OVERVIEW

What is Middle East Respiratory Syndrome?

Middle East Respiratory Syndrome, abbreviated as MERS, is officially known as "Middle East Respiratory Syndrome Coronavirus Infection."

MERS is an infectious disease caused by the coronavirus MERS-CoV. Some infected individuals may show no symptoms, while others may experience fever (>38°C), chills, cough, and difficulty breathing.

If not detected and treated promptly, severe complications such as kidney failure, septic shock, and respiratory failure can occur, with a fatality rate as high as 34.4%.

Currently, there is no specific antiviral treatment for MERS, and care is primarily supportive. No vaccine is available to prevent MERS. Suspected or confirmed cases should be isolated and treated immediately.

Is Middle East Respiratory Syndrome common? Where is it most prevalent?

Middle East Respiratory Syndrome is an infectious disease but not a common one.

The disease was first identified in Saudi Arabia in 2012. To date, MERS remains prevalent in countries on the Arabian Peninsula, including Saudi Arabia, the UAE, Kuwait, Jordan, Qatar, Oman, and Lebanon.

As of November 2019, data from the World Health Organization (WHO) reported 2,494 laboratory-confirmed cases of MERS globally, with 2,102 cases originating from Saudi Arabia.

Additionally, cases have been reported in countries such as the UK, Italy, France, Germany, Greece, the Netherlands, Malaysia, the Philippines, China, South Korea, Egypt, and the United States. Most of these patients had travel history to the Arabian Peninsula or close contact with MERS patients.

Notably, the 2015 MERS outbreak in South Korea was the largest outside the Arabian Peninsula. That same year, China also reported one imported case of MERS.

Have there been MERS cases in China?

In 2015, China recorded one imported case of Middle East Respiratory Syndrome. As of now, no official reports indicate the presence of MERS cases in China.

SYMPTOMS

What are the symptoms of Middle East Respiratory Syndrome?

Patients primarily experience symptoms such as fever, chills, cough, and difficulty breathing. A small number of patients may also have hemoptysis, sore throat, myalgia, diarrhea, vomiting, and abdominal pain.

• Fever: Patients feel hot to the touch, with a body temperature typically above 38°C;
• Chills: Patients experience full-body shivering and a sensation of coldness;
• Cough;
• Difficulty breathing: Patients feel short of breath, with rapid or labored breathing;
• Hemoptysis: Coughing up blood;
• Sore throat: Patients experience a stinging or painful sensation in the throat;
• Myalgia: Patients feel muscle aches and discomfort throughout the body;
• Diarrhea: Commonly referred to as "loose stools," with increased frequency of bowel movements that are watery or unformed;
• Vomiting: Expelling stomach contents or gastric acid through the mouth, often accompanied by nausea, which may improve after vomiting;
• Abdominal pain: Commonly referred to as "stomachache."

What severe complications can Middle East Respiratory Syndrome cause?

In a study by Professor Abdullah Assiri involving 47 MERS patients, 12 were severe cases. Among them, 11 patients experienced shock, 7 developed acute kidney injury, and 3 patients with both pneumonia and MERS exhibited neurological symptoms.

CAUSES

What is the pathogen causing Middle East Respiratory Syndrome?

The pathogen responsible for Middle East Respiratory Syndrome is MERS-CoV, a type of coronavirus.

In addition to humans, this virus has also been found in camels. Many patients with MERS had close contact with camels before the onset of symptoms, leading to the hypothesis that the MERS-CoV infecting humans originated from camels.

MERS-CoV is sensitive to ultraviolet light and heat. It can be effectively inactivated by heating at 56°C for 30 minutes, as well as by 75% ethanol (alcohol), ether, chlorine-based disinfectants, chloroform, peracetic acid, and other lipid solvents. However, it is important to note that chlorhexidine is not effective in inactivating the virus.

Is Middle East Respiratory Syndrome contagious? How is it transmitted?

Middle East Respiratory Syndrome is contagious. It is primarily transmitted through contact and respiratory routes, and it is currently uncertain whether it can spread through the digestive tract.

• Contact transmission: Direct transmission occurs when a healthy person engages in sexual activity or kissing with a MERS patient, leading to virus transfer. Indirect transmission happens when a healthy person comes into contact with contaminated items used by a patient, resulting in infection.
• Respiratory transmission: The virus is expelled into the air through the patient's breathing or sneezing and spreads via droplets to unprotected (e.g., unmasked) individuals nearby.

Which groups are commonly affected by Middle East Respiratory Syndrome?

Most MERS cases occur in adults, though a small number of pediatric cases have been reported. The majority of affected individuals are residents of epidemic areas, have traveled to these areas within two weeks before symptom onset, or have had contact with MERS patients.

DIAGNOSIS

How is MERS diagnosed?

