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Middle East respiratory syndrome coronavirus:

Sawsan Mustafa Abdalla Associate Professor Community Medicine Faculty of Medicine Middle East respiratory syndrome coronavirus


In temperate climates coronavirus respiratory infections occur primarily in the winter although smaller peaks are sometimes seen in the fall or spring and infections can occur at any time of the year Epidemiology

Epidemiology :

and HCoV appear to predominate unpredictably in certain years and in certain parts of the world. Because of the varying sensitivity of different diagnostic assays, as well as the unpredictable prevalence of the various strains from year to year, it is difficult to say which, if any, of the strains is the most common. Epidemiology

What Are Coronaviruses? :

Coronaviruses are important human and animal pathogens. cause of up to one-third of community-acquired upper respiratory tract infections in both children and adults. certain coronaviruses cause diarrhea in infants and children Cause central nervous diseases (has been suggested but not proven). What Are Coronaviruses?

What Are Coronaviruses?:

medium-sized Enveloped positive-stranded RNA viruses whose name derives from their characteristic crown-like appearance in electron micrographs These viruses have the largest known viral RNA genomes, with a length of 27 to 32 kb. What Are Coronaviruses?

What Are Coronaviruses?:

Replication of viral RNA occurs in the host cytoplasm in which RNA polymerase binds to a leader sequence and then detaches and reattaches at multiple locations, allowing for the production of a nested set of mRNA molecules with common 3’ ends What Are Coronaviruses?

What Are Coronaviruses?:

Coronaviruses are named so 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. What Are Coronaviruses?


It was first reported on 24th September 2012 by  Egyptian  virologist Dr. Ali Mohamed Zaki in  Jeddah ,  Saudi Arabia This virus is different from any other coronavirus previously found in people. History???


It is also different from the coronavirus that caused SARS  (Severe Acute Respiratory Syndrome) in 2003. Until 23 May2013, MERS- CoV had frequently been referred to as a SARS-like virus, [8] History???


novel coronavirus that emerged in Saudi Arabia two years ago, Recently 244 people were infected in the kingdom, of whom 76 have died. ( Health Ministry) History???

Incubation period:

 In an outbreak of MERS-CoV in Saudi Arabia that resulted in laboratory-confirmed MERS-CoV in 23 individuals, the median incubation period was 5.2 days secondary case that occurred in a patient in France the incubation period was estimated at 9 to 12 days Incubation period

Clinical features:

Most patients with MERS- CoV : severely ill with pneumonia and acute respiratory distress syndrome acute kidney injury. Many patients have required mechanical ventilation and extracorporeal membrane oxygenation. Clinical features

Clinical features:

gastrointestinal symptoms: anorexia nausea vomiting abdominal pain diarrhea) pericarditis disseminated intravascular coagulation Clinical features

The following clinical findings were observed among 47 patients with MERS-CoV in Saudi Arabia::

Fever (>38°C) – 46 patients (98 percent ) Fever with chills or rigors – 41 patients (87 percent ) Cough – 39 patients (83 percent ) Shortness of breath – 34 patients (72 percent ) Hemoptysis – 8 patients (17 percent) The following clinical findings were observed among 47 patients with MERS- CoV in Saudi Arabia:


Sore throat – 10 patients (21 percent ) Myalgias – 15 patients (32 percent ) Diarrhea – 12 patients (26 percent ) Vomiting – 10 patients (21 percent ) Abdominal pain – 8 patients (17 percent ) Abnormal chest x-ray – 47 patients (100 percent) Continue:

Mode of Transmission:

Air: by droplets from coughing, sneezing ,ect. Come in contact with ill patients Mode of Transmission


It is not certain whether the infections are result of asingle  zoonotic  event with subsequent human-to-human transmission or if the multiple geographic sites of infection represent multiple zoonotic events from a common unknown source. Zoonotic???


The virus MERS- CoV belongs to the genus  Betacoronavirus  some researchers believe the virus is related to one found in the tomb bat . An Epidemiologist Ian Lipkin of Columbia University in New York city claims the virus isolated from the bat was a 100% match to the virus found in humans. Zoonotic???


On April 17, 2014 a Saudi expert on the virus announced a link between the virus and camels, stating that a virus sample from a camel was a 100% match to that found in a Saudi patient. [ Zoonotic???


As noted above, it is likely that animals serve as intermediate hosts for MERS-CoV. In 2013, MERS-CoV sequences were detected by reverse-transcriptase polymerase chain reaction (RT-PCR) in samples from a juvenile camel belonging to a patient with MERS-CoV in Jeddah, Saudi Arabia Zoonotic???

Management and prevention:

Taking these everyday actions can help prevent the spread of germs and protect against colds, flu, and other illnesses: Management and prevention

Management and prevention:

Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer . Avoid touching your eyes, nose, and mouth. Germs spread this way. Avoid close contact with sick people. Management and prevention

Management and prevention:

If Traveling : Be sure you are up-to-date with all of your shots, and if possible, see your healthcare provider at least 4–6 weeks before travel to get any additional shots. Management and prevention

Management and prevention:

If you are sick: Cover your mouth with a tissue when you cough or sneeze, and throw the tissue in the trash. Avoid contact with other people to keep from infecting them. Management and prevention

When Should Someone See a Health Care Provider? :

Visit a health care provider if you develop: fever lower respiratory illness cough shortness of breath within 14 days after traveling from countries in or near the Arabian Peninsula * . When Should Someone See a Health Care Provider?

Clinician Information: :

Health care providers should be alert to patients who develop: Severe acute lower respiratory illness (e.g., requiring hospitalization) within 14 days after traveling from countries in the Arabian Peninsula *  or Clinician Information:

Clinician Information:

Consider other more common causes of respiratory illness, such as influenza. Evaluate patients using  CDC’s case definitions and guidance . Immediately report patients with unexplained respiratory illness and who meet CDC’s criteria for “patient under investigation (PUI)” to local health department. Clinician Information

Recommendations :

Saudi Arabia recommends that the following groups should postpone their plans for Hajj and Umrah this year: People over 65 years old Children under 12 years old Pregnant women Recommendations


People with chronic diseases (such as heart disease, kidney disease, diabetes, or respiratory disease) People with weakened immune systems People with cancer or terminal illnesses Recommendations

Arabian Peninsula:

Countries considered in the Arabian Peninsula and neighboring include: Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen. Arabian Peninsula

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