Learn about Middle Eastern Respiratory Syndrome (MERS)
MERS stands for Middle Eastern Respiratory Syndrome and is a viral infection affecting humans. It primarily causes infection of the lungs and affects the breathing in an individual. It may also cause damage to the kidneys and other organs. Collectively, the symptoms produced by this virus are called Middle Eastern Respiratory Syndrome.
- MERS is a viral disease that can cause lung infection and kidney failure in humans. It is transmitted from camels and bats to humans. It can also be transmitted by human-to-human contact.
- The main symptoms of MERS are fever, cough, shortness of breath, body pain, vomiting, diarrhea, and muscle pain.
- There is no approved treatment available for MERS. If your health-care provider diagnoses MERS, you may be admitted to the hospital, where your breathing and other body functions will be monitored and supported by the health-care workers. Around one-third of patients with MERS has died.
What is MERS?
A virus called coronavirus causes MERS. As a result, this syndrome is also called MERS-Coronavirus (MERS-CoV). The virus belongs to the same family as the common cold virus but has a completely different genetic makeup. It causes flu-like symptoms along with lung infection (pneumonia) in humans. It was first described in Saudi Arabia in 2012, in a person who was admitted to the hospital with lung infection and kidney failure. Thereafter, it was identified in other people in the Arabian Peninsula and in those who traveled to Saudi Arabia. More recently, an outbreak was detected in the Republic of Korea, where more than 180 people were affected, including American military troops who were stationed there. So far, only 2 cases of MERS have been reported in the continental United States, in health-care workers who recently traveled to Saudi Arabia. Overall, more than 20 countries worldwide have reported cases of MERS. Details of those countries affected can be found on the World Health Organization website: (www.who.int).
How does MERS affect your body?
The MERS virus, MERS-CoV, causes respiratory, or lung-related, illness. It may cause severe pneumonia and lung failure in some people, requiring admission to the hospital. It may also affect other parts of the body, causing dehydration (loss of body fluid) and kidney failure due to vomiting and diarrhea.
How serious is MERS?
According the Center for Disease Control (CDC), 3-4 out of every 10 patients diagnosed with MERS have died. Most of those who died also had underlying health problems before they became infected with MERS. Some have been found to have mild symptoms or even no symptoms at all. However, it is very important to monitor these milder cases closely for any worsening disease.
MERS Symptoms, Causes, and Risk Factors
The MERS virus causes a flu-like disease with pneumonia in most cases. However, it is important to distinguish it from other diseases with similar symptoms. A history of travel to affected areas, particularly the Middle East, and contact with patients known to be infected with the MERS virus are helpful for early detection.
The more common symptoms reported with MERS include:
- Fever with or without chills and rigors
- Cough, shortness of breath, coughing up blood
- Sore throat, muscle pain, muscle soreness
- Vomiting, diarrhea, stomach or belly pain
People with MERS can present with severe disease – acute breathing failure, kidney damage, and high fevers. These people have to be admitted to the intensive care unit of a hospital. Some people may have milder symptoms or no symptoms and are followed closely at home. It is important for any patient with the above symptoms and a history of travel to the Arabian Peninsula, or any other affected region, to report to his/her nearest health-care provider and be tested for possible MERS infection.
MERS is caused by a coronavirus, which is primarily spread by respiratory secretions, though the exact manner in which the virus spreads is currently unknown. MERS can be caused by close contact with persons infected with the MERS virus. It can also be caused by close contact with camels. The World Health Organization recommends that in regions with a high risk of MERS, people avoid having close contact with camels, avoid drinking raw camel milk/urine, and don’t eat undercooked camel meat. The incubation period, the time from virus exposure to start of symptoms, for the MERS virus is usually about 5 or 6 days, but it can range from 2-14 days.
Who is at Risk for MERS?
- Recent travelers to the Arabian Peninsula who develop symptoms of respiratory (lung) illness within 14 days of their return.
- Patients with underlying medical problems and reduced immunity may be at risk for developing severe disease.
- Close contact with an ill traveler (with respiratory illness), within 14 days after the sick person traveled to the Arabian Peninsula (Egypt, Iran, Kuwait, Bahrain, Lebanon, Jordan, Oman, Qatar, UAE, Yemen), South Korea, or other countries affected with MERS.