Doctors make a diagnosis based on the patient's clinical manifestations, laboratory tests, and imaging studies:

• Clinical manifestations: Symptoms mentioned in the previous "Symptoms" section.
• Laboratory tests: Respiratory secretions are tested using reverse transcription-polymerase chain reaction (rRT-PCR). A positive result confirms MERS-CoV infection. Some patients may also show abnormalities in blood tests, such as lymphocytopenia, thrombocytopenia, leukopenia, as well as elevated lactate dehydrogenase and liver enzymes.
• Imaging findings: Common chest CT findings in MERS patients include ground-glass opacities, infiltrative or patchy shadows, often affecting both lungs.

What diseases should MERS be distinguished from?

• Severe Acute Respiratory Syndrome (SARS): SARS is caused by a different virus than MERS; MERS primarily occurs in Saudi Arabia, while SARS was mainly reported in China. MERS symptoms typically include fever, chills, cough, and difficulty breathing, whereas SARS symptoms are nonspecific and vary in severity.
• COVID-19: COVID-19 is caused by a different virus than MERS. MERS symptoms mainly involve fever, chills, cough, and difficulty breathing, while COVID-19 primarily presents with fever, fatigue, and dry cough.

In reality, SARS, MERS, and COVID-19 may exhibit similar symptoms. Definitive diagnosis and differentiation rely on pathogen testing to identify the causative virus.

TREATMENT

Which department should I see for Middle East Respiratory Syndrome?

Respiratory Medicine, Infectious Diseases, or Infection Department.

Can Middle East Respiratory Syndrome heal on its own?

Some mild cases may recover due to strong immune resistance. However, many patients experience severe symptoms or initially mild symptoms that worsen later.

Therefore, if Middle East Respiratory Syndrome is suspected or confirmed, patients should actively cooperate with doctors for isolation and treatment.

Does Middle East Respiratory Syndrome require hospitalization?

Yes, hospitalization is necessary for isolation and treatment.

How is Middle East Respiratory Syndrome treated?

Currently, there are no specific antiviral drugs for MERS-CoV. Treatment focuses on supportive care (e.g., respiratory support, nutritional support) to help patients fight the virus.

• Isolation: Suspected or confirmed cases should be immediately transferred to designated medical facilities or hospitals with proper isolation and protective measures.
• General treatment: Bed rest, nutritional support, maintaining fluid and electrolyte balance, and close monitoring of vital signs, oxygen saturation, blood tests, liver/kidney function, etc.
• Symptomatic treatment: For excessive phlegm, expectorants may be used; for secondary bacterial infections, antibiotics may be administered (avoid misuse). Respiratory failure requires mechanical ventilation (non-invasive or invasive). Kidney failure may require dialysis.
• Management of underlying conditions: Patients with diabetes, hypertension, chronic kidney/heart disease, etc., must receive treatment for these conditions to prevent complications.

Is Middle East Respiratory Syndrome easy to treat? Can it be completely cured?

Mild cases are often curable without sequelae.

Severe cases, especially those with complications like respiratory/kidney failure, shock, or multiple underlying conditions (e.g., hypertension, diabetes, heart/kidney disease), particularly in elderly patients, are harder to treat with higher mortality rates. Survivors may experience long-term complications.

Is the mortality risk high for Middle East Respiratory Syndrome?

According to WHO data (as of November 2019), 2,494 lab-confirmed MERS cases were reported globally, with 858 deaths (34.4% mortality rate).

Common causes of death include septic shock from secondary infections, respiratory failure, and multi-organ failure.

DIET & LIFESTYLE

What dietary precautions should be taken during the treatment of Middle East Respiratory Syndrome?

During treatment, in addition to staple foods, it is important to consume more fruits and vegetables, supplement high-quality protein (such as fish, lean meat, etc.), ensure sufficient daily energy intake, and also avoid raw foods and strictly refrain from eating wild animals.

What lifestyle precautions should be taken during the treatment of Middle East Respiratory Syndrome?

During treatment, maintain adequate sleep, follow a regular routine, and keep a positive mood every day.

Do patients with Middle East Respiratory Syndrome need to be isolated?

Patients with Middle East Respiratory Syndrome require isolation, which means staying alone in a room, avoiding shared meals, conversations, or sleeping with others, with daily room disinfection and ventilation.

Isolation should continue until full recovery and the absence of contagiousness.

PREVENTION

How to prevent Middle East Respiratory Syndrome?

• Maintain good hygiene habits and wash hands frequently;
• Wear a mask when going out;
• Pay attention to food hygiene and avoid sharing tableware or eating from the same dish;
• Ensure indoor ventilation for at least 2 hours daily;
• Avoid prolonged stays in crowded public places;
• Avoid contact with people showing symptoms of respiratory infections.
• Maintain a healthy routine and ensure adequate sleep;
• Exercise daily.
• Avoid visiting areas with abundant wildlife, direct contact with wild animals or their excrement, and consuming wild animals.

Seek medical attention promptly if respiratory infection symptoms appear. If you have had contact with a confirmed patient, self-isolate at home for at least 15 days, regardless of symptoms.

Is there a vaccine for Middle East Respiratory Syndrome?

Under development. Currently, there is no vaccine available for humans to prevent MERS.