Semin Respir Crit Care Med 2021; 42(06): 828-838
DOI: 10.1055/s-0041-1733804
Review Article

Middle East Respiratory Syndrome Coronavirus

Jaffar A. Al-Tawfiq
1   Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
2   Division of Infectious Disease, Indiana University School of Medicine, Indianapolis, Indiana
3   Division of Infectious Disease, Johns Hopkins University, Baltimore, Maryland
Esam I. Azhar
4   Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
Ziad A. Memish
5   Research and Innovation Centre, King Saud Medical City, Ministry of Health and College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
6   Hubert Department of Global Health, Emory University, Atlanta, Georgia
Alimuddin Zumla
7   Division of Infection and Immunity, Department of Infection, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, United Kingdom
› Author Affiliations
Funding A.Z. acknowledges support from the PANDORA-ID-NET (grant no. RIA2016E-1609) funded by the European and Developing Countries Clinical Trials Partnership (EDCTP2) under Horizon 2020, the EU's Framework Program for Research and Innovation. A.Z. is the recipient of a UK National Institutes of Health Research senior investigator award and is a Mahathir Science Foundation 2021 Prize laureate.


The past two decades have witnessed the emergence of three zoonotic coronaviruses which have jumped species to cause lethal disease in humans: severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1), Middle East respiratory syndrome coronavirus (MERS-CoV), and SARS-CoV-2. MERS-CoV emerged in Saudi Arabia in 2012 and the origins of MERS-CoV are not fully understood. Genomic analysis indicates it originated in bats and transmitted to camels. Human-to-human transmission occurs in varying frequency, being highest in healthcare environment and to a lesser degree in the community and among family members. Several nosocomial outbreaks of human-to-human transmission have occurred, the largest in Riyadh and Jeddah in 2014 and South Korea in 2015. MERS-CoV remains a high-threat pathogen identified by World Health Organization as a priority pathogen because it causes severe disease that has a high mortality rate, epidemic potential, and no medical countermeasures. MERS-CoV has been identified in dromedaries in several countries in the Middle East, Africa, and South Asia. MERS-CoV-2 causes a wide range of clinical presentations, although the respiratory system is predominantly affected. There are no specific antiviral treatments, although recent trials indicate that combination antivirals may be useful in severely ill patients. Diagnosing MERS-CoV early and implementation infection control measures are critical to preventing hospital-associated outbreaks. Preventing MERS relies on avoiding unpasteurized or uncooked animal products, practicing safe hygiene habits in health care settings and around dromedaries, community education and awareness training for health workers, as well as implementing effective control measures. Effective vaccines for MERS-COV are urgently needed but still under development.

Publication History

Article published online:
16 December 2021

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