- Close contact with camels in those affected areas.
- Health-care professionals treating patients with MERS and not using the recommended infection prevention precautions.
- Close contact with patients diagnosed with MERS.
When to see your doctor
If you develop new respiratory symptoms or fever and (1) recently visited/ lived in the Arabian Peninsula or any of the other countries described above; OR (2) have been in contact with a person with a respiratory illness who had recently traveled (within 14 days of his/her illness) to the Arabian Peninsula.
Please see your doctor or healthcare provider for an evaluation. If you are feeling sick and have severe breathing difficulty then you should go directly to the nearest hospital or emergency department. If you have access to a facemask, you should wear it to avoid spreading the virus to other people. Your doctor will evaluate you for possible MERS and may order a chest x-ray and other blood tests to make the diagnosis.
Diagnosing and treating MERS
While early diagnosis of MERS is important for preventing complications and viral spread, many patients present late and with more severe illness.
What to Expect
Persons with a new respiratory illness after recent travel to the Arabian Peninsula, or close contact with a person with MERS, should be evaluated. If you have mild symptoms, you may be asked by your doctor to stay well hydrated, remain at home, and avoid contact with others to reduce the risk of spreading the disease. If you have severe symptoms, you will be admitted to the hospital and kept in an isolation room to avoid spreading the disease to others. Some patients with severe symptoms may develop lung or respiratory failure and require a breathing tube and an artificial breathing device.
How is MERS diagnosed?
Symptoms of respiratory illness and recent travel to the Middle East region are the first screening measures used to diagnose MERS. The World Health Organization has also developed a questionnaire that is used to investigate possible cases of disease. If your doctor suspects MERS, you may have a chest x-ray, blood counts, kidney function tests, and respiratory samples (lung secretions) for evaluation.
How is MERS treated?
Currently, there is no approved treatment for MERS. Patients with mild disease are given symptomatic treatment (fluids, pain relievers) for relief. If a patient is not hospitalized, he/she should stay at home and avoid contact with others to reduce spread of the virus. If a patient has severe disease, he/she will be admitted to the hospital. Supportive lung care and monitoring of body functions are usually performed. A patient may also be given oxygen, antibiotics, and intravenous fluids. There is presently no vaccine available to prevent MERS. Infection prevention measures, such as wearing a mask, avoiding contact with a MERS infected patient, and avoiding contact with camel milk or meat may lower your risk of developing MERS. It is suggested that if you are older than 65 years of age, pregnant, have pre-existing heart, lung, kidney disease, or cancer you should avoid travel to the Arabian Peninsula and other places with recent MERS infection. Government travel notices can help guide your decision about traveling to the Arabian Peninsula.
Living with MERS
Patient with MERS may have mild to severe disease. Most patients with mild disease recover without complications. Patients with severe disease may require longer hospitalizations and have a higher risk of death.
What to Expect
As described above, patients with pre-existing medical problems may have more severe disease and a higher risk of death. Usually, younger patients without prior medical problems do well and recover completely. If you think you may have MERS, see your doctor or nurse for an evaluation. If you have mild symptoms, your doctor may monitor you at home. You should remain at home and stay away from other people to keep the virus from spreading. Additionally, you should keep personal items such as towels, bed sheets, utensils, and clothes away from others and wear a facemask. Cover your cough and sneezes, and wash your hands often with soap and water. It is also important to watch closely for any worsening symptoms and report them to your health-care provider immediately.
Details about home care for patients with MERS can be found on the Center for Disease Control (CDC) website: (www.cdc.gov). Sicker patients are cared for in the hospital and may need artificial lung support if their breathing becomes worse. Those who had contact with someone with MERS are at greater risk of infection and may infect others if they have symptoms. Such individuals should be closely monitored for 14 days from the last day of exposure.
Managing the disease
If you have new respiratory illness and are at risk for MERS, you should contact your healthcare provider as soon as possible. Until that happens, you should wear a mask, stay home, and avoid contact with others. Drink plenty of fluids and get rest at home. While no antiviral treatment or vaccine is currently available for MERS, there is ongoing research to find an effective treatment.
