus
has been found in camels to which human
cases have been exposed, seriological data
which shows widespread transmission in
camels, and the similarity of the camel CoV to
the human CoV.

11. 0n 4-May-2014
Infected: 480 case
Died: 133
Mortality rate: 28%
http://coronamap.com/

12. 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.

13. Symptoms of MERS-CoV infection
include renal failure and severe
acute pneumonia, which often
result in a fatal outcome. The first
patient, in June 2012, had a "7-
day history of fever, cough,
expectoration, and dysnea."
MERS has incubation period of 12
days. MERS may occasionally lead
to pneumonia, either direct viral
pneumonia or secondary
bacterial pneumonia.
Signs and symptoms

14. 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)

15. 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.

16. 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

17. 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.

18. Thank you!