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Frontiers of Medicine

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Front. Med.    2016, Vol. 10 Issue (2) : 120-136    https://doi.org/10.1007/s11684-016-0430-6
REVIEW
Middle East respiratory syndrome coronavirus: a comprehensive review
Mahmoud M. Shehata1,Mokhtar R. Gomaa1,Mohamed A. Ali1,Ghazi Kayali2,*()
1. Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza, Egypt
2. Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
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Abstract

The Middle East respiratory syndrome coronavirus was first identified in 2012 and has since then remained uncontrolled. Cases have been mostly reported in the Middle East, however travel-associated cases and outbreaks have also occurred. Nosocomial and zoonotic transmission of the virus appear to be the most important routes. The infection is severe and highly fatal thus necessitating rapid and efficacious interventions. Here, we performed a comprehensive review of published literature and summarized the epidemiology of the virus. In addition, we summarized the virological aspects of the infection and reviewed the animal models used as well as vaccination and antiviral tested against it.
Keywords MERS      coronavirus      review     
Corresponding Author(s): Ghazi Kayali   
Just Accepted Date: 25 December 2015   Online First Date: 20 January 2016    Issue Date: 27 May 2016
 Cite this article:   
Mahmoud M. Shehata,Mokhtar R. Gomaa,Mohamed A. Ali, et al. Middle East respiratory syndrome coronavirus: a comprehensive review[J]. Front. Med., 2016, 10(2): 120-136.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-016-0430-6
https://academic.hep.com.cn/fmd/EN/Y2016/V10/I2/120
First cases reported April, 2012 (Zarqa, Jordan)June, 2012 (Jeddah, Saudi Arabia)
Incubation period
?Mean (d) 5.2 (1.9–14.7)
?Range (d) 2–13
Patient characteristics
?Adults 98%
?Children 2%
?Age range (year) 1–94
?Average age (year) Median 50
?Sex ratio (male/female) 64.5%/35.5%
Mortality
?Overall CFR 35.35%
?CFR in patients with comorbidities 60%
Disease progression
?Time from onset to ventilatory support Median 7 days
?Time from onset to death Median 11.5 days
Presenting symptoms
?Fever (>38°C) 98%
?Chills or rigors 87%
?Cough 83%
?Dry 56%
?Productive 44%
?Hemoptysis 17%
?Headache 11%
?Myalgia 32%
?Malaise 38%
?Shortness of breath 72%
?Nausea 21%
?Vomiting 21%
?Diarrhea 26%
?Sore throat 14%
?Rhinorrhea 6%
?Comorbidities 76%
?Dead subjects with underlying conditions 86%
?Asymptomatic or recovered subjects with underlying conditions 42%
Laboratory results
?Chest radiography abnormalities 90%–100%
?Leucopenia (<4.0×109 cells per L) 14%
?Lymphopenia (<1.5×109 cells per L) 32%
?Thrombocytopenia (<140×109 platelets per L) 36%
?High lactate dehydrogenase 48%
?High alanine aminotransferase 11%
?High aspartate aminotransferase 14%
Tab.1  Clinical features for MERS-CoV patients
Country 2012 2013 2014 2015 Total
Algeria 0 0 2 0 2
Austria 0 0 1 0 1
China 0 0 0 1 1
Egypt 0 0 1 0 1
France 0 2 0 0 2
Germany 1 1 0 1 3
Greece 0 0 1 0 1
Iran 0 0 5 1 6
Italy 0 1 0 0 1
Jordan 2 0 10 0 12
Kuwait 0 2 1 0 3
Lebanon 0 0 1 0 1
Malaysia 0 0 1 0 1
Netherlands 0 0 2 0 2
Oman 0 1 1 4 6
Philippines 0 0 0 2 2
Qatar 0 7 2 4 13
South Korea 0 0 0 185 185
Saudi Arabia 5 136 679 210 1037
Thailand 0 0 0 1 1
Tunisia 0 3 0 0 3
Turkey 0 0 1 0 1
United Arab Emirates 0 12 57 7 76
UK 1 3 0 0 4
USA 0 0 2 0 2
Yemen 0 0 1 0 1
Total 9 168 768 413 1368
Tab.2  Number of MERS-CoV by country as of July 7, 2015 as per WHO data
Fig.1  Epidemiological curve of MERS-CoV up to week 23, 2015 as per WHO data.
Study location Sampling time Sample size Test name Animal species Seropositive ?percentage Camel age Reference
Oman 2013 50 Protein microarray, ?neutralization test Dromedary 100 Adult [102]
Canary Islands 2013 195 Protein microarray, ?neutralization test Dromedary 14 Adults and one juvenile [102]
Egypt 2013 110 Pseudoparticle, ?neutralization assay Dromedary 94 Adult [63]
Egypt 2013 52 Pseudoparticle, ?neutralization assay Dromedary 92.3 Adult [107]
Egypt, Sudan, ?Somalia 1983?1997 43 ELISA, ?neutralization test Dromedary 81.4 Not available [106]
Qatar 2013 14 Neutralization assay Dromedary 100 Not mentioned [108]
Saudi Arabia 2010?2013 310 Pseudoparticle ?neutralization assay Dromedary 90 27 juveniles, 283 adults [109]
Saudi Arabia 2014 9 Immunofluorescence ?assay Dromedary 22.2 6 adults, 3 juveniles [73]
UAE 2005 151, 500 Spike protein ?microarray Dromedary 81.8 Adult [104]
USA, Canada 2000?2001 6 Neutralization assay Dromedary 0 Adult [110]
Ethiopia 2010?2011 188 Protein microarray Dromedary 96 1?13 years [111]
Nigeria 2010?2011 358 Protein microarray Dromedary 94 Adult [111]
Jordan 2013 11 Protein microarray, ?neutralization test Dromedary 100 Juvenile [101]
Tunisia 2010?2011 204 Protein microarray Dromedary 48.5 1?16 years [111]
Sudan 1983 60 ELISA, ?neutralization test Dromedary 86.7 Adult [106]
Somalia 1983, 1984 25, 61 ELISA, ?neutralization test Dromedary 80, 85.2 Adult [106]
Kenya 1993?2013 774 ELISA Dromedary 27.5 Not mentioned [112]
Australia 2014 25 Pseudoparticle, ?neutralization assay Dromedary 0 Adults and juvenile [95]
Mongolia 2015 200 Pseudoparticle ?neutralization test Bactrian 0 Adults and juvenile [105]
Tab.3  Serological studies in camels
Fig.2  Zoonotic transmission of newly emerged MERS-CoV.
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