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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2016, Vol. 10 Issue (2) : 111-119     DOI: 10.1007/s11684-016-0446-y
REVIEW |
Middle East respiratory syndrome coronavirus: current situation and travel-associated concerns
Jaffar A. Al-Tawfiq1,2,Ali S. Omrani3,Ziad A. Memish4,5,*()
1. Johns Hopkins Aramco Healthcare, Dhahran 31311, Kingdom of Saudi Arabia
2. Indiana University School of Medicine, Indianapolis, IN 46202-3082, USA
3. Department of Medicine, Section of Infectious Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Kingdom of Saudi Arabia
4. Ministry of Health, Riyadh 11514, Kingdom of Saudi Arabia
5. College of Medicine, Alfaisal University, Riyadh 11533, Kingdom of Saudi Arabia
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Abstract  

The emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012 brought back memories of the occurrence of severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002. More than 1500 MERS-CoV cases were recorded in 42 months with a case fatality rate (CFR) of 40%. Meanwhile, 8000 cases of SARS-CoV were confirmed in six months with a CFR of 10%. The clinical presentation of MERS-CoV ranges from mild and non-specific presentation to progressive and severe pneumonia. No predictive signs or symptoms exist to differentiate MERS-CoV from community-acquired pneumonia in hospitalized patients. An apparent heterogeneity was observed in transmission. Most MERS-CoV cases were secondary to large outbreaks in healthcare settings. These cases were secondary to community-acquired cases, which may also cause family outbreaks. Travel-associated MERS infection remains low. However, the virus exhibited a clear tendency to cause large outbreaks outside the Arabian Peninsula as exemplified by the outbreak in the Republic of Korea. In this review, we summarize the current knowledge about MERS-CoV and highlight travel-related issues.

Keywords coronavirus      MERS      Middle East respiratory syndrome     
Corresponding Authors: Ziad A. Memish   
Just Accepted Date: 12 April 2016   Online First Date: 04 May 2016    Issue Date: 27 May 2016
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-016-0446-y     OR     http://academic.hep.com.cn/fmd/EN/Y2016/V10/I2/111
Fig.1  A summary of the major events in the timeline of MERS-CoV epidemic.
Assiri et al. [26] Saad et al. [36] Al-Tawfiq et al. [37] Arabi et al. [38] Assiri et al. [39] Shalhoub et al. [40]
Total 23 70 17 12 47 24
Male 17 46 11 8 36 14
Diabetes mellitus 17 ? 13 8 32 15
Cardiac disease 9 ? 11 7 13 0
Renal failure 12 ? ? 5 23 10
Hemodialysis ? ? 5 1 ? 6
Malignancy ? ? 1 1 1 0
Hypertension ? ? 6 6 16 18
Fever 20 43 10 8 46 19
Dyspnea 11 42 1 11 34 20
Chest pain ? ? 12 10 7 0
Cough 20 38 1 1 39 21
Hemoptysis ? 6 1 1 8 ?
Sore throat ? ? 1 2 10 ?
Headache ? 9 1 3 6 ?
Myalgia ? 14 1 ? 15 ?
Vomiting 4 21 1 ? 10 4
Diarrhea 5 21 1 2 12 3
Weakness ? 21 1 2 12 ?
Abdominal pain ? 17 ? ? 8 2
Rhinorrhea ? ? 6 1 2 ?
Lymphopenia ? 36 ? 9 16 ?
Thrombocytopenia 4 ? ? 2 17 ?
Tab.1  Summary of the number of cases of MERS-CoV with designated symptoms and signs from four different studies and the total percentage of patients with any given symptom or sign
Fig.2  Timeline of WHO Emergency Committee (EC) meeting to discuss the IHR MERS-COV situation in relation to major events in the time of the disease.
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[1] Mahmoud M. Shehata,Mokhtar R. Gomaa,Mohamed A. Ali,Ghazi Kayali. Middle East respiratory syndrome coronavirus: a comprehensive review[J]. Front. Med., 2016, 10(2): 120-136.
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