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
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.
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