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MERS-Middle East Respiratory
Syndrome
By Alfaz I Solanki
1
INTRODUCTION
 The Middle East Respiratory Syndrome (MERS) is
similar like 2003 outbreak virus called Severe Acute
Respiratory Syndrome (SARS).
 These virus is also belongs to large group of virus
containing Corona virus family.
 The nomenclature of MERS is Middle East
Respiratory Syndrome Corona virus (MERS-CoV).
 In the name Middle East suggests that this virus first
detected in The Kingdom of Saudi Arabia in the year
of 2012 and other word respiratory syndrome
suggests that it causes illness in particular
respiratory system and lungs.
2
INTRODUCTION
 It is one of the deadly virus with the high Fatality rate
and majorly risk groups are infants, elderly people,
persons with immune system problems like diabetes,
blood pressure, heart and Lungs disease and Kidney
problem people are easily infected with MERS-COV.
 These virus are zoonotic in nature and majorly
camels are responsible for the transmission but the
role of bats are still under investigation in the mode
of transmission of MERS-CoV.
3
SYMPTOMS
 Fever
 Cough
 Shortness of breath
 Myalgia
 Diarrhea
 Vomiting
 Abdominal pain
 The incubation period of MERS-CoV is 2 to 14 days
after person infected from the MERS-CoV.
 But most of the cases showed symptoms in 5 to 6
days.
4
VIRAL STRUCTURE
 The MERS-CoV is belongs to large corona virus
family.
 In corona virus family it belongs to β-corona virus
type.
 The size of MERS-CoV is approximately 50 to 200
nm.
 The genomic size of MERS-CoV is about 26.2 to
31.7 kb and consist ssRNA (Single Stranded) as a
genetic material and spike proteins which covered
from the large envelope.
 The genome of MERS-CoV is classified into two
clades.
 That are Clade A and Clade B. Clade A is observed
5
VIRAL STRUCTURE
6
EPIDEMIOLOGY
 The virus first detect in Saudi Arabia in September,
2012.
 Since now this virus had seen in 27 countries with 3
major outbreaks.
COUNTRY YEAR CASES TOTAL
CASES TILL
NOW
TOTAL
DEATHS TILL
NOW
Saudi Arabia 2014 402 1029 452
South Korea 2015 150 150 38
UAE 2017 74 78 10
7
EPIDEMIOLOGY
 The total cases of MERS-CoV as per January, 2020
according to World Health Organization (WHO) are
2,519 cases with 866 deaths all over the world.
 The fatality rate of MERS-CoV is 34.3 % which is the
highest in corona virus family.
 The countries which are affected is shown in below
graph;
8
EPIDEMIOLOGY
9
DIAGNOSIS
 The MERS-CoV is detected using a reverse
transcriptase polymerase chain reaction (PCR)
test.
 On June 5, 2013 the FDA issued an emergency-
use authorization (EUA) for the CDC Novel
Corona virus 2012 Real-Time RT-PCR Assay.
 This test detects Middle East respiratory
syndrome corona virus (MERS-CoV) formerly
known as novel corona virus 2012 or NCV-2012,
in patients with signs and symptoms of MERS
and appropriate risk factors.
10
DIAGNOSIS
 This assay is distributed by the CDC to
qualified laboratories.
 The PCR is performed on a sample of
respiratory secretions or blood.
 ELISA or enzyme-linked immune sorbent
assay and IFA or immune fluorescence
assay are tests for antibody to MERS-CoV
but it is used for research purposes rather
than patient care.
11
TRANSMISSION
 Transmission MERS-CoV is the zoonotic virus.
 Mostly camel are responsible for the transmission of
this virus but the role of bats are still under
investigation.
 The MERS-CoV is transmitted in the three different
patterns which are mention in as below;
 1. Camel to camel transmission
 2. Camel to Human transmission
 3. Human to Human transmission
12
TRANSMISSION
13
TRANSMISSION
 Camel to Camel Transmission
 The MERS-CoV are usually found in younger camels
as compare to adult one.
 The spread of MERS-CoV in camel to camel or
camel to human it could be influenced by crowding
mixing of camels from transportation and in animal
markets or could be in slaughter houses.
