Middle East respiratory syndrome coronavirus infection causes: Difference between revisions

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{{MERS}}
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{{Taxobox
| color        = violet
| name          = MERS-CoV
| image        = MERS-CoV electron micrograph1.jpg
| image_caption = MERS-CoV particles as seen by negative stain electron microscopy. Virions contain characteristic club-like projections emanating from the viral membrane.
| virus_group  = iv
| ordo          = ''[[Nidovirales]]''
| familia      = ''[[Coronaviridae]]''
| subfamilia    = ''[[Coronavirinae]]''
| genus        = ''[[Betacoronavirus]]''
| species      = '''''MERS-CoV'''''
}}


==Overview==
==Overview==
The [[Middle east respiratory syndrome]] [[coronavirus]] ([[MERS-CoV]]),<ref name=deGroot>{{cite journal
MERS-CoV is caused by a lineage C betacoronavirus, an enveloped, spherical (120 nm in diameter), single-stranded, positive-strand RNA virus that belongs to the family''[[Coronaviridae]]''of the order''[[Nidovirales]]. ''The natural reservoir of MERS-CoV is unknown, but bats are thought to be the most likely natural reservoir. MERS-CoV is thought to have a zoonotic activity, whereby transmission occurs from animals to humans. Limited data is available to confirm or rule out human-to-human transmission.
|author=De Groot RJ |title=Middle East Respiratory Syndrome Coronavirus (MERS-CoV): Announcement of the Coronavirus Study Group |journal=Journal of Virology |date=15 May 2013
|doi=10.1128/JVI.01244-13 |pmid=23678167 |pmc=3700179 |volume=87 |issue=14 |pages=7790–2|author-separator= |author2=and others |displayauthors=1 }}</ref> also termed '''EMC/2012''' (HCoV-EMC/2012), is positive-sense, single-stranded [[RNA]] novel [[species]] of the genus ''Betacoronavirus''.


First called ''novel coronavirus 2012'' or simply ''novel coronavirus'', it was first reported in 2012 after [[genome]] sequencing of a [[virus]] isolated from [[sputum]] samples from patients who fell ill in a 2012 outbreak of a new [[flu]].
==Causes==
MERS-CoV is caused by a lineage C betacoronavirus.


As of 14 May 2014, [[MERS-CoV]] cases have been reported in several countries, including Saudi Arabia, Malaysia, Jordan, Qatar, Egypt, the United Arab Emirates, Tunisia, Kuwait, Oman, Algeria, Bangladesh, the Philippines (still [[MERS]]-free), Indonesia (none was confirmed), the United Kingdom, and the United States.<ref>{{cite web|url=http://rt.com/usa/158852-mers-florida-health-virus/|title=Patient with deadly MERS virus waited hours in Florida ER|date=2014-05-14|accessdate=2014-05-14}}</ref>
===Taxonomy===
 
==Virology==
The [[Middle East respiratory syndrome]] [[coronavirus]] ([[MERS-CoV]]) is an emerging type of [[coronavirus]], specifically a ''betacoronavirus'' of the lineage C. Attending to the phylogenetic classification, the MERS-CoV is classified into two [[clades]] - ''clade A'' and ''clade B''. Initially, the reported cases of MERS-CoV were clade A clusters, recently reported cases are genetically distinct, including clade B clusters.<ref>{{cite web|url=http://wwwnc.cdc.gov/eid/article/20/6/14-0299_article.htm|title=MERS Coronaviruses in Dromedary Camels, Egypt|date=June 2014|accessdate=22 Apr 2014}}</ref>


Until May 23rd 2013, MERS-CoV was being described as a ''SARS-like virus'' or colloquially as "Saudi SARS". Since then it is known to be distinct, not only from SARS, but also from other known endemic coronaviruses, such as betacoronavirus HCoV-OC43 and HCoV-HKU1, as well as from the common-cold coronavirus.<ref name=sciencenews27feb2013>{{cite news |first=Tina Hesman |last=Saey|title=Scientists race to understand deadly new virus: SARS-like infection causes severe illness, but may not spread quickly |journal=[[Science News]] |volume=183 |number=6 |date=27 February 2013| url=http://www.sciencenews.org/view/generic/id/348643/description/Scientists_race_to_understand_deadly_new_virus|page=5}}</ref>
Betacoronavirus is an enveloped, spherical (120 nm in diameter), single-stranded, positive-strand RNA virus that belongs to the family ''[[Coronaviridae]]'' of the order ''[[Nidovirales]].''
===Origin===
The first confirmed case was reported in Saudi Arabia 2012.<ref name="rapid">{{cite web|url=http://www.ecdc.europa.eu/en/publications/Publications/novel-coronavirus-rapid-risk-assessment-update.pdf|title=ECDC Rapid Risk Assessment - Severe respiratory disease associated with a novel coronavirus|date=19 Feb 2013|accessdate=22 Apr 2014}}</ref>
[[Egypt]]ian virologist Dr. Ali Mohamed Zaki isolated and identified a previously unknown coronavirus from the man's [[Human lung|lungs]].<ref name=zaki8nov2012>{{cite journal |author=Ali Mohamed Zaki |author2=Sander van Boheemen |author3=Theo M. Bestebroer |author4=Albert D.M.E. Osterhaus |author5=Ron A.M. Fouchier |title=Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia |journal=New England Journal of Medicine |volume=367 |date=8 November 2012 |page=1814 |url=http://www.virology-bonn.de/fileadmin/user_upload/_temp_/Zaki_et_al.pdf |format=PDF |doi=10.1056/NEJMoa1211721|issue=19 }}</ref><ref name="thechart.blogs">{{cite news |last=Falco |first=Miriam |title=New SARS-like virus poses medical mystery |url= http://thechart.blogs.cnn.com/2012/09/24/new-sars-like-virus-poses-medical-mystery/ |accessdate=27 September 2012 |publisher=CNN |date=24 September 2012}}</ref><ref>{{cite news |last=Dziadosz |first=Alexander |title=The doctor who discovered a new SARS-like virus says it will probably trigger an epidemic at some point, but not necessarily in its current form .
|url=http://www.reuters.com/article/2013/05/13/us-coronavirus-egypt-idUSBRE94C0MH20130513 |accessdate=25 May 2013 |newspaper=Reuters |date=13 May 2013}}</ref> Dr. Zaki then posted his findings on 24 September 2012 on [[ProMED-mail]].<ref name="thechart.blogs" /><ref name="promedmail.org"/><ref name="promedmail.org">{{cite web |title=See Also |publisher=[[ProMED-mail]] |date=2012-09-20 |url=http://www.promedmail.org/direct.php?id=20120920.1302733 |accessdate=2013-05-31}}</ref> The isolated cells showed [[cytopathic effect]]s (CPE),  in the form of rounding and [[syncytium|syncytia]] formation.<ref name="promedmail.org"/>


