Middle East Respiratory Syndrome Corona Virus: MERS-CoV

Norovirus Season Its Not Over Til Its OverAn Emerging Virus

Middle East Respiratory Syndrome, “MERS,” is a respiratory illness caused by an emerging coronavirus1.  Although other coronaviruses are common, the MERS coronavirus (“MERS-CoV”) has only recently been reported to infect people.  Symptoms of MERS include fever, cough and shortness of breath.  MERS has proven fatal for approximately 30 percent of individuals infected.  There is no vaccine or antiviral treatment for MERS, according to the Centers for Disease Control and Prevention (CDC).  Supportive therapy, such as assisted breathing devices may be provided to patients during the illness.

First reported in Saudi Arabia in September, 2012, CDC recently noted the frequency of reporting of MERS cases has increased since mid-March of this year.  Most cases of MERS are in the Middle East. Headlines were made in May when single cases of MERS were announced in Indiana, Florida and Illinois; the Illinois diagnosis was later determined to be in error.  The Indiana and Florida cases involved individuals who contracted MERS in Saudi Arabia and then traveled to the US.  CDC notes that most US residents have a very low risk of contracting MERS.

Animal Origin?

MERS Outbreak Statistics

The World Health Organization reports since April, 2012, 636 laboratory-confirmed cases of human infection with MERS, including 193 deaths (statistics as of May 28, 2014). Most MERS cases represent people in the Middle East, but also include people who had recently travelled from Middle Eastern countries. The latest MERS disease outbreak news can be found on the World Health Organization’s Global Alert and Response web page.

According to the CDC, it is likely that MERS came from an animal source, possibly camels or bats; the virus has been detected in these animals in the Middle East.  Some people who were infected with MERS had close contact with camels or with other persons infected with the virus.  The potential mode of transmission from animals to humans is not understood, but human to human transmission through close contact and contact with contaminated surfaces and/or virus transfer to the hands are all probable.  Viruses on the hands are transmitted to the eyes, nose or mouth through touching.

Who is at Increased Risk?

According to CDC, you may be at increased risk of contracting MERS if you:

  • Traveled recently to the Arabian Peninsula
    • If you develop fever and symptoms of respiratory illness within 14 days of travel to countries in or near the Arabian Peninsula, notify a healthcare provider of your recent travel and stay home to reduce the possibility of spreading the illness to others.
  • Have close contact with an ill person who recently traveled to the Arabian Peninsula
    • Monitor your health for 14 days after having had close contact with the ill person. If you develop fever and symptoms of respiratory illness, call ahead to a healthcare provider and mention your recent contact with the traveler.
  • Have close contact with a confirmed or probable case of MERS
    • Contact a healthcare provider for an evaluation.

Prudent Precautions

Disinfecting Surfaces

University of Michigan researchers showed that keeping surfaces disinfected is just as important as hand washing to reduce your risk of viral infection.2 The research was done as part of the Center for Advancing Microbial Risk Assessment, supported by the US Department of Homeland Security and the Environmental Protection Agency.

To reduce your risk of MERS, CDC recommends:

  • Wash your hands often with soap and water for 20 seconds and help young children do the same; alcohol-based hand sanitizer may be used when soap and water are not available.
  • Clean and disinfect frequently touched surfaces such as toys and doorknobs. A  Colorado State University fact sheet recommends one minute of surface contact with a 1:10 solution of household bleach and water3
  • Cover your nose and mouth with a tissue when you cough or sneeze, and then throw the tissue in the trash.
  • Avoid touching your eyes, nose and mouth with unwashed hands.
  • Avoid personal contact, such as kissing, or sharing cups or eating utensils, with sick people.

For more information on MERS, please see this CDC website.


Barbara M. Soule, R.N. MPA, CIC, is an Infection Preventionist and a member of the Water Quality & Health Council.

Joan Rose, PhD, is the Homer Nowlin Chair in Water Research at Michigan State University and a member of the Water Quality and Health Council.


1 Coronaviruses are named for the crown-like spikes on their surfaces.  Coronaviruses cause everything from the common cold to Severe Acute Respiratory Syndrome (SARS).

2 Li, S. et al. (2009).  “Dynamics and Control of Infections Transmitted From Person to Person Through the Environment,” American Journal of Epidemiology, 170(2): 257-65.

3 5,000 parts per million free available chlorine