 Many countries have reported that the MERS-CoV
had been in the camel which are in farmhouse or in
animal market.
 Because a study shows that camels produced the
antibody of MERS-CoV at the age of 1 year old.
14
TRANSMISSION
 Camel to Human Transmission
 The MERS-CoV is a zoonotic virus.
 It is infected through direct or indirect contact with
infected dromedary camels in the Middle East.
 Strains of MERS-CoV have been identified in camels
in several countries including Egypt, Jordan, Oman,
Qatar and Saudi Arabia.
 Most of human cases do not have a history of direct
contact with camels if camels or other animals are
the source the route of the transmission to humans
could be indirect.
15
TRANSMISSION
 Human to Human Transmission
 The virus does not appear to pass easily from
person to person unless there is close contact such
as providing clinical care to an infected patient.
 This has been among family members, patients and
health care workers.
 Undermined droplet and direct contact probably
large droplet transmission is suspected as the most
likely route.
 Majority cases have resulted from human to human
transmission in health care settings.
 All reported cases have been linked to countries in
and near the Arabian Peninsula.
16
TREATMENT
 Till now date there is been no specific vaccine or
medicinal treatment available to cure MERS-CoV
disease.
 But certain type of drugs like Lopinavir, Ritonavir,
Remdesivir and Favipiravir can be used in treatment
of patients with having MERS-CoV.
 The pharmaceutical companies and other institutions
are still trying to develop a drug or a vaccine which
can prevent these diseases but it is very long and
costly process.
17
VACCINE
 In 2014, the researchers began to develop a vaccine
against the MERS corona virus in preparation for
large outbreaks of the virus.
 The vaccine is based on an attenuated virus (MVA:
Modified Vaccine Virus), which had previously been
used in a smallpox vaccination and has now been
altered to contain protein components from the
MERS corona virus.
 This recombinant, vector-based vaccine is
scientifically termed MVA-MERS-S.
18
PREVENTION
 To prevent MERS-CoV people should avoid
close contact with camels and avoid the
consumption of raw or undercooked animal
products like their meat, milk and other
material.
 The infected person should be properly
isolated.
 According to guidelines of World Health
Organization and Center for Disease Control
CDC cover nose and mouth with mask and
wash hands often with soap and hand wash for
20 sec.
19
PREVENTION
20

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Mers middle east respiratory syndrome

  • 2. INTRODUCTION  The Middle East Respiratory Syndrome (MERS) is similar like 2003 outbreak virus called Severe Acute Respiratory Syndrome (SARS).  These virus is also belongs to large group of virus containing Corona virus family.  The nomenclature of MERS is Middle East Respiratory Syndrome Corona virus (MERS-CoV).  In the name Middle East suggests that this virus first detected in The Kingdom of Saudi Arabia in the year of 2012 and other word respiratory syndrome suggests that it causes illness in particular respiratory system and lungs. 2
  • 3. INTRODUCTION  It is one of the deadly virus with the high Fatality rate and majorly risk groups are infants, elderly people, persons with immune system problems like diabetes, blood pressure, heart and Lungs disease and Kidney problem people are easily infected with MERS-COV.  These virus are zoonotic in nature and majorly camels are responsible for the transmission but the role of bats are still under investigation in the mode of transmission of MERS-CoV. 3
  • 4. SYMPTOMS  Fever  Cough  Shortness of breath  Myalgia  Diarrhea  Vomiting  Abdominal pain  The incubation period of MERS-CoV is 2 to 14 days after person infected from the MERS-CoV.  But most of the cases showed symptoms in 5 to 6 days. 4
  • 5. VIRAL STRUCTURE  The MERS-CoV is belongs to large corona virus family.  In corona virus family it belongs to β-corona virus type.  The size of MERS-CoV is approximately 50 to 200 nm.  The genomic size of MERS-CoV is about 26.2 to 31.7 kb and consist ssRNA (Single Stranded) as a genetic material and spike proteins which covered from the large envelope.  The genome of MERS-CoV is classified into two clades.  That are Clade A and Clade B. Clade A is observed 5
