About MERS

Middle East Respiratory Syndrome (MERS) is an illness caused by a virus (more specifically, a coronavirus) called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). MERS affects the respiratory system (lungs and breathing tubes). Most MERS patients developed severe acute respiratory illness with symptoms of fever, cough and shortness of breath. About 3-4 out of every 10 patients reported with MERS have died.

Health officials first reported the disease in Saudi Arabia in September 2012. Through retrospective investigations, health officials later identified that the first known cases of MERS occurred in Jordan in April 2012. So far, all cases of MERS have been linked to countries in and near the Arabian Peninsula.

MERS-CoV has spread from ill people to others through close contact, such as caring for or living with an infected person.

MERS can affect anyone. MERS patients have ranged in age from younger than 1 to 99 years old.

CDC continues to closely monitor the MERS situation globally and work with partners to better understand the risks of this virus, including the source, how it spreads, and how infections might be prevented. CDC recognizes the potential for MERS-CoV to spread further and cause more cases globally and in the U.S. We have provided information for travelers and are working with health departments, hospitals, and other partners to prepare for this.

Symptoms & Complications

fever
cough
shortness of breath

Some people also had gastrointestinal symptoms including diarrhea and nausea/vomiting. For many people with MERS, more severe complications followed, such as pneumonia and kidney failure. About 3-4 out of every 10 people reported with MERS have died. Most of the people who died had an underlying medical condition. Some infected people had mild symptoms (such as cold-like symptoms) or no symptoms at all; they recovered.

Based on what researchers know so far, people with pre-existing medical conditions (also called comorbidities) may be more likely to become infected with MERS-CoV, or have a severe case. Pre-existing conditions from reported cases for which we have information have included diabetes; cancer; and chronic lung, heart, and kidney disease. Individuals with weakened immune systems are also at higher risk for getting MERS or having a severe case.

Based on information we have to date, the incubation period for MERS (time between when a person is exposed to MERS-CoV and when they start to have symptoms) is usually about 5 or 6 days, but can range from 2-14 days.

Transmission

MERS-CoV, like other coronaviruses, is thought to spread from an infected person’s respiratory secretions, such as through coughing. However, the precise ways the virus spreads are not currently well understood.

MERS-CoV has spread from ill people to others through close contact, such as caring for or living with an infected person. Infected people have spread MERS-CoV to others in healthcare settings, such as hospitals. Researchers studying MERS have not seen any ongoing spreading of MERS-CoV in the community.

All reported cases have been linked to countries in and near the Arabian Peninsula. Most infected people either lived in the Arabian Peninsula or recently traveled from the Arabian Peninsula before they became ill. A few people became infected with MERS-CoV after having close contact with an infected person who had recently traveled from the Arabian Peninsula.

Public health agencies continue to investigate clusters of cases in several countries to better understand how MERS-CoV spreads from person to person.

Prevention & Treatment

Prevention

Currently, there is no vaccine to prevent MERS-CoV infection. The U.S. National Institutes of Health is exploring the possibility of developing one.

CDC routinely advises that people help protect themselves from respiratory illnesses by taking everyday preventive actions:

Wash your hands often with soap and water for 20 seconds, and help young children do the same. If soap and water are not available, use an alcohol-based hand sanitizer.
Cover your nose and mouth with a tissue when you cough or sneeze, 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.
Clean and disinfect frequently touched surfaces and objects, such as doorknobs.

If you are caring for or living with a person confirmed to have, or being evaluated for, MERS-CoV infection, see Interim Guidance for Preventing MERS-CoV from Spreading in Homes and Communities.

Treatment

There is no specific antiviral treatment recommended for MERS-CoV infection. Individuals with MERS can seek medical care to help relieve symptoms. For severe cases, current treatment includes care to support vital organ functions.

People Who May Be at Increased Risk for MERS

Recent Travelers from the Arabian Peninsula

If you develop a fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after traveling from countries in or near the Arabian Peninsula*, you should call ahead to a healthcare provider and mention your recent travel. While sick, stay home from work or school and delay future travel to reduce the possibility of spreading illness to others.

