Middle East respiratory syndrome coronavirus infection causes: Difference between revisions

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__NOTOC__
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{{MERS}}
{{MERS}}
{{CMG}}
{{CMG}}; {{AE}} {{JS}}
 
{{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==
Ten years after the outbreak of SARS-CoV, the MERS-CoV is identified as the agent of a lethal pneumonia in patients who have recently been related to the Arabian Peninsula. The [[Middle east respiratory syndrome]] [[coronavirus]] ([[MERS-CoV]]), also termed '''EMC/2012''' (HCoV-EMC/2012), is positive-sense, single-stranded [[RNA]] novel [[species]] of the genus ''Betacoronavirus''.<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><ref name="Perlman2013">{{cite journal|last1=Perlman|first1=S.|title=The Middle East Respiratory Syndrome--How Worried Should We Be?|journal=mBio|volume=4|issue=4|year=2013|pages=e00531-13–e00531-13|issn=2150-7511|doi=10.1128/mBio.00531-13}}</ref>


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, in a 2012 outbreak of a "new [[flu]]".
==Causes==
MERS-CoV is caused by a lineage C betacoronavirus.


As of 14 May 2014, several [[MERS-CoV]] cases have been reported in different countries, including Saudi Arabia, Malaysia, Jordan, Qatar, Egypt, the United Arab Emirates, Tunisia, Kuwait, Oman, Algeria, Bangladesh, 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, however, 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-CoV]], but also from other known [[endemic]] [[coronaviruses]], such as betacoronavirus HCoV-OC43 and HCoV-HKU1, as well as from the [[common cold virus|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>
 
===Origin===
The first reported case of a [[human]] [[infected]] by [[MERS-CoV]] was in September 2012, in Saudi Arabia. This patient developed a [[lethal]] [[infection]] marked by a severe [[pneumonia]] and [[renal failure]]. However, some reports claim that the infection might have occurred first in a family from Jordan in April 2012. The [[virus]] was first isolated by an egyptian physician, while he was examining the [[lungs]] of a previously unknown [[MERS-CoV]] [[infected]] patient. The isolated [[infected]] [[cells]] showed [[cytopathic effect]] with [[syncytia]] formation and noted rounding.<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><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 name="Zakivan Boheemen2012">{{cite journal|last1=Zaki|first1=Ali M.|last2=van Boheemen|first2=Sander|last3=Bestebroer|first3=Theo M.|last4=Osterhaus|first4=Albert D.M.E.|last5=Fouchier|first5=Ron A.M.|title=Isolation of a Novel Coronavirus from a Man with Pneumonia in Saudi Arabia|journal=New England Journal of Medicine|volume=367|issue=19|year=2012|pages=1814–1820|issn=0028-4793|doi=10.1056/NEJMoa1211721}}</ref>
 
In September 2012, a second case was reported in a 49 year old man in Qatar. This patient presented with [[Influenza history and symptoms#History and Symptoms|flu-like symptoms]] and the [[viral]] sequence was proved to be similar to the one from the first case. In November of the same year, identical cases kept appearing in Saudi Arabia and Qatar, with associated deaths.


Up until now it hasn't been determined if the [[infections]] were the result of a [[zoonotic]] event, with further human-to-human [[transmission]] or if they were a case of multiple [[zoonotic]] events from a common source. A study from the Riyadh University has suggested that, since the the [[virus]] first appeared, there may have been 7 different [[zoonotic]] [[transmissions]]. Although there is still limited data, it has been noted that the [[coronavirus]] has a large [[genetic]] diversity among [[animal reservoirs]], yet the sample analysis of the [[infected]] patients suggests a common [[genome]] and therefore source. Since this early period, several clusters of [[infection]] have been created, suggesting that a human-to-human [[transmission]] has occurred.<ref name="Perlman2013">{{cite journal|last1=Perlman|first1=S.|title=The Middle East Respiratory Syndrome--How Worried Should We Be?|journal=mBio|volume=4|issue=4|year=2013|pages=e00531-13–e00531-13|issn=2150-7511|doi=10.1128/mBio.00531-13}}</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]].''


[[Molecular clock analysis]] studies have determined that the [[viruses]] from the EMC/2012 and from England/Qatar/2012 date from 2011. This suggests, not only a single [[zoonotic]] event as source of the reported cases, possibly implying that the [[MERS-CoV]] has been present asymptomatically in the human population for longer than one year without being detected, but also that it might have had an independent [[transmission]] from an unidentified 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>
===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===
===Tropism===
Studies have shown that in [[humans]], unlike most [[viruses]] that tend to [[infect]] [[ciliated]] [[cells]], [[MERS-CoV]] has a strong [[tropism]] for the [[cilium|nonciliated]] [[bronchial]] [[epithelium]]. Also, it has been noted that the [[virus]] has the capacity to evade the [[innate immune system]] and inhibit [[interferon]] production.<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.  
 
It took only 6 months for the [[MERS-CoV]] [[receptor]] to be identified and published. Initially, due to the similarityies between the [[MERS-CoV]] and the [[SARS-CoV]], it was proposed that the [[MERS-CoV]] would use the same [[cell receptor|cellular receptor]] for [[infection]], as the [[SARS-CoV]], namely the [[Angiotensin-converting enzyme 2|angiotensin converting enzyme 2]].<ref name="Perlman2013">{{cite journal|last1=Perlman|first1=S.|title=The Middle East Respiratory Syndrome--How Worried Should We Be?|journal=mBio|volume=4|issue=4|year=2013|pages=e00531-13–e00531-13|issn=2150-7511|doi=10.1128/mBio.00531-13}}</ref><ref name="RajMou2013">{{cite journal|last1=Raj|first1=V. Stalin|last2=Mou|first2=Huihui|last3=Smits|first3=Saskia L.|last4=Dekkers|first4=Dick H. W.|last5=Müller|first5=Marcel A.|last6=Dijkman|first6=Ronald|last7=Muth|first7=Doreen|last8=Demmers|first8=Jeroen A. A.|last9=Zaki|first9=Ali|last10=Fouchier|first10=Ron A. M.|last11=Thiel|first11=Volker|last12=Drosten|first12=Christian|last13=Rottier|first13=Peter J. M.|last14=Osterhaus|first14=Albert D. M. E.|last15=Bosch|first15=Berend Jan|last16=Haagmans|first16=Bart L.|title=Dipeptidyl peptidase 4 is a functional receptor for the emerging human coronavirus-EMC|journal=Nature|volume=495|issue=7440|year=2013|pages=251–254|issn=0028-0836|doi=10.1038/nature12005}}</ref><ref name="MullerRaj2012">{{cite journal|last1=Muller|first1=M. A.|last2=Raj|first2=V. S.|last3=Muth|first3=D.|last4=Meyer|first4=B.|last5=Kallies|first5=S.|last6=Smits|first6=S. L.|last7=Wollny|first7=R.|last8=Bestebroer|first8=T. M.|last9=Specht|first9=S.|last10=Suliman|first10=T.|last11=Zimmermann|first11=K.|last12=Binger|first12=T.|last13=Eckerle|first13=I.|last14=Tschapka|first14=M.|last15=Zaki|first15=A. M.|last16=Osterhaus|first16=A. D. M. E.|last17=Fouchier|first17=R. A. M.|last18=Haagmans|first18=B. L.|last19=Drosten|first19=C.|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|year=2012|pages=e00515-12–e00515-12|issn=2150-7511|doi=10.1128/mBio.00515-12}}</ref>
However, the [[cell receptor|cellular receptor]] for [[MERS-CoV]] was later identified as being the ''dipeptidyl [[peptidase]] 4'' (DDP4) or ''CD26''.<ref name="Raj-2013" /> The ''DPP4 receptor'' is an ectopeptidase, which is similar to other [[molecules]] that other [[coronaviruses]] use to [[infect]] [[cells]], such as the ''human angiotensin-converting enzyme 2'', for [[SARS-CoV]], and the ''aminopeptidade N'', for alphacoronaviruses. The [[amino acid]] sequence of this [[receptor]] is a highly conserved sequence across [[species]], being expressed in human [[bronchial]] [[epithelium]] and [[kidneys]], and its [[enzymatic]] activity is not required for the process of [[infection]].<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> When comparing the [[receptor]] for [[MERS-CoV]] with the one for [[SARS-CoV]], it is important to notice that both are shed of the [[cell membrane|cell surface]] after the respective [[infections]]. In the case of [[SARS-CoV]], the loss of this [[receptor]] leads to the worsening of the condition, evolving to a more severe [[pulmonary disease]]. On the other hand, DDP4 is a [[neutrophil]] [[chemorepellent]] and its loss from the [[cell membrane|cell surface]] leads to [[cellular]] changes that may alter the composition of the [[immune cell]] infiltrate, which may consequently alter the evolution of the [[infectious]] state.<ref name="Perlman2013">{{cite journal|last1=Perlman|first1=S.|title=The Middle East Respiratory Syndrome--How Worried Should We Be?|journal=mBio|volume=4|issue=4|year=2013|pages=e00531-13–e00531-13|issn=2150-7511|doi=10.1128/mBio.00531-13}}</ref><ref name="pmid20134095">{{cite journal| author=Imai Y, Kuba K, Ohto-Nakanishi T, Penninger JM| title=Angiotensin-converting enzyme 2 (ACE2) in disease pathogenesis. | journal=Circ J | year= 2010 | volume= 74 | issue= 3 | pages= 405-10 | pmid=20134095 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20134095  }} </ref><ref name="pmid12892317">{{cite journal| author=Lambeir AM, Durinx C, Scharpé S, De Meester I| title=Dipeptidyl-peptidase IV from bench to bedside: an update on structural properties, functions, and clinical aspects of the enzyme DPP IV. | journal=Crit Rev Clin Lab Sci | year= 2003 | volume= 40 | issue= 3 | pages= 209-94 | pmid=12892317 | doi=10.1080/713609354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12892317  }} </ref><ref name="pmid23677473">{{cite journal| author=Herlihy SE, Pilling D, Maharjan AS, Gomer RH| title=Dipeptidyl peptidase IV is a human and murine neutrophil chemorepellent. | journal=J Immunol | year= 2013 | volume= 190 | issue= 12 | pages= 6468-77 | pmid=23677473 | doi=10.4049/jimmunol.1202583 | pmc=PMC3756559 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23677473  }} </ref>


===Transmission===
===Transmission===
Since may 29th 2013, the [[WHO]] has warned that the [[MERS-CoV]] should be considered a "threat to the entire world".<ref name="Perlman2013">{{cite journal|last1=Perlman|first1=S.|title=The Middle East Respiratory Syndrome--How Worried Should We Be?|journal=mBio|volume=4|issue=4|year=2013|pages=e00531-13–e00531-13|issn=2150-7511|doi=10.1128/mBio.00531-13}}</ref> [[Transmission]] of [[MERS-CoV]] is prone to occur in [[immunocompromised]] patients, or in patients with other [[comorbidities]], such as [[diabetes]] or [[renal failure]].<ref name="Perlman2013">{{cite journal|last1=Perlman|first1=S.|title=The Middle East Respiratory Syndrome--How Worried Should We Be?|journal=mBio|volume=4|issue=4|year=2013|pages=e00531-13–e00531-13|issn=2150-7511|doi=10.1128/mBio.00531-13}}</ref> In a study of 23 patients of the largest [[outbreak]] so far, in Saudi Arabia, was determined that 74% had underlying [[diabetes mellitus]], 52% [[renal disease]] and 43% [[lung disease]], highlighting the impact of underlying [[comorbidities]] in the overall risk of [[infection]] with [[MERS-CoV]]. This evidence is further supported by the fact that cases of [[infected]] family members and health-care workers was only reported in 1 to 2% of contacts.<ref name="Perlman2013">{{cite journal|last1=Perlman|first1=S.|title=The Middle East Respiratory Syndrome--How Worried Should We Be?|journal=mBio|volume=4|issue=4|year=2013|pages=e00531-13–e00531-13|issn=2150-7511|doi=10.1128/mBio.00531-13}}</ref><ref name="AssiriMcGeer2013">{{cite journal|last1=Assiri|first1=Abdullah|last2=McGeer|first2=Allison|last3=Perl|first3=Trish M.|last4=Price|first4=Connie S.|last5=Al Rabeeah|first5=Abdullah A.|last6=Cummings|first6=Derek A.T.|last7=Alabdullatif|first7=Zaki N.|last8=Assad|first8=Maher|last9=Almulhim|first9=Abdulmohsen|last10=Makhdoom|first10=Hatem|last11=Madani|first11=Hossam|last12=Alhakeem|first12=Rafat|last13=Al-Tawfiq|first13=Jaffar A.|last14=Cotten|first14=Matthew|last15=Watson|first15=Simon J.|last16=Kellam|first16=Paul|last17=Zumla|first17=Alimuddin I.|last18=Memish|first18=Ziad A.|title=Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus|journal=New England Journal of Medicine|volume=369|issue=5|year=2013|pages=407–416|issn=0028-4793|doi=10.1056/NEJMoa1306742}}</ref>
* 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.
At the present time it is not known the stage at which an [[infected]] [[MERS-CoV]] patient becomes [[contagious]], if he is able to [[transmission|transmit]] the [[virus]] while there is still no evidence [[respiratory illness]], or if there is [[transmission]] only after [[symptom]] onset. If the first is correct, then the the control of a larger [[outbreak]] will be more challenging, considering the prevalence of global traveling nowadays.<ref name="Perlman2013">{{cite journal|last1=Perlman|first1=S.|title=The Middle East Respiratory Syndrome--How Worried Should We Be?|journal=mBio|volume=4|issue=4|year=2013|pages=e00531-13–e00531-13|issn=2150-7511|doi=10.1128/mBio.00531-13}}</ref>
* Limited data is available to confirm or rule out human-to-human transmission.
 
One of the major gaps of knowledge about this [[virus]] is that its prevalence in the community is not known, therefore, and since most of the identified cases were patients with underlying [[comorbidities]], there is a possibility of [[MERS-CoV]] to be a common [[infection]] in Saudi-Arabia, with which patients without these comorbidties only develop minor [[respiratory]] [[symptoms]] or are [[asymptomatic]].<ref name="Perlman2013">{{cite journal|last1=Perlman|first1=S.|title=The Middle East Respiratory Syndrome--How Worried Should We Be?|journal=mBio|volume=4|issue=4|year=2013|pages=e00531-13–e00531-13|issn=2150-7511|doi=10.1128/mBio.00531-13}}</ref>
 
===Natural reservoir===
 
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=
[[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/
|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
|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>{{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>
 
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>
 
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"/>
===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


==Research and patent==
==Gallery==


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>
<gallery>
{{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>
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>


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>
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>
{{cite news
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>
|date=23 May 2013
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>
|title=WHO urges information sharing over novel coronavirus
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>
|url=http://www.bbc.co.uk/news/health-22649922
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>
|publisher=BBC News
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>
}}</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==
{| style="float: right;"
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].
| [[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>]]
|-
| [[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>]]
|-
| [[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>]]
|-
| [[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>]]
|-
| [[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>]]
|}


==See also==
</gallery>


*[[Outbreak]]
==Related chapters==
*[[Virulence]]
* [[Middle East respiratory syndrome coronavirus]]
*[[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

Gallery

Related chapters

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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