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Middle East Respiratory Syndrome (MERS)

Last updated April 3, 2018

Approved by: Maulik P. Purohit MD, MPH

Middle East Respiratory Syndrome (MERS) is a respiratory infection that is new to humans (first case reported in 2012). The causative organism of the infection is a coronavirus called MERS-coronavirus.


What are the other Names for this Condition? (Also known as/Synonyms)

  • MERS (Middle East Respiratory Syndrome)
  • Middle East Coronavirus Infection
  • Middle East Respiratory Syndrome - Coronavirus Infection

What is Middle East Respiratory Syndrome? (Definition/Background Information)

  • Middle East Respiratory Syndrome (MERS) is a respiratory infection that is new to humans (first case reported in 2012). The causative organism of the infection is a coronavirus called MERS-coronavirus
  • Coronaviruses are quite common and are known to cause nasal, sinus, and upper throat infections; most of them are not dangerous. However, MERS-CoV Infection is a dangerous condition and can be deadly
  • The virus is believed to have spread to humans from an animal source. Arabian camel infections are suspected of spread to humans; the strains of MERS-CoV are similar to the ones found in the Arabian camels. However, studies are still needed to confirm the same. One published report suggests the possibility of other hosts than camel, such as bats
  • It is believed that individuals could get infected with either through a direct or indirect contact with the infected animals. Individuals with weakened immune systems are more susceptible to MERS and so are farm and healthcare workers, who have a higher risk of infection
  • Not all infected individuals with MERS show signs and symptoms of the infection. The symptoms may include cough, fever, and respiratory distress; digestive and urinary system related signs and symptoms are also common. Depending on the symptoms and travel pattern, a physician may order blood tests to diagnose MERS
  • Treatment options are limited and are geared towards treating the symptoms and giving supportive care. The prognosis for recovery from Middle East Respiratory Syndrome is generally not very good, with fatalities ranging from 40-60%, due to complications such as acute respiratory distress, organ failure, and septic shock, leading to death

Who gets Middle East Respiratory Syndrome? (Age and Sex Distribution)

  • Individuals with weak immune systems and elderly adults are more susceptible to Middle East Respiratory Syndrome
  • Both men and women are equally susceptible to this viral infection
  • Individuals affected by cancer and chronic illnesses, such as diabetes and lung disease, are more likely to be susceptible to MERS

The World Health Organization (WHO) states that MERS has been reported in Middle East Asia, Europe, Africa, Asia, and America, and it lists the following countries:

Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, the United Arab Emirates, and Yemen (Middle East); Austria, France, Germany, Greece, Italy, Netherlands, Turkey, and the United Kingdom (UK) (Europe); Algeria, Tunisia and Egypt (Africa); China, Malaysia, Republic of Korea, the Philippines and Thailand (Asia); and the United States of America (Americas)

What are the Risk Factors for Middle East Respiratory Syndrome? (Predisposing Factors)

Middle East Respiratory Syndrome is believed to spread through direct contact with infected animals or humans, and by consuming infected animal products. The following are the risk factors for contracting MERS:

  • Working in a healthcare facility in direct contact with MERS patients
  • Working in a farm with infected animals
  • Having a weakened immune system (such as HIV/AIDS patients)
  • Elderly adults
  • Individuals with cancer, chronic respiratory illnesses, or diabetes
  • Traveling to parts of the world known to harbor the virus and not practicing proper hygiene
  • Consuming milk from an infected animal
  • Being a family member of an infected individual, with situations that bring about close contact with the infected individual. MERS, to a limited extent, can spread from human-to-human through close contact

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Middle East Respiratory Syndrome? (Etiology)

  • Middle East Respiratory Syndrome is an infection that is caused by the MERS-coronavirus. The virus is a single stranded, positive-sense RNA beta-coronavirus
  • It is believed that the virus spreads from an animal source, which could be a camel (or may be a bat). The virus spreads from infected animals either through direct contact, or through consuming undercooked meat or milk of such infected animals

The following conditions may cause the transmission of the MERS-coronavirus:

  • Working closely with an infected individual in a healthcare setting
  • Exposure to MERS virus as a result of a family member being infected
  • Working in farms with infected camels and neglecting proper personal hygiene
  • Consuming infected, improperly or undercooked meat
  • Exposure to the virus with a weakened immune system

What are the Signs and Symptoms of Middle East Respiratory Syndrome?

Individuals infected with Middle East Respiratory Syndrome may or may not show symptoms during the early stages. Also, many early-stage symptoms can be non-specific. Nevertheless, the following symptoms should not be ignored, if an individual suspects that he/she might be infected with MERS:

  • Fever
  • Cough
  • Severe shortness of breath
  • Atypical pneumonia: An individual may have infection of the lungs without the usual signs and symptoms, such as fatigue, cough, fever, breathlessness, etc.
  • Gastrointestinal symptoms, such as diarrhea

How is Middle East Respiratory Syndrome Diagnosed?

A physician will check an individual’s travel and medical history, symptoms, etc., and if he/she suspects Middle East Respiratory Syndrome, could order the following tests:

  • A serology test if the individual is suspected of having been exposed to the MERS virus (ELISA or enzyme-linked immunosorbent assay, to detect antibodies)
  • A molecular test if the individual appears to have an active infection (reverse-transcriptase polymerase chain reaction)

The physician may also conduct other tests and exams to rule-out other causes of infection, such as:

  • Blood test and blood culture
  • Chest X-ray
  • CT scan of chest

What are the possible Complications of Middle East Respiratory Syndrome?

The symptoms of Middle East Respiratory Syndrome could be mild to severe. When the infection is severe, the following complications may arise:

  • Pneumonia (infection of the lungs)
  • Severe gastrointestinal distress
  • Organ failure (example of the kidneys)
  • Septic shock: It is a condition in which many body organs can fail, causing a life-threatening situation

Severe cases of MERS with complications can result in death.

How is Middle East Respiratory Syndrome Treated?

At this time, there are no vaccines against Middle East Respiratory Syndrome (MERS) and the treatment options are limited. The treatment is based on symptoms to relieve pain or distress and offer support.

How can Middle East Respiratory Syndrome be Prevented?

Good personal hygiene is recommended for preventing Middle East Respiratory Syndrome - Coronavirus Infection. Several sources, including the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) suggest that:

  • Workers on a farm should employ regular and thorough hand washing, before and after touching animals
  • Farm workers should avoid exposing family members to soiled clothes, footwear, etc. from the farm
  • The frequently used surfaces should be often sanitized
  • One should never share cups, other items with infected people
  • One should avoid eating undercooked camel meat or drinking milk of the infected animals
  • A direct contact with the infected animals must be avoided
  • Those with weakened immune system or those suffering from chronic illnesses should avoid travel to regions where the virus has been reported and exposure to infected meat, animals, individuals, etc.
  • Good personal hygiene must be followed by the healthcare workers

What is the Prognosis of Middle East Respiratory Syndrome? (Outcomes/Resolutions)

  • Since there is no vaccine or treatment available at this time for Middle East Respiratory Syndrome, only a small number of infected individuals develop mild symptoms
  • The majority of infected individuals develop acute respiratory symptoms requiring hospitalization. The mortality rate is reported to be 40-60%
  • The severely infected individuals often suffer extreme respiratory distress, pneumonia, gastrointestinal distress, organ failure, and septic shock that ultimately lead to death

Additional and Relevant Useful Information for Middle East Respiratory Syndrome:

Middle East Respiratory Syndrome was first reported in Saudi Arabia in the year 2012.

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: July 4, 2015
Last updated: April 3, 2018