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{{Short description|Viral respiratory infection}}
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{{other uses|Mers (disambiguation)}}
{{About|the disease|the virus that causes it|Middle East respiratory syndrome–related coronavirus}}
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<!-- Definition and symptoms -->
'''Middle East respiratory syndrome''' ('''MERS''') is a viral [[respiratory infection]] caused by ''[[Middle East respiratory syndrome–related coronavirus]]'' (MERS-CoV).<ref name=WHO2019/> Symptoms may range from none, to mild, to severe depending on age and risk level
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MERS-CoV is a virus in the [[coronavirus]] family believed to be originally from bats.<ref name=WHO2019/> However, humans are typically infected from [[camels]], either during direct contact or indirectly through respiratory droplets.<ref name=WHO2019/> [[Human-to-human transmission|Spread between humans]] typically requires close contact with an infected person.<ref name=WHO2019/> Its spread is uncommon outside of hospitals.<ref name=Lancet2015/> Thus, its risk to the global population is currently deemed to be
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==== Camels ====
A study performed between 2010 and 2013, in which the incidence of MERS was evaluated in 310 [[dromedary|dromedary camels]], revealed high titers of neutralizing antibodies to MERS-CoV in the blood serum of these animals.<ref name=Hemida12dec2013/> A further study sequenced MERS-CoV from nasal swabs of [[dromedary]] camels in Saudi Arabia and found they had sequences identical to previously sequenced human isolates. Some individual camels were also found to have more than one genomic variant in their [[Pharynx|nasopharynx]].<ref name=Briese29apr2014/> There is also a 2014 report of a Saudi Arabian man who became ill seven days after applying topical medicine to the noses of several sick camels and later he and one of the camels were found to have identical strains of MERS-CoV.<ref name=BBC5jun2014/><ref name=Azhar4jun2014/> It is still unclear how the virus is transmitted from camels to humans. In 2014, the Saudi Ministry of Agriculture advised people to avoid contact with camels or wear breathing masks when around them.<ref name=BBC11may2014/> In response "some people have refused to listen to the government's advice"<ref name=BBC13may2014/> and kiss their camels in defiance of their government's advice. In 2020, the World Health Organization advised avoiding contact with camels and to eat only fully cooked camel meat, pasteurized camel milk, and to avoid drinking [[camel urine]].<ref>{{Cite web|url=https://www.who.int/news-room/fact-sheets/detail/middle-east-respiratory-syndrome-coronavirus-(mers-cov)|title=Middle East respiratory syndrome coronavirus (MERS-CoV)|website=www.who.int|language=en|access-date=6 April 2020
==== Between people ====
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The duration of infectivity is also unknown so it is unclear how long people must be isolated, but current recommendations are for 24 hours after resolution of symptoms. In the SARS outbreak the virus was not cultured from people after the resolution of their symptoms.<ref name=Chan2004feb/>
It is believed that the existing [[SARS]] research may provide a useful template for developing vaccines and therapeutics against a MERS-CoV infection.<ref name=Jiang2013/><ref name=Butler3oct2013/> As of March 2020 there was one ([[DNA vaccination|DNA based]]) MERS vaccine which completed [[Phases of clinical research|phase I clinical trials]] in humans,<ref>{{cite journal|title=Safety and immunogenicity of an anti-Middle East respiratory syndrome coronavirus DNA vaccine: a phase 1, open-label, single-arm, dose-escalation trial.|year=2019|pmid=31351922|doi=10.1016/S1473-3099(19)30266-X|last1=Modjarrad|first1=Kayvon|last2=Roberts|first2=Christine C.|last3=Mills|first3=Kristin T.|last4=Castellano|first4=Amy R.|last5=Paolino|first5=Kristopher|last6=Muthumani|first6=Kar|last7=Reuschel|first7=Emma L.|last8=Robb|first8=Merlin L.|last9=Racine|first9=Trina|last10=Oh|first10=Myoung-don|last11=Lamarre|first11=Claude|last12=Zaidi|first12=Faraz I.