Middle East Respiratory Syndrome-Coronavirus (MERS-CoV)

MERS-CoV is a virus that causes MERS. MERS is a severe respiratory illness that was first discovered in Saudi Arabia in 2012 (1). It affects the respiratory system, which refers to the lungs and the breathing tubes. Most of the patients suffering from it develop an acute respiratory illness. Some of the typical symptoms include fever, cough, and shortness of breath. In some cases, patients develop pneumonia and gastrointestinal symptoms, such as diarrhea. An approximated 30% of the reported cases of patients with MERS were reported to have died (2). However, most of them had underlying medical conditions. People with pre-existing conditions such as diabetes; cancer; acute lungs, heart, or kidney diseases have a higher risk of getting MERS. Moreover, those with weak immune systems are also at risk of contracting the infection and their condition becoming severe. There are minimal chances of person-to-to person transmissions. A person providing care to an infected person without protection is at a high risk of getting the infection. This paper discusses the origin, ways of transmission, and symptoms of Middle East Respiratory Syndrome, as well as ways of curing it.

Origin Middle East Respiratory Syndrome-Coronavirus

The virus is said to have originated from bats, with the virus having been isolated from a bat (1). However, the bat species that was the original host of the virus has not been determined. According to research, the virus later spread to camels, which are thought to have been infected with the virus for at least 20 years (2). The virus then spread from the camels to human beings. Studies show that camels in Saudi Arabia, Oman, Qatar, and Egypt were found to have coronavirus similar to those found in humans (4). Human beings are said to have gotten the virus through coming in contact with camels (4). The virus can also be gotten through the consumption of uncooked meat or unpasteurized milk, especially if the produce was derived from camels. Studies conducted on camels in Qatar showed the presence of MERS-CoV in raw milk of the infected camels (7). With the first case having been reported in 2012, the virus is thought to have spread to humans in early 2010.

Learning the above information, one can seek to find out if the virus has effects on the infected camels. It is critical to know the types of effects that MERS-CoV has on animals like camels and bats. Infected camels are unlikely to show signs of infection. However, the MERS-CoV is shed through eyes or nasal discharge if any, as well as feces and urine. There have been many studies on the effects that MERS-CoV in connection to the infected camels or bats. The research was conducted on the camels showed that the camels possessed antibodies that strongly cross-reacted to the spike protein of human-isolated MERS-CoV (2). The antibodies also do not cross-react with either SARS-CoV or human coronavirus OC43. It is critical to know how to distinguish between an infected camel and one that is not infected. It might be hard to distinguish between the two since there are no specific symptoms shown by the camels that have been infected.

Transmission

The main form of transmission is thought to be direct contact with an infected camel (2). However, the virus can also be transmitted through the consumption of uncooked meat or milk, especially one from a camel. The fact that it is hard to distinguish between an infected camel and the one that is not infected makes the consumption of any raw camel products increase the risk of contracting the illness. There were traces of MER-CoV in raw milk in a study carried out among camels in Qatar.

Human to human transmission is minimal with the only possibility of transmission being catching the infection by giving unprotected care to an infected person. The first serological study was carried out in China on an imported MERS-CoV case. Of the 53 people that had close contacts with the patient, no seroconversion was found (1). The findings showed that no transmission of MERS-CoV occurred in China. Although the findings show minimal chances of human to human transmission, it is hard to know whether one can completely eliminate the possibility of community transmission. People who have closer contact with infected people have higher chances of catching the infection.

Transmission can also occur through contaminated air and surfaces. The biggest outbreak that occurred outside the Middle East was in South Korea in 2015 where 186 people were confirmed to be having the infection (6). 36 of them resulted in death (6). Half of the transmissions were thought to have occurred in the hospitals that were treating the condition. Some of the hospitals that were considered the epicenters of the infection were voluntarily closed down. Although it was not certain how the transmission had occurred in a hospital setting, it was thought to have been aided by the contaminated hospital air and surfaces. Air was collected and surfaces were swabbed in two of the hospitals and tested for viral culture. In four out of seven air samples, MERS-CoV was present. MERS-CoV was also detected in fifteen out of sixty-eight surface swabs that had been collected (2).

