Middle East respiratory syndrome coronavirus (“Middle East respiratory syndrome coronavirus”; MERS coronavirus; MERS-CoV; ICD-10-GM: B34.2 Infection caused by coronaviruses of unspecified localization, ICD-10-GM B97.2: Coronaviruses as causes of diseases classified in other chapters) was first detected in patients in the Arabian Peninsula in April 2012.
The disease is caused by the MERS coronavirus. The virus belongs to the Coronaviridae family (genus: Betacoronavirus).Other viruses in the coronavirus family include SARS-CoV-1 coronavirus (SARS-associated coronavirus, SARS-CoV) and the currently rampant SARS-CoV-2 (synonyms: novel coronavirus (2019-nCoV); 2019-nCoV (2019-novel coronavirus; coronavirus 2019-nCoV)).
Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic virus transmitted largely from dromedaries to humans.
The disease belongs to the group of viral zoonoses (animal diseases).
The pathogen reservoir is dromedaries (intermediate host); primary host organisms are probably bats.
Occurrence: The infection so far takes its origin from the Arabian Peninsula (Saudi Arabia (majority of cases), the United Arab Emirates, Jordan, Kuwait, Oman, Qatar, and Yemen). Isolated imported cases have also been reported from Egypt, Iran, Lebanon, Turkey, Algeria, Tunisia, Malaysia, the Philippines, South Korea, China, and the United States. In Europe, individual cases have been imported into France, Austria, Germany, Greece, Italy, the Netherlands, and the United Kingdom.
Contagiousness (infectiousness or transmissibility of the pathogen) is low. However, according to the Robert Koch Institute, in a hospital-associated outbreak in South Korea, there are also infections originating from the index case up to three subsequently infected persons (chain of infection), including the index case as the 1st generation.
Transmission of the pathogen (route of infection) is likely to be aerogenic (airborne droplet infection) in close contact with dromedaries and by contact or smear infection (fecal-oral: infections in which pathogens excreted in feces (fecal) are ingested via the mouth (oral), e.g., through contaminated drinking water and/or contaminated food).
Human-to-human transmission: Only difficult to transmit; to a limited extent, the pathogen can be transmitted from person to person in hospitals. The incubation period (time from infection to onset of disease) is usually less than a week (3-4 days); however, isolated cases of nine to twelve days have been observed.
The duration of infectiousness (contagiousness) is not yet known. What is certain is that infected persons can spread the virus after the disease has spread.
Since 2012, more than 1,600 laboratory-confirmed cases of MERS have been reported.
Course and prognosis: The disease usually begins with flu-like symptoms such as fever, cough, sputum; possibly also dyspnea (shortness of breath). Furthermore, gastrointestinal complaints (especially diarrhea) may occur (accompanying symptom). As a complication, pneumonia can occur in the further course, which can turn into an acute respiratory distress syndrome. In severe cases, kidney failure may also occur. Particularly severe courses affect immunocompromised patients (e.g., after organ transplantation; tumor patients) and patients with underlying diseases such as diabetes mellitus and chronic lung and kidney diseases.The infection can also be asymptomatic, i.e., without the appearance of symptoms. The lethality (mortality relative to the total number of people with the disease) among laboratory-confirmed cases is 37%.
Vaccination: A protective vaccination against MERS coronavirus is not yet available.
In Germany, the disease is notifiable according to the Infection Protection Act (IfSG).