|last13=Boyer|first13=Jean|last14=Kudchodkar|first14=Sagar B.|last15=Jeong|first15=Moonsup|last16=Darden|first16=Janice M.|last17=Park|first17=Young K.|last18=Scott|first18=Paul T.|last19=Remigio|first19=Celine|last20=Parikh|first20=Ajay P.|last21=Wise|first21=Megan C.|last22=Patel|first22=Ami|last23=Duperret|first23=Elizabeth K.|last24=Kim|first24=Kevin Y.|last25=Choi|first25=Hyeree|last26=White|first26=Scott|last27=Bagarazzi|first27=Mark|last28=May|first28=Jeanine M.|last29=Kane|first29=Deborah|last30=Lee|first30=Hyojin|journal=The Lancet Infectious Diseases|volume=19|issue=9|pages=1013–1022|pmc=7185789
== Treatment ==
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| align="left" | [[South Korea]]<ref>{{cite news | url=https://news.chosun.com/site/data/html_dir/2015/11/25/2015112500517.html | title=Last MERS patient died | publisher=chosun.com | date=25
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| align="left" | [[Spain]]<ref>{{cite web | url=https://www.who.int/csr/disease/coronavirus_infections/MERS_CoV_Update_20_Jan_2014.pdf | title=Middle East respiratory syndrome coronavirus (MERS-CoV) summary and literature update–as of 20 January 2014 | publisher=[[World Health Organization]] | date=20 January 2014 | access-date=13 May 2014 | type=PDF | archive-date=29 April 2014 | archive-url=https://web.archive.org/web/20140429094050/http://www.who.int/csr/disease/coronavirus_infections/MERS_CoV_Update_20_Jan_2014.pdf | url-status=live }}</ref><ref>{{cite web | url=http://www.cidrap.umn.edu/news-perspective/2014/01/who-2-probable-mers-cases-spain-never-confirmed | title=US detects 2nd MERS case; Saudi Arabia has 18 more | publisher=[[Center for Infectious Disease Research and Policy]] | date=21 January 2014 | access-date=13 May 2014 | first1=Lisa | last1=Schnirring
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MERS was also implicated in an outbreak in April 2014 in [[Saudi Arabia]], where MERS has infected 688 people and 282 MERS-related deaths have been reported since 2012.<ref name=NYT20140604/> In response to newly reported cases and deaths, and the resignation of four doctors at Jeddah's King Fahd Hospital who refused to treat MERS patients for fear of infection, the government removed the Minister of Health and set up three MERS treatment centers.<ref name=KhaleejTimes27apr2014/><ref name=Reuters27apr2014/> Eighteen more cases were reported in early May.<ref name=Reuters08may2014/> In June 2014, Saudi Arabia announced 113 previously unreported cases of MERS, revising the death toll to 282.{{citation needed|date=June 2022}}
A hospital-related outbreak in Riyadh in the summer of 2015 increased fears of an epidemic occurring during the annual [[Hajj]] pilgrimage that was to begin in late September. After a period of few cases, cases began increasing in the middle of the summer.<ref>{{cite magazine|last1=McKenna|first1=Maryn|title=MERS Cases Increasing in Saudi Arabia, And The Hajj Is Coming|url=http://phenomena.nationalgeographic.com/2015/08/22/mers-saudi-1/|magazine=National Geographic|access-date=23 August 2015|archive-date=23 August 2015|archive-url=https://web.archive.org/web/20150823140819/http://phenomena.nationalgeographic.com/2015/08/22/mers-saudi-1/|url-status=
In May 2019, 14 cases of MERS were reported to the World Health
[https://web.archive.org/web/20190719183129/https://www.who.int/csr/don/16-july-2019-mers-saudi-arabia/en/ Archived Edition (Permanent Link)]. Retrieved and archived on 19 July 2019</ref><ref>[https://www.who.int/csr/don/20190626_mers_saudi_arabia.xls?ua=1 Excel spreadsheet: 20190626_mers_saudi_arabia.xls] [https://web.archive.org/web/20190719183141/https://www.who.int/csr/don/20190626_mers_saudi_arabia.xls?ua=1 Archived Edition (Permanent Link)] Retrieved and archived on 19 July 2019</ref> ===United States===
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In May 2015, the first case in South Korea was confirmed in a man who had visited Saudi Arabia, United Arab Emirates and Bahrain.<ref name=USAToday2jun2015/> Another man from South Korea, who was travelling to China, was diagnosed as the first case in China. So far, no Chinese citizen has been found infected.<ref name=Xinhua30may2015/>