In another case, there was an outbreak of MERS in Jeddah, Saudi Arabia. The people that contracted the infection included the medical attendants, workers, and those that were receiving treatment in King Fahd General Hospital. 78 people who were laboratory-confirmed to have contracted the infection were investigated (5). 53 were patients, 19 were health workers and 9 were visitors. The area that was thought to be the main source of the contaminated air was the emergency department with 22 of the infected people contracting the infection from that area. 17 of them contracted the infection from the inpatient area, 11 from the dialysis units, and 3 contracting from the outpatient areas (3). Cases of MERS are common among older men in the Middle East (7). This is because they are the ones that normally deal with camels. They are more exposed and at a higher risk of contracting the infection.

It proves that MERS-CoV thrived in air and can be easily transmitted through inhalation of contaminated air and coming into contact with contaminated surfaces. The question still remains, if hospitals are thought to be the safe places of handling the infections. It is still unclear how half of the transmissions occur in a hospital setting. Although there are no specific symptoms for the infection, it is not clear whether there is another way of detecting the disease. Early detection of the symptoms would help the hospital attendants to be able to seclude the infected patients, as with other infections that are transmitted through the air. Overcrowding at the hospitals should also be controlled. It would possibly reduce the cases of transmissions through contaminated air and surfaces. Any form of detection would also help in giving those that are in critical stages of urgent care and maximum medical attention. A critical question is if the transmission can occur through contaminated air, doesn’t it increase the chances of the public easily contracting the infection? With the possibility of the transmission being airborne, it raises a lot of questions on the control procedures that have been set in place since there are still used now. There should be a strict application of and adherence to the infection control precautions.

Symptoms and Treatment

The common symptoms of MERS include fever, cough, and shortness of breath. Some patients might experience gastrointestinal complications such as diarrhea (1). MERS has no specific clinical symptom. With only these general symptoms, is it an effective way of identifying a MERS patient. It causes unnecessary panic or undermining of a situation. There is also a possibility of it being confused with other illnesses before laboratory tests. Fever is common among many illnesses. The presence of the above symptoms could cause unnecessary tension if a person is thought to have contracted the infection when in real sense they are ailing from some other illness. A situation could also be assumed to be a normal medical condition when in real sense MERS coronavirus is present in their bodies. It can be quite confusing before medical or laboratory tests are conducted.

Usually, the Real-time Polymerase Chain reaction (RT-PCR) is the mainstay for the diagnosis of MERS-CoV (2). However, RT-PCR has setbacks, which include long turnaround time. There is also a lack of common measurements and correlations with Viral Load (VL). (2) It is usually recommended that screening for MERS-CoV be done using RT-PCR of the upstream of envelope gene (upE). A confirmation of the presence of the genes (open reading frame 1A, 1B genes or nucleocapsid (N) gene) then follows (2). With the presence of the setbacks, there is no clear efficient method of diagnosing MERS-CoV. Serological assays have been considered for implementation in the routine testing of the patients.

Since its discovery, there is not enough information on the efficacy of treatment regimens for MERS-CoV. There are no specific antiviral vaccines or therapies that have been developed to specifically treat the infection (3).

A study was carried out in a regional referral center in Saudi Arabia to determine the efficacy of the treatment being administered to MERS patients in relation to their survival. The treatment used included beta interferon beta, alpha interferon, ribavirin, and mycophenolate mofetil. The patients also received routine supportive care. (3) 23 patients (45%) received interferon-beta and in this cohort, eight patients received interferon-alpha (16%). Nine patients (37%) received ribavirin, which was either administered in conjunction with interferon-alpha or interferon beta, and 8 patients received mycophenolate mofetil (3). There was an improved survival rate among patients that received beta interferon and mofetil. Survival was also reported in all the patients that received mycophenolate mofetil. According to the findings, treatment with beta-interferon and mycophenolate mofetil could be predictive of survival (3). It was also found out that survival depended on how severe the illness was.