According to Center for Disease Control, the MERS situation in the United States currently represents a very low risk to persons in this country. Updates about vaccinations and treatment for MERS can be found on the Center for Disease Control (www.cdc.gov) and World Health Organization (www.who.int) websites. For those outside the United States, you should contact your local health authorities and review the information on the websites listed above.
Questions to Ask Your Doctor about MERS
People in the United Staes who do not travel to areas where MERS usually occurs are at very low risk of infection. However, if you develop new respiratory symptoms or fever and have recently traveled, lived, or came in contact with someone in one of these areas, you should see your health-care provider.
Making notes before your visit, as well as taking along a trusted family member or friend, can help you through the first appointment with your doctor.
What is Middle East respiratory syndrome (MERS)?
Middle East Respiratory Syndrome (MERS) is a viral lung disease caused by a coronavirus (MERS‐CoV). It was first identified in 2012 in Saudi Arabia and presently reported in over 20 countries. The virus that causes MERS is different from any other coronavirus previously found in people.
Where is MERS found?
So far, cases of MERS have been reported in more than 20 countries: Middle East – Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, the United Arab Emirates, and Yemen; Europe – Austria, France, Germany, Greece, Italy, Netherlands, Turkey, and the United Kingdom; Africa – Algeria, Tunisia and Egypt; Asia – China, Malaysia, Republic of Korea, the Philippines and Thailand; and the United States of America. Most cases have occurred in Saudi Arabia.
What causes MERS?
The virus that causes MERS is a coronavirus called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). The viruses that cause the common cold and SARS are also coronaviruses; however, the MERS virus is different from those other coronaviruses. MERS was first reported in Saudi Arabia in 2012 and has now been detected in over 20 countries worldwide.
How do people get MERS?
It is not yet clear how people become infected with the MERS-CoV, the virus that causes MERS. Infected camels in the Middle East are thought to be a source of the infection. The virus may pass from person-to-person when there is close contact, such as with family members, patients, or health‐care workers. Most cases have occurred by human-to-human transmission among health-care workers.
To lower your risk of developing MERS, you should:
- Wash your hands thoroughly before and after touching camels and other animals in areas where MERS is found, and do not touch sick animals.
- Avoid eating raw or undercooked animal products (particularly camel meat and camel milk).
- Don’t touch your eyes, nose, or mouth with unwashed hands.
Who is at a higher risk for developing MERS?
- Recent travelers from the Arabian Peninsula who develop fever, cough, or shortness of breath within 14 days of travel.
- People in contact with a sick individual who traveled to the Arabian Peninsula or any of the other affected countries.
- People who had contact with a confirmed MERS patient.
- People with a respiratory illness and exposure to camels.
- Healthcare workers who had contact with MERS patients.
What are the symptoms of MERS?
Some patients with MERS may have no symptoms or mild breathing problems. Other may have more severe lung disease and a higher risk of death. Symptoms may include fever, cough, and shortness of breath. Some patients may have pneumonia. Stomach-related symptoms, including nausea and diarrhea, may occur. Older patients, those with weaker immune systems, and those with chronic health problems (such as kidney failure, cancer, cirrhosis, or lung problems) may develop severe MERS.
Who should be tested for MERS?
If you develop fever, cough, or shortness of breath within 14 days of traveling from a country around the Middle East, or if you had close contact with someone with these problems who recently traveled from any of the areas where MERS is found, you should contact your healthcare provider and report your recent travel or contact.
How is a person tested for MERS?
In general, your healthcare provider will perform a blood test to check for the MERS virus. Respiratory (lung) samples can also be tested to see if there is an active MERS infection.
How is MERS treated?
Currently, there is specific treatment or vaccine for MERS. If MERS is diagnosed, you will receive supportive care with fluids and medicines according to your clinical condition. In the case of severe pneumonia, oxygen or an artificial breathing tube may be needed to support the lungs.
What happens to a person infected with the MERS virus?
Patient with MERS may have no symptoms, mild disease, or severe disease. Most patients with mild disease recover without problems and have no long-term effects. However, patients with severe disease may need to be hospitalized longer and are at higher risk of dying from MERS. Approximately 3 – 4 of every 10 patients reported with MERS have died.
Is there a MERS vaccine?
Presently, there is no vaccine against the MERS virus.
Keith Wille, MD, FCCP
Nirmal Sharma, MD
Robert Hyzy, MD, FCCP
Date Last Reviewed