As of 27 June 2015, 19 people in South Korea have died from [[2015 Middle East respiratory syndrome coronavirus outbreak in South Korea|this outbreak]], with 184 confirmed cases of infection.<ref>{{cite news | url=http://koreajoongangdaily.joins.com/news/article/article.aspx?aid=3005306 | title=MERS forces total sealing off of two hospitals | date=12 June 2015 | access-date=11 June 2015 | archive-date=12 June 2015 | archive-url=https://web.archive.org/web/20150612031621/http://koreajoongangdaily.joins.com/news/article/Article.aspx?aid=3005306 | url-status=live }}</ref> There have been at least 6508 quarantined.<ref>{{cite news | url=https://www.reuters.com/article/health-mers-southkorea-idUSL3N0YU5TT20150609 | title=REFILE-UPDATE 2-Hong Kong to issue "red travel alert" to South Korea as MERS spreads | work=Reuters | first1=Ju-min | last1=Park | first2=James | last2=Pomfret
In 2018 a case was found in South Korea; the patient had recently returned from Kuwait (via Dubai).<ref>{{cite news|title=South Korea searching for 50 foreigners possibly exposed to Mers|url=https://www.straitstimes.com/asia/east-asia/south-korea-searching-for-50-foreigners-possibly-exposed-to-mers|date=11 September 2018|access-date=24 January 2020|newspaper=The Straits Times|archive-date=13 September 2018|archive-url=https://web.archive.org/web/20180913040833/https://www.straitstimes.com/asia/east-asia/south-korea-searching-for-50-foreigners-possibly-exposed-to-mers|url-status=live}}</ref>
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===Philippines===
In April 2014, MERS emerged in the [[Philippines]] with a suspected case of a home-bound Overseas Filipino Worker (OFW). Several suspected cases involving individuals who were on the same flight as the initial suspected case are being tracked but are believed to have dispersed throughout the country. Another suspected MERS-involved death in [[Sultan Kudarat]] province caused the Department of Health (DOH) to put out an alert.<ref name=GMA24apr2014a/><ref name=GMA24apr2014b/><ref name=MindaNews22apr2014/><ref name=PhilStar18sep2013/>
On 6 July 2015 the [[Department of Health|DOH]] confirmed the second case of MERS in the Philippines. A 36-year-old male foreigner from the Middle East was tested positive.<ref>{{cite news | url=http://cnnphilippines.com/news/2015/07/06/merscov-philippines-doh.html | title=DOH confirms MERS case in PH | date=6 July 2015 | access-date=8 July 2015 | archive-date=6 July 2015 | archive-url=https://web.archive.org/web/20150706090646/http://cnnphilippines.com/news/2015/07/06/merscov-philippines-doh.html | url-status=
===United Kingdom===
On 27 July 2015, the accident and emergency department at [[Manchester Royal Infirmary]] closed after two patients were treated for suspected MERS infection.<ref>{{cite news|url=https://www.bbc.co.uk/news/uk-england-manchester-33675356|title=Manchester Royal Infirmary A&E unit closed over virus outbreak|date=27 July 2015|work=BBC News|access-date=27 July 2015|archive-date=27 July 2015|archive-url=https://web.archive.org/web/20150727165051/http://www.bbc.co.uk/news/uk-england-manchester-33675356|url-status=live}}</ref> The facility was reopened later that evening, and it was later confirmed by [[Public Health England]] that the two patients had tested negative for the disease.<ref>{{cite web|url=http://www.manchestereveningnews.co.uk/news/greater-manchester-news/two-patients-manchester-test-negative-9741801|title=Two patients in Manchester test negative for MERS virus|first1=Amy|last1=Glendinning
===Kenya===
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<ref name=CDC10apr2015>{{cite web|url=https://www.cdc.gov/coronavirus/mers/case-def.html |title=Middle East Respiratory Syndrome (MERS): Case definitions |date=10 April 2015 |access-date=2 June 2015 |publisher=[[Centers for Disease Control and Prevention|CDC]] |url-status=dead |archive-url=https://web.archive.org/web/20140527094632/http://www.cdc.gov/coronavirus/mers/case-def.html |archive-date=27 May 2014 }}</ref>
