Middle East respiratory syndrome coronavirus (MERS-CoV) infection for health professionals

Middle East respiratory syndrome (MERS) was first recognised in Saudi Arabia in 2012. It is caused by infection with Middle East respiratory syndrome coronavirus (MERS-CoV). It was formerly called ‘novel coronavirus’. Initially it was confined to travellers in the Middle East, or contacts of travellers to the Middle East, however in 2015, there was a health care associated outbreak in the Republic of Korea resulting in 185 secondary and tertiary cases and 36 deaths. For up to date information on MERS-CoV see:

Clinical presentation

MERS-CoV mainly causes a respiratory infection, which can range from mild illness to severe pneumonia.

The most frequent symptoms are:

  • fever and chills
  • cough
  • shortness of breath
  • breathing difficulties
  • muscles and joint aches. 

Less common symptoms include: 

  • diarrhoea
  • nausea
  • vomiting.

There appears to be a higher risk of severe disease and death in older adults and patients with underlying medical conditions, particularly diabetes, kidney disease, and immunosuppression.

Incubation period

Estimated range of 2 to 14 days, with a mean of 5 days.

Infectious period

Uncertain. Cases are likely not infectious during the incubation period.

Transmission

MERS-CoV has been linked to transmission from dromedary camels to humans. In addition, human-to-human transmission has been confirmed in hospital, workplace, and household outbreaks.

Infection prevention and control

In the health care setting, contact and airborne precautions in addition to standard precautions, are recommended for patients with known or suspected MERS-CoV infection.

For further details please see the Management of Infectious Diseases Summary Table (PDF 839KB) and the Australian Guidelines for the Prevention and Control of Infection in Healthcare.

Diagnosis

Consider testing in persons as recommended in Information about MERS for health professionals | Australian Government Department of Health and Aged Care.

Request reverse-transcriptase polymerase chain reaction (RT-PCR) for MERS-CoV on respiratory specimens, preferably lower respiratory tract specimens. If initial tests are negative and MERS-CoV infection is still suspected, repeat testing is recommended. Use appropriate infection control precautions when taking specimens.

Treatment

There is no specific antiviral therapy recommended for MERS-CoV infection.

Notify

MERS-CoV infection is a notifiable condition under the South Australian Public Health Act 2011. Notify any suspected or confirmed cases to the South Australian Communicable Disease Control Branch on 1300 232 272 (24 hours /7 days).

Prevention

There is no licensed vaccine available against MERS-CoV infection.

Avoid close contact with camels in affected countries, and avoid consuming raw, undercooked or unpasteurised camel products, including meat, urine and milk.

Wash hands regularly and take particular care when visiting places where animals are present.

Resources and useful links

Further information for health professionals on MERS-CoV infection is available from the following resources: