Overview (Microbiological Features and Global Epidemiological Situation)

The Middle East respiratory syndrome; MERS is a viral respiratory disease caused by a novel coronavirus (MERS‐CoV). It was first identified in Saudi Arabia in 2012. Coronaviruses are a large family of viruses that can cause diseases ranging from the common cold to Severe acute respiratory syndrome (SARS). Approximately 36% of reported patients with MERS have died.

Transmission Route

Although the majority of human cases of MERS have been attributed to human-to-human infections, camels are likely to be a major reservoir host for MERS-CoV and an animal source of MERS infection in humans. However, the exact role of camels in the transmission of the virus and the exact route(s) of transmission are not yet confirmed.


Most people who were confirmed have MERS-CoV infection have had a severe acute respiratory illness with symptoms of fever, cough and shortness of breath. Some people also had gastrointestinal symptoms including diarrhoea and nausea/vomiting. Based on what researchers know so far, people with pre-existing medical conditions may be more likely to become infected with MERS-CoV, or have more severe cases. The incubation period for MERS is usually about 5 or 6 days but can range from 2-14 days.

Prevention Methods in Healthcare Facilities

All healthcare facilities should apply standard precautions for infectious diseases in general. According to the CDC, healthcare workers should perform hand hygiene frequently, including before and after all patient contact, contact with the potentially infectious material, and before putting on and upon removal of PPE such as gloves and masks. Healthcare facilities should ensure that hand hygiene supplies are readily available. Environmental infection controls are also recommended by using effective disinfectants.

If MERS-CoV is suspected, the policies and procedure for rapid screening and assessment of potential MERS-CoV cases should be in place to ensure the rapid care of the patient and to minimize the number of contacts to other patients, visitors and health workers. Droplet precautions, including eye protection, should be added to the standard precautions when providing care to any patient with symptoms of acute respiratory infection. Linen management, cleaning and disinfection and waste management should also be in place. Airborne precautions are not generally recommended except when performing aerosol-generating procedures.

Since people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease, these people should avoid close contact with animals, particularly camels, when visiting farms, markets, or barns areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand hygiene before and after touching animals and avoiding contact with sick animals should be adhered to.

Food hygiene practices should also be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

Reference List

WHO, fact sheet, Middle East Respiratory Syndrome coronavirus (MERS-CoV)
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CDC, Middle East Respiratory Syndrome (MERS), Symptoms & Complications
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WHO, Summary and risk assessment of current situation in Republic of Korea and China
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CDC, Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
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