<ref name=HPA14mar2013>{{cite journal | title = State of Knowledge and Data Gaps of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Humans | journal = PLOS Currents | volume = 5 | date = November 2013 | pmid = 24270606 | pmc = 3828229 | doi = 10.1371/currents.outbreaks.0bf719e352e7478f8ad85fa30127ddb8 | last1 = The Who Mers-Cov Research Group | doi-broken-date = 5 April 2024 | doi-access = free }} {{open access}}</ref>
<ref name=WHOsep2013>{{cite web | url = https://www.who.int/csr/disease/coronavirus_infections/MERS_Lab_recos_16_Sept_2013.pdf?ua=1 | title = Laboratory Testing for Middle East Respiratory Syndrome Coronavirus | date = September 2013 | access-date = 19 May 2014 | publisher = [[World Health Organization|WHO]] | archive-date = 14 May 2014 | archive-url = https://web.archive.org/web/20140514204048/http://www.who.int/csr/disease/coronavirus_infections/MERS_Lab_recos_16_Sept_2013.pdf?ua=1 | url-status = live }}</ref>
<ref name=Corman27sep2012>{{cite journal | vauthors = Corman VM, Eckerle I, Bleicker T, Zaki A, Landt O, Eschbach-Bludau M, van Boheemen S, Gopal R, Ballhause M, Bestebroer TM, Muth D, Müller MA, Drexler JF, Zambon M, Osterhaus AD, Fouchier RM, Drosten C | title = Detection of a novel human coronavirus by real-time reverse-transcription polymerase chain reaction | journal = Euro Surveillance | volume = 17 | issue = 39 | date = September 2012 | pmid = 23041020 | doi=10.2807/ese.17.39.20285-en| doi-access = free | hdl = 1765/87211 | hdl-access = free }} {{open access}}</ref>
<ref name=Corman6dec2012>{{cite journal | vauthors = Corman VM, Müller MA, Costabel U, Timm J, Binger T, Meyer B, Kreher P, Lattwein E, Eschbach-Bludau M, Nitsche A, Bleicker T, Landt O, Schweiger B, Drexler JF, Osterhaus AD, Haagmans BL, Dittmer U, Bonin F, Wolff T, Drosten C | title = Assays for laboratory confirmation of novel human coronavirus (hCoV-EMC) infections | journal = Euro Surveillance | volume = 17 | issue = 49 | date = December 2012 | pmid = 23231891 | doi=10.2807/ese.17.49.20334-en | doi-access = free | hdl = 1765/91517 | hdl-access = free }} {{open access}}</ref>
<ref name=Lu1jan2014>{{cite journal | vauthors = Lu X, Whitaker B, Sakthivel SK, Kamili S, Rose LE, Lowe L, Mohareb E, Elassal EM, Al-sanouri T, Haddadin A, Erdman DD | title = Real-time reverse transcription-PCR assay panel for Middle East respiratory syndrome coronavirus | journal = Journal of Clinical Microbiology | volume = 52 | issue = 1 | pages = 67–75 | date = January 2014 | pmid = 24153118 | pmc = 3911421 | doi = 10.1128/JCM.02533-13 }}</ref>
<ref name=Reusken4apr2013>{{cite journal | vauthors = Reusken C, Mou H, Godeke GJ, van der Hoek L, Meyer B, Müller MA, Haagmans B, de Sousa R, Schuurman N, Dittmer U, Rottier P, Osterhaus A, Drosten C, Bosch BJ, Koopmans M | title = Specific serology for emerging human coronaviruses by protein microarray | journal = Euro Surveillance | volume = 18 | issue = 14 | pages = 20441 | date = April 2013 | pmid = 23594517 | doi = 10.2807/1560-7917.es2013.18.14.20441 | doi-access = free | hdl = 1765/87235 | hdl-access = free }}</ref>
<ref name=Falzarano8sep2013>{{cite journal | vauthors = Falzarano D, de Wit E, Rasmussen AL, Feldmann F, Okumura A, Scott DP, Brining D, Bushmaker T, Martellaro C, Baseler L, Benecke AG, Katze MG, Munster VJ, Feldmann H | title = Treatment with interferon-
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<ref name=Chan2004feb>{{cite journal | vauthors = Chan KH, Poon LL, Cheng VC, Guan Y, Hung IF, Kong J, Yam LY, Seto WH, Yuen KY, Peiris JS | title = Detection of SARS coronavirus in patients with suspected SARS | journal = Emerging Infectious Diseases | volume = 10 | issue = 2 | pages = 294–9 | date = February 2004 | pmid = 15030700 | pmc = 3322905 | doi = 10.3201/eid1002.030610 }}</ref>
<ref name=Jiang2013>{{cite news | title=Development of SARS Vaccines and Therapeutics Is Still Needed | url=http://www.medscape.com/viewarticle/777375 | first1=Shibo | last1=Jiang | first2=Lu | last2=Lu | first3=Lanying | last3=Du
<ref name=Butler3oct2013>{{cite journal | vauthors = Butler D | title = SARS veterans tackle coronavirus | journal = Nature | volume = 490 | issue = 7418 | pages = 20 | date = October 2012 | pmid = 23038444 | doi = 10.1038/490020a | bibcode = 2012Natur.490...20B | doi-access = free }}</ref>
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