MERS 101: Middle East Respiratory Syndrome arrives in US

Middle East Respiratory Syndrome (MERS) was first recognized in the Middle East in 2012 in Saudi Arabia.

MERS is caused by a coronavirus (a similar type of coronavirus causes Severe Acute Respiratory Syndrome (SARS)). People who are infected develop pneumonia with fever and cough.

There have been a few hundred cases of MERS in the Middle East and a few other countries. Apparently. it reached those other countries because infected people traveled there and spread the virus locally.

MERS has a 30% fatality rate. MERS is known to exist in these countries:

Saudi Arabia, United Arab Emirates, Qatar, Oman, Jordan, Kuwait

And has spread to these countries via travelers:

United Kingdom, France, Tunisia, Italy, Malaysia.

And now, the United States.

There is no antiviral drug to treat MERS, and no vaccine is available. You treat the victims’ symptoms, and they may need to be placed on ventilators if necessary.

Not known how MERS spreads

It’s not definitively known how MERS spreads. It can be spread from person-to-person. In people known to be infected because of contact with infected humans, it seems those at highest risk are those who were taking care of other MERS cases. These were family, friends and health care workers. The source of MERS is not known. Camels have been found who were infected with the same virus. Possibly camels are a reservoir. So transmission may come from infected people and possibly from other sources, like camels or possibly other animals.

Chid in medical garb, via Shutterstock

Chid in medical garb, via Shutterstock

The mechanism of transmission is not certain. It may be spread through respiratory droplets produced when an infected patient coughs or sneezes. It may be transmitted via sharing contaminated fomites (inanimate objects that get MERS virus on them). Thing like sharing used silverware, cups, drinking glasses, or toothbrushes. Possibly MERS particles could land on surfaces after a patient coughs or sneezes. Later someone could touch these surfaces bare handed and get the virus on his hands. Subsequently, without hand washing, the viruses could be brought to the nose, mouth or eyes of the other person.who came into contact with those fomites.

Because of this, medical personnel taking care of MERS patients have to wear gowns, gloves, respirator masks and other safety gear. Surfaces need to be disinfected, bedding and clothing items need to be handled separately. The patient needs to be kept in strict isolation in a room that is specially designed to inhibit the escape of the virus.

The first documented US case of MERS

The index case (the first documented patient in a series) in the United States is a traveler returning home from the Middle East.

The traveler was providing health care services in the Middle East region. He started feeling somewhat ill a few days ago. He flew from Riyadh to London, then from London to Chicago. From Chicago he took a bus to Indiana. When he reached his destination in Indiana, he was feeling so ill he went to a local hospital’s Emergency Department. They diagnosed pneumonia and admitted him. They were suspicious of MERS, based on his symptoms and his travel history. They placed him in isolation and did confirmatory tests for MERS. He tested positive yesterday afternoon. He is receiving oxygen, but is not on a ventilator.

The Centers for Disease Control (CDC) is involved. They will attempt to contact all passengers who were on flights with him or on the bus he rode. They will alert them of the possibility of infection with MERS, and may ask some to be examined and/or tested for MERS.

The CDC considers that MERS is low-risk for members of the general population who just came into casual contact with the index case. For example, people who were passing by him at airports or eating near him at restaurants should be at very low to no risk of acquiring MERS.

The CDC is not recommending that people avoid travel to the Middle East or to London, Chicago or Indiana based on this single confirmed infection.

Best way to avoid MERS

At this time ,the best precautions to take to avoid MERS and many other infectious diseases are:

  • Frequent and thorough hand-washing. (You may think that you know how to wash your hands. You probably don’t, based on World Health Guidelines. John wrote about this a while back — you’re supposed to wash your hands for 20 full seconds.)
  • Don’t touch your face without first washing your hands.
  • Don’t sit near someone who is coughing or sneezing frequently.
  • Don’t share fomites like eating utensils, cups, silverware, soda straws, cigarettes, toothbrushes, etc.

You can read more on MERS from this CDC fact sheet.

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Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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