A second case was found in September 2012. A 49-year-old male living in Qatar presented similar flu symptoms, and a sequence of the virus was nearly identical to that of the first case.<ref name="rapid"/> In November 2012, similar cases appeared in Qatar and Saudi Arabia. Additional cases were noted, with deaths associated, and rapid research and monitoring of this novel coronavirus began.
===Genome===
 
The betacoronavirus contains a [[genome]] composed of 30,119 [[nucleotides]] that encodes structural and non-structural [[proteins]]. The genome is considered the largest among all RNA virus genomes, reaching 27-32 kb in size.
It is not certain whether the infections are the result of a single [[Zoonosis|zoonotic]] event with subsequent human-to-human transmission, or if the multiple geographic sites of infection represent multiple zoonotic events from a common unknown source.
 
A study by Ziad Memish of Riyadh University and colleagues suggests that the virus arose sometime between July 2007 and June 2012, with perhaps as many as 7 separate zoonotic transmissions. Among animal reservoirs, CoV has a large genetic diversity yet the samples from patients suggest a similar genome, and therefore common source, though the data are limited. It has been determined through molecular clock analysis, that viruses from the EMC/2012 and England/Qatar/2012 date to early 2011 suggesting that these cases are descended from a single zoonotic event. It would appear the MERS-CoV has been circulating in the human population for greater than one year without detection and suggests independent transmission from an unknown source.<ref>{{cite web|url=http://wwwnc.cdc.gov/eid/article/19/5/13-0057_article.htm |title=Full-Genome Deep Sequencing and Phylogenetic Analysis of Novel Human Betacoronavirus - Vol. 19 No. 5 - May 2013 - CDC |publisher=[[Emerging Infectious Diseases]]|date=2013-05-19 |accessdate=2013-06-01}}</ref><ref>Lau SK, Lee P, Tsang AK, Yip CC, Tse H, Lee RA, Molecular epidemiology of human coronavirus OC43 reveals evolution of different genotypes over time and recent emergence of a novel genotype due to natural recombination. [[J Virol.]] 2011;85:11325–37. DOIExtract</ref>


===Tropism===
===Tropism===
In humans, the virus has a strong [[tropism]] for nonciliated bronchial epithelial cells, and it has been shown to effectively evade the innate immune responses and antagonize [[interferon]] (IFN) production in these cells. This tropism is unique in that most respiratory viruses target ciliated cells.<ref name="Kindler-2013">
* [[MERS-CoV]] has a strong [[tropism]] for the [[cilium|non-ciliated]] [[bronchial]] [[epithelium]].
{{Cite journal|last1=Kindler|first1=E.|last2=Jónsdóttir|first2=H. R.|last3=Muth|first3=D.|last4=Hamming|first4=O. J.|last5=Hartmann|first5=R.|last6=Rodriguez|first6=R.|last7=Geffers|first7=R.|last8=Fouchier|first8=R. A.|last9=Drosten|first9=C.|title=Efficient Replication of the Novel Human Betacoronavirus EMC on Primary Human Epithelium Highlights Its Zoonotic Potential|journal=MBio|volume=4|issue=1|pages=e00611–12|year=2013|doi= 10.1128/mBio.00611-12|pmid=23422412|pmc=3573664|display-authors=9}}</ref><ref name="Raj-2013">{{Cite journal|last1=Raj|first1=V. S.|last2=Mou|first2=H.|last3=Smits|first3=S. L.|last4=Dekkers|first4=D. H.|last5=Müller|first5=M. A.|last6=Dijkman|first6=R.|last7=Muth|first7=D.|last8=Demmers|first8=J. A.|last9=Zaki|first9 = A.|title=Dipeptidyl peptidase 4 is a functional receptor for the emerging human coronavirus-EMC|journal=Nature|volume=495|issue=7440|pages=251–4|date=March 2013|doi=10.1038/nature12005|pmid=23486063|display-authors=9}}</ref>
* Less commonly, MERS-CoV may primarily infect cells of the GI tract or the neurological system.  
 
Due to the clinical similarity between MERS-CoV and [[SARS-CoV]], it was proposed that they may use the same cellular receptor; the exopeptidase, angiotensin converting enzyme 2 ([[ACE2]]).<ref name=nih_expr>{{cite journal|title=ACE2 Receptor Expression and Severe Acute Respiratory Syndrome Coronavirus Infection Depend on Differentiation of Human Airway Epithelia|date=2005-12-xx |publisher=ncbi.nlm.nih.gov |pmc=1287568 |last1=Jia |first1=HP |last2=Look |first2=DC |last3=Shi|first3=L |last4=Hickey | first4=M |last5=Pewe |first5=L |last6=Netland |first6=J |last7=Farzan|first7=M|last8=Wohlford-Lenane |first8=C |last9=Perlman |first9=S |volume=79 |issue=23 |pages=14614–14621 |doi=10.1128/JVI.79.23.14614-14621.2005|journal=Journal of Virology|pmid=16282461|display-authors=9}}</ref> However, it was later discovered that neutralization of ACE2 by recombinant antibodies does not prevent MERS-CoV infection.<ref name="Müller-2012">
{{Cite journal
| last1 = Müller | first1 = MA.
| last2 = Raj | first2 = VS.
| last3 = Muth | first3 = D.
| last4 = Meyer | first4 = B.
| last5 = Kallies | first5 = S.
| last6 = Smits | first6 = SL.
| last7 = Wollny | first7 = R.
| last8 = Bestebroer | first8 = TM.
| last9 = Specht | first9 = S.
| title = Human coronavirus EMC does not require the SARS-coronavirus receptor and maintains broad replicative capability in mammalian cell lines
| journal = MBio
| volume = 3
| issue = 6
| pages =  e00515–12
| date=11 December 2012
| doi = 10.1128/mBio.00515-12
| pmid = 23232719
| pmc = 3520110
| display-authors = 9 }}</ref> Further research identified dipeptyl peptidase 4 ([[DPP4]]; also known as [[CD26]]) as a functional cellular receptor for MERS-CoV.<ref name="Raj-2013" /> Unlike other known coronavirus receptors, the [[enzymatic activity]] of DPP4 is not required for infection. As would be expected, the amino acid sequence of DPP4 is highly conserved across species and is expressed in the human bronchial epithelium and kidneys.<ref name="Raj-2013" /><ref name="dpp4_receptor">{{cite web|title=Receptor for new coronavirus found|url=http://www.nature.com/news/receptor-for-new-coronavirus-found-1.12584|date=2013-03-13|accessdate=2013-03-18|publisher=nature.com}}</ref> Bat DPP4 genes appear to have been subject to a high degree of adaptive evolution as a response to coronavirus infections, so the lineage leading to MERS-CoV may have circulated in bat populations for a long period of time before being transmitted to people.<ref>{{cite doi|10.1186/1743-422X-10-304|noedit}}</ref>


===Transmission===
===Transmission===
On 13 February 2013, the [[World Health Organization]] stated "the risk of sustained person-to-person transmission appears to be very low."<ref name=WHO(13Feb2013)>[http://www.who.int/csr/don/2013_02_13/en/index.html WHO: Novel coronavirus infection&nbsp;– update (13 February 2013)] (accessed 13 February 2013)</ref> The cells MERS-CoV infects in the lungs only account for 20% of respiratory epithelial cells, so a large number of virions are likely needed to be inhaled to cause infection.<ref name="dpp4_receptor" />
* MERS-CoV is thought to have a zoonotic activity, whereby transmission occurs from animals to humans.
* Although bats are the natural host of the betacoronavirus, it is unknown if MERS coronavirus transmission to humans is through bats, through an intermediate animal hosts following crossover and subsequent adaptation, or through a completely different host.
* Limited data is available to confirm or rule out human-to-human transmission.


{{As of|2013|5|29}}, the WHO is now warning that the MERS-CoV virus is a "threat to entire world."<ref>{{cite news|title=WHO calls Middle Eastern virus, MERS, 'threat to the entire world' as death toll rises to 27|url=http://www.dailymail.co.uk/news/article-2332677/WHO-calls-Middle-Eastern-virus-MERS-threat-entire-world-death-toll-rises-27.html?ito=feeds-newsxml|accessdate=29 May 2013 |newspaper=Daily Mail|date=29 May 2013}}</ref> However, Dr. [[Anthony S. Fauci]] of the [[National Institutes of Health]] in Bethesda, Maryland, stated that as of now MERS-CoV "does not spread in a sustained person to person way at all." Dr. Fauci stated that there is potential danger in that it is possible for the virus to mutate into a strain that does transmit from person to person.<ref>{{cite web|url=http://www.washingtontimes.com/video/national-news/fauci-new-virus-not-yet-a-threat-to-the-world/ |title=Fauci: New Virus Not Yet a 'threat to the world' (video) |publisher=Washington Times |date=2012-08-31 |accessdate=2013-05-31}}</ref>
===Natural Reservoir===
* The natural reservoir of MERS-CoV is unknown.
* The following are thought to be the natural reservoirs of MERS-CoV:
** Bats (The majority of reports hypothesized that bats are the natural reservoir of MERS-CoV)
** Camels
** Goats


The infection of healthcare workers (HCW) has lead to concerns of human to human transmission.<ref>{{cite web|url=http://blogs.wsj.com/middleeast/2014/04/20/concerns-spread-as-new-saudi-mers-cases-spike/|title=Concerns Spread as New Saudi MERS Cases Spike|last=Knickmeyer|first=Ellen|last2=Al Omran|first2=Ahmed|date=20 Apr 2014|accessdate=22 Apr 2014}}</ref>
==Gallery==


The [[Centers for Disease Control and Prevention]] (CDC) list MERS as [http://www.cdc.gov/coronavirus/mers/faq.html transmissible from human-to-human]. From their FAQ, in answer to the question "Does MERS-CoV spread from person to person?", they answer "MERS-CoV has been shown to spread between people who are in close contact. Transmission from infected patients to healthcare personnel has also been observed. Clusters of cases in several countries are being investigated."<ref>{{cite web|url=http://www.cdc.gov/coronavirus/mers/faq.html|title=Centers for Disease Control and Prevention FAQ on MERS}}</ref> There is also a ''[[New York Times]]'' article which provides some correlative context for this.<ref>{{cite web|url=http://www.nytimes.com/2013/06/20/health/fast-spreading-virus-under-inquiry-in-saudi-arabia.html|title=Investigation Follows Trail of a Virus in Hospitals|author=DENISE GRADY|date=June 19, 2013}}</ref>
<gallery>


However on the 28th of May, the CDC revealed that the Illinois man who was originally thought to have been the first incidence of person to person spread (from the Indiana man at a business meeting), had in fact tested negative for MERS-CoV. After completing additional and more definitive tests using a neutralising antibody assay, experts at the CDC have concluded that the Indiana patient did not spread the virus to the Illinois patient. Tests concluded that the Illinois man had not been previously infected. It is possible for silent MERS to occur, this is when the patient does not develop symptoms. Early research has shown that up to 20% of cases show no signs of active infection but have MERS-CoV antibodies in their blood.<ref>{{cite news|url=http://www.nbcnews.com/storyline/mers-mystery/cdc-backtracks-illinois-man-didnt-have-mers-after-all-n116436|title=CDC Backtracks: Illinois Man Didn't Have MERS After All|accessdate=2 June 2014|date=28 May 2014|author=Jonrl Aleccia}}</ref>
Image: Coronavirus14.jpeg| TEM reveals ultrastructural morphology of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Coronavirus13.jpeg| TEM reveals ultrastructural morphology of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Coronavirus12.jpeg| TEM reveals ultrastructural morphology of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Coronavirus11.jpeg| Middle East Respiratory Syndrome Coronavirus (MERS-CoV) viral particles. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Coronavirus09.jpeg| Middle East Respiratory Syndrome Coronavirus (MERS-CoV) virion. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Coronavirus08.jpeg|TEM reveals ultrastructural details exhibited by three spherical-shaped Middle East Respiratory Syndrome Coronavirus (MERS-CoV) virions. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Coronavirus07.jpeg|TEM reveals ultrastructural details exhibited by a number of spherical-shaped Middle East Respiratory Syndrome Coronavirus (MERS-CoV) virions. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>


===Natural reservoir===
Image: Coronavirus06.jpeg|TEM reveals ultrastructural details exhibited by a number of red-colored, spherical-shaped Middle East Respiratory Syndrome Coronavirus (MERS-CoV) virions. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Coronavirus05.jpeg|TEM reveals ultrastructural details exhibited by five spherical-shaped Middle East Respiratory Syndrome Coronavirus (MERS-CoV) virions, which were colorized yellow. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Coronavirus04.jpeg|TEM reveals ultrastructural details exhibited by a single, spherical-shaped Middle East Respiratory Syndrome Coronavirus (MERS-CoV) virion. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Coronavirus03.jpeg|TEM reveals ultrastructural details exhibited by a single, spherical-shaped Middle East Respiratory Syndrome Coronavirus (MERS-CoV) virion. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Coronavirus02.jpeg|SEM reveals ultrastructural details at the site of interaction of two spherical-shaped Middle East Respiratory Syndrome Coronavirus (MERS-CoV) viral particles, colorized blue, that were on the surface of a camel epithelial cell, colorized red. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
Image: Coronavirus01.jpeg|SEM reveals ultrastructural details at the site of interaction of numerous yellow-colored Middle East respiratory syndrome Coronavirus (MERS-CoV) viral particles on the surface of a Vero E6 cell (blue). <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>


Early research suggested the virus is related to one found in the [[Egyptian tomb bat]]. In September 2012 Ron Fouchier speculated that the virus might have originated in bats.<ref name=NPRFouchierbats>{{cite news |last=Doucleff |first=Michaeleen |title=Holy Bat Virus! Genome Hints At Origin Of SARS-Like Virus|url=http://www.npr.org/blogs/health/2012/09/28/161944734/holy-bat-virus-genome-hints-at-origin-of-sars-like-virus|accessdate=29 September 2012 |newspaper=
{| style="float: right;"
[[NPR]]|date=28 September 2012}}</ref> Work by epidemiologist Ian Lipkin of [[Columbia University]] in New York showed that the virus isolated from a bat looked to be a match to the virus found in humans.<ref name="cnn130313">{{cite news |url= http://www.cnn.com/2013/03/13/health/new-coronavirus-case/
| [[File:MERS electron micrograph.jpg|250px|thumb|none|This negatively-stained transmission electron micrograph revealed ultrastructural morphology of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). <SMALL>Courtesy: ''[http://phil.cdc.gov/phil/home.asp Public Health Image Library (PHIL), Centers for Disease Control and Prevention (CDC)]''<ref>{{Cite web | title = http://phil.cdc.gov/phil/details.asp | url = http://phil.cdc.gov/phil/details.asp}}</ref></SMALL>]]
|title=Death toll from new SARS-like virus climbs to 9 |first=Saad |last=Abedine |publisher=CNN |date=13 March 2013 |accessdate= 2013-03-13}}</ref><ref>
|-
{{cite news
| [[File:MERS electron micrograph 3.jpg|250px|thumb|none|This highly-magnified negatively-stained transmission electron micrograph revealed ultrastructural morphology of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). <SMALL>Courtesy: ''[http://phil.cdc.gov/phil/home.asp Public Health Image Library (PHIL), Centers for Disease Control and Prevention (CDC)]''<ref>{{Cite web | title = http://phil.cdc.gov/phil/details.asp | url = http://phil.cdc.gov/phil/details.asp}}</ref></SMALL>]]
|last=Doucleff|first=Michaeleen
|-
|title=Holy Bat Virus! Genome Hints At Origin Of SARS-Like Virus
| [[File:MERS electron micrograph 2.jpg|250px|thumb|none|This thin section transmission electron micrograph revealed ultrastructural morphology of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). <SMALL>Courtesy: ''[http://phil.cdc.gov/phil/home.asp Public Health Image Library (PHIL), Centers for Disease Control and Prevention (CDC)]''<ref>{{Cite web | title = http://phil.cdc.gov/phil/details.asp | url = http://phil.cdc.gov/phil/details.asp}}</ref></SMALL>]]
|url=http://www.npr.org/blogs/health/2012/09/28/161944734/holy-bat-virus-genome-hints-at-origin-of-sars-like-virus
|-
|accessdate=29 September 2012
| [[File:MERS electron micrograph 4.jpg|250px|thumb|none|This highly-magnified transmission electron micrograph revealed the presence of numerous Middle East Respiratory Syndrome Coronavirus (MERS-CoV) virions in this tissue culture sample. <SMALL>Courtesy: ''[http://phil.cdc.gov/phil/home.asp Public Health Image Library (PHIL), Centers for Disease Control and Prevention (CDC)]''<ref>{{Cite web | title = http://phil.cdc.gov/phil/details.asp | url = http://phil.cdc.gov/phil/details.asp}}</ref></SMALL>]]
|newspaper=NPR
|-
|date=28 September 2012
| [[File:MERS electron micrograph 5.jpg|250px|thumb|none|This highly-magnified transmission electron micrograph revealed the presence of numerous Middle East Respiratory Syndrome Coronavirus (MERS-CoV) virions in this tissue culture sample. <SMALL>Courtesy: ''[http://phil.cdc.gov/phil/home.asp Public Health Image Library (PHIL), Centers for Disease Control and Prevention (CDC)]''<ref>{{Cite web | title = http://phil.cdc.gov/phil/details.asp | url = http://phil.cdc.gov/phil/details.asp}}</ref></SMALL>]]
}}</ref> 
|}
<ref>{{cite web|author=jobs |url=http://www.nature.com/news/deadly-coronavirus-found-in-bats-1.13597 |title=Deadly coronavirus found in bats : Nature News & Comment |publisher=Nature.com |date=2013-08-23 |accessdate=2014-01-19}}</ref> 2c betacoronaviruses were detected in ''[[Nycteris]]'' bats in Ghana and ''[[Pipistrellus]]'' bats in Europe that are phylogenetically related to the MERS-CoV virus.<ref name="wwwnc.cdc.gov"/>


Recent work links [[camel]]s to the virus. An ahead-of-print dispatch for the journal ''[[Emerging Infectious Diseases]]'' records research showing the coronavirus infection in [[dromedary camel]] calves and adults, 99.9% matching to the genomes of human clade B MERS-CoV.<ref>{{cite web|url=http://dx.doi.org/10.3201/eid2007.140571|title=MERS coronavirus in dromedary camel herd, Saudi Arabia.|last=Hemida first=Maged G|last2=Chu|first2=Daniel KW|last3=Poon|first3=Ranawaka|last4=Perera|first4=Mohammad A A|last5=Ng|first5= Hoiyee-Y|quote=The full-genome sequence of MERS-CoV from dromedaries in this study is 99.9% similar to genomes of human clade B MERS-CoV.|date=Jul 2014|accessdate=22 Apr 2014}}</ref>
</gallery>


At least one person who has fallen sick with MERS was known to have come into contact with camels or recently drank [[camel milk]].<ref name="camel">{{cite web|url=http://www.cidrap.umn.edu/news-perspective/2014/04/mers-outbreaks-grow-malaysian-case-had-camel-link|title=MERS outbreaks grow; Malaysian case had camel link|date=17 Apr 2014|last=Roos|first=Robert|accessdate=22 Apr 2014}}</ref>
==Related chapters==
 
* [[Middle East respiratory syndrome coronavirus]]
On 9 August 2013, a report in the journal ''[[The Lancet Infectious Diseases]]'' showed that 50 out of 50 (100%) [[Serum (blood)|blood serum]] from [[Oman]]i camels and {{nowrap|15 of 105}} (14%) from Spanish camels had protein-specific antibodies against the MERS-CoV spike protein. Blood serum from European sheep, goats, cattle, and other camelids had no such antibodies.<ref name=lancet_camel>{{cite doi|10.1016/S1473-3099(13)70164-6|noedit}}</ref> Countries like [[Saudi Arabia]] and the [[United Arab Emirates]] produce and consume large amounts of [[camel meat]]. The possibility exists that African or Australian [[bat]]s harbor the virus and transmit it to camels. Imported camels from these regions might have carried the virus to the Middle East.<ref name=scimag_camel>{{cite web|title=Camels May Transmit New Middle Eastern Virus|url=http://news.sciencemag.org/2013/08/camels-may-transmit-new-middle-eastern-virus|date=8 August 2013|accessdate=8 August 2013}}</ref>
 
In 2013 MERS-CoV was identified in three members of a dromedary camel herd held in a Qatar barn, which was linked to two confirmed human cases who have since recovered. The presence of MERS-CoV in the camels was confirmed by the [[RIVM|National Institute of Public Health and Environment]] (RIVM) of the Ministry of Health and the [[Erasmus Medical Center]] (WHO Collaborating Center), the Netherlands. None of the camels showed any sign of disease when the samples were collected. The Qatar Supreme Council of Health advised in November 2013 that people with underlying health conditions, such as heart disease, diabetes, kidney disease, respiratory disease, the immunosuppressed, and the elderly, avoid any close animal contacts when visiting farms and markets, and to practice good hygiene, such as washing hands.<ref>{{cite web|title=Three camels hit by MERS coronavirus in Qatar|url=http://www.sch.gov.qa/sch/En/catcontent.jsp?scatId=833&scatType=1&CSRT=8118031749383040885|publisher=Qatar Supreme Council of Health|accessdate=28 November 2013}}</ref>
 
A further study on dromedary camels from Saudi Arabia published in December 2013 revealed the presence of MERS-CoV in 90% of the evaluated dromedary camels (310), suggesting that dromedary camels not only could be the main reservoir of MERS-CoV, but also the animal source of MERS.<ref>{{cite journal|last=Hemida|first=MG|title=Middle East Respiratory Syndrome (MERS) coronavirus seroprevalence in domestic livestock in Saudi Arabia, 2010 to 2013|journal=Euro Surveillance|date=2013|volume=18|issue=50|url=http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20659}}</ref>
 
According to the 27 March 2014 MERS-CoV summary update, recent studies support that camels serve as the primary source of the MERS-CoV infecting humans, while bats may be the ultimate reservoir of the virus. Evidence includes the frequency with which the virus has been found in camels to which human cases have been exposed, seriological data which shows widespread transmission in camels, and the similarity of the camel CoV to the human CoV.<ref>{{cite web|url=http://www.who.int/csr/disease/coronavirus_infections/MERS_CoV_Update_27_March_2014.pdf?ua=1|title=Middle East respiratory syndrome coronavirus (MERS‐CoV)Summary and literature update – as of 27 March2014|date=27 Mar 2014|accessdate=24 Apr 2014}}</ref>
 
On 6 June 2014, the ''[[Arab News]]'' newspaper highlighted the latest research findings in the New England Journal of Medicine in which a 44-year-old Saudi man who kept a herd of nine camels died of MERS in November 2013.  His friends said they witnessed him applying a topical medicine to the nose of one of his ill camels--four of them reportedly sick with nasal discharge--seven days before he himself became stricken with MERS.  Researchers sequenced the virus found in one of the sick camels and the virus that killed the man, and found that their genomes were identical.  In that same article, the ''Arab News'' reported that as of 6 June 2014, there have been 689 cases of MERS reported within the Kingdom of Saudi Arabia with 283 deaths.<ref>Mohammed Rasooldeen, Fakeih: 80% drop in MERS infections, ''Arab News'', Vol XXXIX, Number 183, Page 1, 6 June 2014.</ref>
 
===Taxonomy===
MERS-CoV is more closely related to the bat coronaviruses HKU4 and HKU5 (lineage 2C) than it is to SARS-CoV (lineage 2B) (2, 9), sharing more than 90% sequence identity with their closest relationships, bat coronaviruses HKU4 and [[Pipistrellus Bat coronavirus HKU5|HKU5]] and therefore considered to belong to the same species by the [[International Committee on Taxonomy of Viruses]] (ICTV).
 
*Mnemonic: 
*Taxon identifier: 
*Scientific name: Middle East respiratory syndrome coronavirus<ref name=deGroot />
*Common name: MERS-CoV
*Synonym: Severe acute respiratory syndrome coronavirus
*Other names:
**novel coronavirus (nCoV)
**[[London1 novel CoV 2012]]<ref name=UKHPA>{{cite report|url=http://www.cidrap.umn.edu/cidrap/content/other/sars/news/sep2512corona.html |date=25 September 2013 |publisher=[[Center for Infectious Disease Research & Policy]] (CIDRAP) |title=UK agency picks name for new coronavirus isolate|first=Robert |last=Roos
|location=[[University of Minnesota, Minneapolis]], MN}}</ref>
**[[HCoV-EMC/2012|Human Coronavirus Erasmus Medical Center/2012]] (HCoV-EMC/2012)
*Rank:
*Lineage:
:› [[Virus]]es
::› ssRNA viruses
:::› Group: IV; [[Sense (molecular biology)|positive-sense]], [[Base pair|single-stranded]] [[RNA virus]]es
::::› Order: ''[[Nidovirales]]''
:::::› Family: ''[[Coronaviridae]]''
::::::› Subfamily: ''[[Coronavirinae]]''
:::::::› Genus: ''[[Betacoronavirus]]''<ref name="Bermingham-2012">
{{Cite journal
| last1 = Bermingham | first1 = A.
| last2 = Chand | first2 = MA.
| last3 = Brown | first3 = CS.
| last4 = Aarons | first4 = E.
| last5 = Tong | first5 = C.
| last6 = Langrish | first6 = C.
| last7 = Hoschler | first7 = K.
| last8 = Brown | first8 = K.
| last9 = Galiano | first9 = M.
| title = Severe respiratory illness caused by a novel coronavirus, in a patient transferred to the United Kingdom from the Middle East, September 2012
| journal = Euro Surveillance
|url=http://www.eurosurveillance.org/images/dynamic/EE/V17N40/art20290.pdf
|format=PDF
| volume = 17
| issue = 40
| page = 20290
|date=27 September 2012
| pmid = 23078800 | display-authors = 9 }}</ref>
::::::::› Species: ''[[Betacoronavirus 1]]'' (commonly called ''Human coronavirus OC43''), ''[[Human coronavirus HKU1]]'', ''Murine coronavirus'', ''[[Pipistrellus bat coronavirus HKU5]]'', ''Rousettus bat coronavirus HKU9'', ''Severe acute respiratory syndrome-related coronavirus'', ''Tylonycteris bat coronavirus HKU4'', ''MERS-CoV''
*Virus hosts:
**''[[Homo sapiens]]'' (human)
**[[Pipistrellus Bat coronavirus HKU5|Bats]]<ref name=NPRFouchierbats>{{cite news |last=Doucleff |first=Michaeleen |title=Holy Bat Virus! Genome Hints At Origin Of SARS-Like Virus|url=http://www.npr.org/blogs/health/2012/09/28/161944734/holy-bat-virus-genome-hints-at-origin-of-sars-like-virus|accessdate=29 September 2012 |newspaper=
[[NPR]]|date=28 September 2012}}</ref><ref name="cnn130313" /><ref name="wwwnc.cdc.gov">{{Cite journal
|author1 =Augustina Annan
|author2=Heather J. Baldwin
|author3=Victor Max Corman
|title = Human Betacoronavirus 2c EMC/2012–related Viruses in Bats, Ghana and Europe
|volume=19
|number=3
|journal=Emerging Infectious Disease journal - CDC
|url = http://wwwnc.cdc.gov/eid/article/19/3/12-1503_article.htm
| date =March 2013
| accessdate = 20 March 2013
}}</ref><ref name="Bermingham-2012" /><ref name="sciencedaily">{{cite web
|title  = New Coronavirus Has Many Potential Hosts, Could Pass from Animals to Humans Repeatedly
|url    = http://www.sciencedaily.com/releases/2012/12/121211083210.htm
|publisher=ScienceDaily
|accessdate=13 December 2012
}}</ref>
**[[Suidae|Swine]]<ref name="Bermingham-2012" />
Strains:
*Isolate:
*Isolate:
*NCBI
 
==Microbiology==
 
The virus grows readily on [[Vero cells]] and LLC-MK2 cells.<ref name="promedmail.org"/>
 
==Research and patent==
 
Saudi officials had not given permission to Dr. Zaki to send a sample of the virus to Fouchier and they were angered when Fouchier claimed the patent on the full genetic sequence<ref name=Economist20apr2013>
{{cite news
|url=http://www.economist.com/news/leaders/21576390-despite-progress-world-still-unprepared-new-pandemic-disease-coming-ready-or-not
|title=Pandemic preparedness: Coming, ready or not
|publisher=The Economist
|date=20 April 2013
}}</ref> of the Middle East respiratory syndrome coronavirus.<ref name=Economist20apr2013>
{{cite news
|url=http://www.economist.com/news/leaders/21576390-despite-progress-world-still-unprepared-new-pandemic-disease-coming-ready-or-not
|title=Pandemic preparedness: Coming, ready or not
|publisher=[[The Economist]]
|date=20 April 2013
}}</ref>
 