A new drug, Nitazoxanide has also been suggested for the treatment of MERS (4). The drug is recommended for the treatment of influenza and also the treatment of viral respiratory infections. It has been previously used in clinical trials and found to be effective. Since there is no specific treatment for the infection, it does not make it certain that the infection will not resurface in the patients that are thought to have been previously treated. Although death cases related to the infection are few, there is no assurance of survival of the ones currently having the infection.

SARS-CoV and MERS-CoV

SARS-CoV is a virus that causes Severe Acute Respiratory Syndrome (SARS). It was discovered in 2003 and the coronavirus could be isolated from masked palm civet (1). According to studies, wild animals that were being sold as food in the markets of China were investigated following an outbreak in Asia. It was concluded that the coronavirus had been transmitted to the human beings from the masked palm civet. Later, the virus was also found in domestic cats, raccoon dogs and ferret badgers. Chinese bats were also thought to be the natural reservoirs of SARS-CoV after research showed traces of SARS-like coronavirus in the bats. The bats then transmit the virus to people directly or transmit through the animals held at the local markets (1).

Both MERS-CoV infections and SARS-CoV infections have the same clinical presentation and are caused by the group of the Coronaviruses (3). However, the two coronaviruses tend to have different sources of infection and different evolutions. Just like MERS-CoV, SARS coronavirus is transmitted to the human beings from an animal with research pointing to bats as the natural reservoirs of the coronavirus. Both of them might cause severe respiratory illness with other complications such as diarrhea. A key question is whether there are chances that one of them is being mistaken for the other. Probably, since there are no specific symptoms that distinguish one from the other. However, MERS normally progresses to respiratory failure more rapidly than SARS. MERS is known to affect the elderly, most common among men. Chances of human to human transmission are also minimal in MERS.

Just like with MERS, health care personnel are at high risk of getting SARS. According to a study carried out in Taiwan, the findings showed that SARS infection rates among healthcare personnel were high compared to MERS acquired by the healthcare personnel. (2) SARS-CoV was also proven to spread rapidly when it comes to transmission from one person to another. There were a total of 8096 SARS cases in just 8 months and it had spread in 29 countries (2). MERS-CoV, however, spreads slowly with at least 1382 cases reported between 2012 and 2015 (1). There are no specific drugs that can be used to treat both MERS and SARS. However, Teicoplanin can block MERS. Questions arise on the effectiveness of Teicoplanin. Many think that Teicoplanin is not quite effective enough because if it were, according to the clinical trials, it would have been recommended as a preventive measure.

Conclusion

Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) is a new type of coronavirus that was first discovered in Saudi Arabia in 2012. Research shows that the original natural reservoirs of the virus are bats. The virus was then transmitted to camels. Human beings get the infection through close contact with the infected camels and consumption of raw milk and meat, especially the ones from infected camels. Since there are no specific symptoms that can be used to identify the infected camels, consumption of unpasteurized milk and uncooked meat increases the chances of getting the infection. In human beings, symptoms vary from fever, cough, and shortness of breath with pneumonia and gastrointestinal symptoms in some cases. Since the above symptoms are present in a variety, there is a limited number of ways to distinguish and isolate the infected ones before a laboratory test. Those that are not infected can contract the infection through the inhalation of contaminated air. With the increased cases of health personnel contracting the infection, what can be done to reduce similar incidences? SARS-CoV and MERS CoV have similar clinical presentations, but there is no single medication that can be used to treat the two.

However. Teicoplanin was found to have the ability to block MERS and SARS coronavirus from entering the body. Additionally, with no specific drugs or vaccine for MERS, There is little to be done to contain the situation. There is also a need for early detection and retention of the infection. People in the Middle East and other areas that the infection has spread to should take preventive measures. It is recommended that those that are in close contact with camels wash their hands with soap or use a hand sanitizer. The best possible remedy for this infection is the vaccination of camels, since with them being vaccinated the probability of the virus thriving in their bodies is minimal.