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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  • Mark_in_MN

    I’m wondering what the clinical differences between MERS and SARS might be. Is there any significant difference in the diseases themselves (as opposed to a different coronavirus associated with each)? If the clinical pattern of disease is much the same, perhaps both of these should be categorized as SARS with the understanding that there are multiple specific viruses that cause the disease (not unlike multiple other diseases and syndromes). This would help avoid the particular identification of the illness with a geographical region, which may have unfortunate social side effects. If there proves to be significant clinical and treatment differences that is based on the particular virus rather than the patient, then separating them again would make some more sense.

    I also wonder if paying too much attention to specific viruses rather than paying attention to groups of similar viruses, might lead to an inaccurate picture of what is happening medically, epidemiologically, environmentally, or biologically. SARS has seemingly disappeared, not being reported for a decade or there about. In a comment below, it’s pointed out that it may simply be missed because someone incorrectly diagnoses it or doesn’t do laboratory tests to determine causal organism. So there could be SARS cases missed. On the other hand, if there have been tests, but they haven’t come back for that particular coronavirus, could it lead to an unhelpful shrug rather than an important point of data in looking at an emerging human disease, thus missing evolution of viral types and overlooking possible interactions or other developments? Might classifying a disease like SARS not by a specific species/strain of virus, but somewhat more widely help give us a better picture?

  • http://musephotos.wordpress.com/ GarySFBCN

    It’s it about time to study the antiviral properties of vitamin A? A long time ago, I was told (by a physician) about study of vitamin A in children with or at risk for Malaria in Africa and an interesting side benefit that the children seemed to be immune from the flu epidemic that was happening at the same time.

  • Buford

    Sorry, but I’ll say it – this ‘Index Patient’ was providing health services in the Middle East where MERS is clearly a hot topic… and then he felt ill… yet he still decided to travel to two other continents. This person is an idiot.

  • docsterx

    There haven’t been any reported cases of SARS, true. But I’m wondering how many people may have had it and not been tested to see if it was SARS or not. SARS symptoms are fever, body aches, some get diarrhea, cough and then many develop pneumonia. I’ll bet there have been a lot of people out there with symptoms like those that were never tested for SARS. And if that’s the case, health care workers taking care of these people who got it themselves probably wouldn’t think of SARS they’d figure whatever it was that that patient had, they got.

    Legionnaires’ disease occurred in Philadelphia in 1976. The bacterium was found shortly after the outbreak started. It turned out that Legionnaires’ had been around since at least 1968 when a number of patients got Pontiac fever in Pontiac, Michigan. The organism causing that outbreak wasn’t ID’ed at the time. Only later was it found out to be Legionella pneumophila. I’m sure that many other people had Legionnaires’ disease between 1968 and 1976 but it wasn’t detected.

    Even though these are different virus types, Lassa and Ebola pop up episodically and then just vanish for some reason. Why that happens is unclear.

    So, is MERS gone? Maybe. Could it still be around but undiagnosed? Yes. Could it have mutated and no longer be infectious to humans? Could there be less virulent strains around akin to different flu strains? Possible. Could it have mutated and no longer be infectious to humans? Maybe. (Ebola is infectious to humans except for one strain, Ebola Reston (named after Reston, VA where it was isolated.) Ebola Reston seems harmless to humans. The other Ebola strains are virulent.)

    I’m not a virologist, I’m just speculating here. But these are interesting questions about SARS and other viruses like Ebola.

  • http://www.americablog.com/ Naja pallida

    Yesh, they missed a perfect opportunity to call it Camel Flu or something equally silly that CNN can run on a loop for a month. When SARS was found to be in palm civets, the Chinese government slaughtered them by the thousands. Only after did they also find the virus in many other species of mammals as well. Phylogenetic analysis finally showed that it probably originated in bats, and spread through other species, eventually to humans, most likely through the Chinese food markets. Seems likely that there’s a similar scenario here, bats to camels, and humans consuming camel meat and milk.

    Do you suppose this will run its course like SARS? There hasn’t been a reported case of SARS since what, 2004? I guess my fear would be that it could easily get to populations in areas like Somalia or Sudan, assuming it isn’t already there, and with lack of adequate medical isolation, kill a large number of people.

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