The editor of ''[[The Economist]]'' observed, "Concern over security must not slow urgent work. Studying a deadly virus is risky. Not studying it is riskier."<ref name=Economist20apr2013 /> Dr. Zaki was fired from his job at the hospital as a result of sharing his sample and findings.<ref>{{cite news|title=Egyptian Virologist Who Discovered New SARS-Like Virus Fears Its Spread|url=http://health.mpelembe.net/home/egyptian-virologist-who-discovered-new-sars-like-virus-fears-its-spread|accessdate=25 May 2013|newspaper=Mpelembe|date=13 May 2013}}</ref><ref>{{cite news|title=Coronavirus victim's widow tells of grief as scientists scramble for treatment|url=http://www.guardian.co.uk/science/2013/mar/15/coronavirus-victim-widow-scientists-treatment|accessdate=25 May 2013|newspaper=[[The Guardian]]|date=15 March 2013|author=Ian Sample|author2=Mark Smith}}</ref><ref>{{cite news|last=Sample|first=Ian|title=Coronavirus: Is this the next pandemic?|url=http://www.guardian.co.uk/science/2013/mar/15/coronavirus-next-global-pandemic|accessdate=25 May 2013|newspaper=The Guardian|date=15 March 2013}}</ref><ref>{{cite news|last=Yang|first=Jennifer|title=How medical sleuths stopped a deadly new SARS-like virus in its tracks|url=http://www.thestar.com/news/world/2012/10/21/how_medical_sleuths_stopped_a_deadly_new_sarslike_virus_in_its_tracks.html|accessdate=25 May 2013|newspaper=[[Toronto Star]]|date=21 October 2012}}</ref>
 
At their annual meeting of the [[World Health Assembly]] in May 2013, WHO chief Margaret Chan declared that [[intellectual property]], or patents on strains of new virus, should not impede nations from protecting their citizens by limiting scientific investigations. Deputy Health Minister Ziad Memish raised concerns that scientists who held the patent for the MERS-CoV virus would not allow other scientists to use patented material and were therefore delaying the development of diagnostic tests.<ref name=coronavirus_patent23may2013>
{{cite news
|date=23 May 2013
|title=WHO urges information sharing over novel coronavirus
|url=http://www.bbc.co.uk/news/health-22649922
|publisher=BBC News
}}</ref> Erasmus MC responded that the patent application did not restrict public health research into MERS coronavirus,<ref name=erasmus>{{cite press release|title=Erasmus MC: no restrictions for public health research into MERS coronavirus|date=24 May 2013|publisher=Erasmus MC|location=Rotterdam|url=http://www.erasmusmc.nl/perskamer/archief/2013/4164294/?lang=en}}</ref> and that the virus and diagnostic tests were shipped—free of charge—to all that requested such reagents.
 
==Corona Map==
There are a number of mapping efforts focused on tracking MERS coronavirus. On 2 May 2014, the [http://CoronaMap.com/ Corona Map] was launched to track the MERS coronavirus in realtime on the world map. The data is officially reported by WHO or the [[Ministry of Health]] of the respective country.<ref name=CoronaMap>{{cite press release|title=Corona Map|date=2 May 2014|url=http://CoronaMap.com}}</ref> [[HealthMap]] also tracks case reports with inclusion of news and social media as data sources as part of [http://healthmap.org/MERS HealthMap MERS].
 
==See also==
 
*[[Outbreak]]
*[[Virulence]]
*[[European Centre for Disease Prevention and Control]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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[[category:Disease]]
[[category:Disease]]
[[Category:Infectious disease]]
 
[[category:Virology]]
[[category:Virology]]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

MERS-CoV is caused by a lineage C betacoronavirus, an enveloped, spherical (120 nm in diameter), single-stranded, positive-strand RNA virus that belongs to the familyCoronaviridaeof the orderNidovirales. The natural reservoir of MERS-CoV is unknown, but bats are thought to be the most likely natural reservoir. MERS-CoV is thought to have a zoonotic activity, whereby transmission occurs from animals to humans. Limited data is available to confirm or rule out human-to-human transmission.

Causes

MERS-CoV is caused by a lineage C betacoronavirus.

Taxonomy

Betacoronavirus is an enveloped, spherical (120 nm in diameter), single-stranded, positive-strand RNA virus that belongs to the family Coronaviridae of the order Nidovirales.

Genome

The betacoronavirus contains a genome composed of 30,119 nucleotides that encodes structural and non-structural proteins. The genome is considered the largest among all RNA virus genomes, reaching 27-32 kb in size.

Tropism

Transmission

  • MERS-CoV is thought to have a zoonotic activity, whereby transmission occurs from animals to humans.
  • Although bats are the natural host of the betacoronavirus, it is unknown if MERS coronavirus transmission to humans is through bats, through an intermediate animal hosts following crossover and subsequent adaptation, or through a completely different host.
  • Limited data is available to confirm or rule out human-to-human transmission.

Natural Reservoir

  • The natural reservoir of MERS-CoV is unknown.
  • The following are thought to be the natural reservoirs of MERS-CoV:
    • Bats (The majority of reports hypothesized that bats are the natural reservoir of MERS-CoV)
    • Camels
    • Goats

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References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 "Public Health Image Library (PHIL)".

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