  • 7. EPIDEMIOLOGY  The virus first detect in Saudi Arabia in September, 2012.  Since now this virus had seen in 27 countries with 3 major outbreaks. COUNTRY YEAR CASES TOTAL CASES TILL NOW TOTAL DEATHS TILL NOW Saudi Arabia 2014 402 1029 452 South Korea 2015 150 150 38 UAE 2017 74 78 10 7
  • 8. EPIDEMIOLOGY  The total cases of MERS-CoV as per January, 2020 according to World Health Organization (WHO) are 2,519 cases with 866 deaths all over the world.  The fatality rate of MERS-CoV is 34.3 % which is the highest in corona virus family.  The countries which are affected is shown in below graph; 8
  • 10. DIAGNOSIS  The MERS-CoV is detected using a reverse transcriptase polymerase chain reaction (PCR) test.  On June 5, 2013 the FDA issued an emergency- use authorization (EUA) for the CDC Novel Corona virus 2012 Real-Time RT-PCR Assay.  This test detects Middle East respiratory syndrome corona virus (MERS-CoV) formerly known as novel corona virus 2012 or NCV-2012, in patients with signs and symptoms of MERS and appropriate risk factors. 10
  • 11. DIAGNOSIS  This assay is distributed by the CDC to qualified laboratories.  The PCR is performed on a sample of respiratory secretions or blood.  ELISA or enzyme-linked immune sorbent assay and IFA or immune fluorescence assay are tests for antibody to MERS-CoV but it is used for research purposes rather than patient care. 11
  • 12. TRANSMISSION  Transmission MERS-CoV is the zoonotic virus.  Mostly camel are responsible for the transmission of this virus but the role of bats are still under investigation.  The MERS-CoV is transmitted in the three different patterns which are mention in as below;  1. Camel to camel transmission  2. Camel to Human transmission  3. Human to Human transmission 12
  • 14. TRANSMISSION  Camel to Camel Transmission  The MERS-CoV are usually found in younger camels as compare to adult one.  The spread of MERS-CoV in camel to camel or camel to human it could be influenced by crowding mixing of camels from transportation and in animal markets or could be in slaughter houses.  Many countries have reported that the MERS-CoV had been in the camel which are in farmhouse or in animal market.  Because a study shows that camels produced the antibody of MERS-CoV at the age of 1 year old. 14
  • 15. TRANSMISSION  Camel to Human Transmission  The MERS-CoV is a zoonotic virus.  It is infected through direct or indirect contact with infected dromedary camels in the Middle East.  Strains of MERS-CoV have been identified in camels in several countries including Egypt, Jordan, Oman, Qatar and Saudi Arabia.  Most of human cases do not have a history of direct contact with camels if camels or other animals are the source the route of the transmission to humans could be indirect. 15
  • 16. TRANSMISSION  Human to Human Transmission  The virus does not appear to pass easily from person to person unless there is close contact such as providing clinical care to an infected patient.  This has been among family members, patients and health care workers.  Undermined droplet and direct contact probably large droplet transmission is suspected as the most likely route.  Majority cases have resulted from human to human transmission in health care settings.  All reported cases have been linked to countries in and near the Arabian Peninsula. 16
  • 17. TREATMENT  Till now date there is been no specific vaccine or medicinal treatment available to cure MERS-CoV disease.  But certain type of drugs like Lopinavir, Ritonavir, Remdesivir and Favipiravir can be used in treatment of patients with having MERS-CoV.  The pharmaceutical companies and other institutions are still trying to develop a drug or a vaccine which can prevent these diseases but it is very long and costly process. 17
  • 18. VACCINE  In 2014, the researchers began to develop a vaccine against the MERS corona virus in preparation for large outbreaks of the virus.  The vaccine is based on an attenuated virus (MVA: Modified Vaccine Virus), which had previously been used in a smallpox vaccination and has now been altered to contain protein components from the MERS corona virus.  This recombinant, vector-based vaccine is scientifically termed MVA-MERS-S. 18
  • 19. PREVENTION  To prevent MERS-CoV people should avoid close contact with camels and avoid the consumption of raw or undercooked animal products like their meat, milk and other material.  The infected person should be properly isolated.  According to guidelines of World Health Organization and Center for Disease Control CDC cover nose and mouth with mask and wash hands often with soap and hand wash for 20 sec. 19