State of knowledge and data gaps of middle east respiratory syndrome coronavirus (MERS-CoV) in humans

M. M. Abdallat
F. Abroug
S. H. Al Dhahry
M. M. Alhajri
R. Al-Hakeem
F. I. Al Hosani
S. M. Al Qasrawi
H. E. Al-Romaihi
A. Assiri
J. K. Baillie
P. K. Ben Embarek
A. Ben Salah
B. Blümel
T. Briese
U. Buchholz
S. B. Cognat
G. N. Defang
S. De La Rocque
I. Donatelli
M. Zambon


© 2016, Public Library of Science. All rights reserved. BACKGROUND: Between September 2012 and 22 October 2013, 144 laboratory-confirmed and 17 probable MERS-CoV cases from nine countries were notified to WHO. METHODS: We summarize what is known about the epidemiology, virology, phylogeny and emergence of MERS-CoV to inform public health policies. RESULTS: The median age of patients (n=161) was 50 years (range 14 months to 94 years), 64.5% were male and 63.4% experienced severe respiratory disease. 76.0% of patients were reported to have ≥1 underlying medical condition and fatal cases, compared to recovered or asymptomatic cases were more likely to have an underlying condition (86.8% vs. 42.4%, p<0.001). Analysis of genetic sequence data suggests multiple independent introductions into human populations and modelled estimates using epidemiologic and genetic data suggest R0 is <1, though the upper range of estimates may exceed 1. Index/sporadic cases (cases with no epidemiologic-link to other cases) were more likely to be older (median 59.0 years vs. 43.0 years, p<0.001) compared to secondary cases, although these proportions have declined over time. 80.9% vs. 67.2% of index/sporadic and secondary cases, respectively, reported ≥1 underlying condition. Clinical presentation ranges from asymptomatic to severe pneumonia with acute respiratory distress syndrome and multi-organ failure. Nearly all symptomatic patients presented with respiratory symptoms and 1/3 of patients also had gastrointestinal symptoms. CONCLUSIONS: Sustained human-to-human transmission of MERS-CoV has not been observed. Outbreaks have been extinguished without overly aggressive isolation and quarantine suggesting that transmission of virus may be stopped with implementation of appropriate infection control measures.