1. Middle East
Respiratory
Syndrome
Coronavirus
(MERS-CoV)
By
Dr Anjum Hashmi
MBBS,CCS(USA),MPH
Infection Control Director
Maternity & Children's Hospital
Najran KSA.
Transmission
electron
micrograph of
MERS-CoV.

2. MERS-CoV
• MERS-CoV is a novel coronavirus first
identified in September 2012 by an Egyptian
virologist, who isolated the previously
unknown coronavirus from the lungs of a 60-
year-old patient with pneumonia and renal
failure.
• To date, the World Health Organization
(WHO) has reported a total of 77 laboratory-
confirmed cases of infection with MERS-CoV,
including 40 deaths.

3. MERS-CoV
• Corona viruses are
named for the crown-like
spikes on their surface.
• They are common
viruses that most people
get in their lifetime.
• These viruses usually
cause mild to moderate
upper-respiratory tract
illnesses. The virions had infected cells in a
Vero cell culture. (CDC).

4. MERS-CoV/SARS-CoV
• MERS-CoV is different
from any other corona
virus previously found
in people.
• It is also different
from the corona virus
that caused SARS
(Severe Acute
Respiratory
Syndrome) in 2003.
• structural morphology
of MERS-CoV
Structural morphology of MERS-CoV (CDC)

5. SARS-CoV/MERS-CoV
• SARS corona virus can infect people and
animals, including monkeys, cats, dogs and
rodents.
• Genetic sequencing has determined MERS-
Corona viruses is most closely related to
corona viruses detected in bats.
• MERS-Corona viruses may also infect animals.
• A camel was recovered of illness after contact
with whom a man got MERS-CoV & died in
UAE.

6. Mode of Transmission
• MERS-CoV was first reported in Saudi Arabia and
has spread to Europe, including England, France,
Germany and most recently Italy.
• The original source of MERS-CoV, routes of
transmission to humans, and mode of human-to-
human transmission have not been determined.
• Health officials do not know how the newly
discovered MERS-CoV spreads
• So far, there is no reported evidence of sustained
community transmission in any country.

7. Mode of Transmission
• All reported cases were directly or indirectly
linked to one of four countries: Saudi Arabia,
Qatar, Jordan, and the United Arab
Emirates.
• Eight clusters of cases to date, which
occurred among close contacts or in
healthcare settings, provide clear evidence
of human-to-human transmission of MERS-
CoV, possibly involving different modes,
such as droplet, airborne & contact

8. MERS Case & Deaths
April 12th
- 27th
June 12

9. Sign & Symptoms
• Most people who became infected with
MERS-CoV developed severe acute respiratory
illness with symptoms like
• Fever 38°C , 100.4°F.
• Cough.
• Shortness of breath.
• Some people were reported as having a mild
respiratory illness.
• About half of them may died.

10. Surveillance of MERS-CoV
• Investigations suggesting incubation
periods for MERS-CoV may be longer than
10 days.
• The time period for considering MERS in
persons who develop severe acute lower
respiratory illness days after traveling
from the Arabian Peninsula or neighboring
countries has been extended from within
10 days to within 14 days of travel.

11. “Patient under investigation”
(PUI)• Persons who meet the following criteria should be
reported and evaluated for MERS-CoV infection:
• •A person with an acute respiratory infection, which may
include fever (= 38°C , 100.4°F) and cough;
AND
• •Suspicion of pulmonary parenchymal disease (e.g.,
pneumonia or acute respiratory distress syndrome based
on clinical or radiological evidence of consolidation);
AND
• •History of travel from the Arabian Peninsula or
neighboring countries within 14 days;
AND
• •Symptoms not already explained by any other infection
or etiology, including clinically indicated tests for
community-acquired pneumonia

12. Persons may be considered for
evaluation for MERS-CoV infection:
• Persons who develop severe acute lower
respiratory illness of known etiology within 14
days after traveling from the Arabian Peninsula
or neighboring countries but who do not
respond to appropriate therapy;
OR
• Persons who develop severe acute lower
respiratory illness who are close contacts of a
symptomatic traveler who developed fever and
acute respiratory illness within 14 days of
traveling from the Arabian Peninsula or
neighboring countries.

13. Close Contact of MERS-CoV
• Any person who provided care for
the patient, including a healthcare
worker or family member, or had
similarly close physical contact.
• Any person who stayed at the same
place (e.g. lived with, visited) as the
patient while the patient was ill.

14. Probable Case of MERS-CoV
• Any person who meets
• the criteria for Patient Under Investigation and has
clinical, radiological, or histopathological evidence of
pulmonary parenchyma disease (e.g. pneumonia or
ARDS), but no possibility of laboratory confirmation exists,
either because the patient or samples are not available or
there is no testing available for other respiratory
infections, AND
• is a close contact with a laboratory-confirmed case,
AND
• has illness not already explained by any other infection or
etiology, including all clinically indicated tests for
community-acquired pneumonia.
OR
• any person with severe acute respiratory illness with no
known etiology, AND
• an epidemiologic link to a confirmed MERS case.

15. Confirmed Case of MERS-CoV
• A person with laboratory
confirmation of infection with
MERS-CoV.

16. Laboratory Testing
• Novel Coronavirus 2012 Real-time RT-PCR Assay
(NCV-2-12 rRT-PCR Assay) is used to conform MERS-
CoV in respiratory, blood and stool samples.
• To increase the likelihood of detecting MERS-CoV,
CDC recommends collection of specimens from
different sites--for example, a nasopharyngeal swab
and a lower respiratory tract specimen such as
sputum, bronchoalveolar lavage, bronchial wash, or
tracheal aspirate.
• Lower respiratory tract specimens should
be a priority for collection and PCR testing.
• Stool specimens are of lower priority.

17. PPE used for MERS-CoV

18. Environmental Infection Control

19. MERS-CoV Vaccine Candidate
• Novavax on June 6, 2013 announced that it had
successfully produced a vaccine candidate
designed to provide protection against the
recently emerging Middle East Respiratory
Syndrome Coronavirus (MERS-CoV).
• The vaccine candidate was made using Novavax’
nanoparticle vaccine technology, is based on the
major surface spike (S) protein.
• Novavax believes that MERS-CoV vaccine
candidate may provide a path forward for a
vaccine for this emerging threat.