Close Contacts of an Ill Traveler from the Arabian Peninsula

If you have had close contact** with someone within 14 days after they traveled from a country in or near the Arabian Peninsula*, and the traveler has/had fever and symptoms of respiratory illness, such as cough or shortness of breath, you should monitor your health for 14 days, starting from the day you were last exposed to the ill person.

If you develop fever and symptoms of respiratory illness, such as cough or shortness of breath, you should call ahead to a healthcare provider and mention your recent contact with the traveler. While sick, stay home from work or school and delay future travel to reduce the possibility of spreading illness to others.

People recently in a healthcare facility in the Republic of Korea

If you develop a fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after being in a healthcare facility (as a patient, worker, or visitor) in the Republic of Korea, you should call ahead to a healthcare provider and mention your recent presence in the healthcare facility. While sick, stay home from work or school and delay future travel to reduce the possibility of spreading illness to others.

Close Contacts of a Confirmed Case of MERS

If you have had close contact** with someone who has a confirmed MERS-CoV infection, you should contact a healthcare provider for an evaluation. Your healthcare provider may request laboratory testing and outline additional recommendations, depending on the findings of your evaluation and whether you have symptoms. You most likely will be asked to monitor your health for 14 days, starting from the day you were last exposed to the ill person. Watch for these symptoms:

Fever. Take your temperature twice a day.
Coughing
Shortness of breath
Other early symptoms to watch for are chills, body aches, sore throat, headache, diarrhea, nausea/vomiting, and runny nose.

If you develop symptoms, call ahead to your healthcare provider as soon as possible and tell him or her about your possible exposure to MERS-CoV so the office can take steps to keep other people from getting infected. Ask your healthcare provider to call the local or state health department.

Healthcare Personnel Not Using Recommended Infection-Control Precautions

Healthcare personnel should adhere to recommended infection control measures, including standard, contact, and airborne precautions, while managing symptomatic close contacts, patients under investigation, and patients who have probable or confirmed MERS-CoV infections. Recommended infection control precautions should also be utilized when collecting specimens.

Healthcare personnel who had close contact** with a confirmed case of MERS while the case was ill, if not using recommended infection control precautions (e.g. appropriate use of personal protective equipment), are at increased risk of developing MERS-CoV infection and should be evaluated and monitored by a healthcare professional with a higher index of suspicion. For more information, see Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV).

People with Exposure to Camels

MERS-CoV has been found in some camels, and some MERS patients have reported contact with camels. However, we do not know exactly how people become infected with MERS-CoV—many people with MERS have had close contact with a person sick with MERS.

The World Health Organization has posted a general precaution for anyone visiting farms, markets, barns, or other places where animals are present. Travelers should practice general hygiene measures, including regular handwashing before and after touching animals, and avoid contact with sick animals. Travelers should also avoid consumption of raw or undercooked animal products. For more information, see WHO’s Frequently Asked Questions on MERS-CoV. (Should people avoid contact with camels or camel products? Is it safe to visit farms, markets, or camel fairs?)

The World Health Organization considers certain groups to be at high risk for severe MERS; these groups include people with diabetes, kidney failure, or chronic lung disease and people who have weakened immune systems. The World Health Organization recommends that these groups take additional precautions:

Avoid contact with camels
Do not drink raw camel milk or raw camel urine
Do not eat undercooked meat, particularly camel meat

*Countries considered in the Arabian Peninsula and neighboring include: Bahrain; Iraq; Iran; Israel, the West Bank, and Gaza; Jordan; Kuwait; Lebanon; Oman; Qatar; Saudi Arabia; Syria; the United Arab Emirates (UAE); and Yemen.

**Close contact is defined as a) being within approximately 6 feet (2 meters) or within the room or care area for a prolonged period of time (e.g., healthcare personnel, household members) while not wearing recommended personal protective equipment (i.e., gowns, gloves, respirator, eye protection–see Infection Prevention and Control Recommendations); or b) having direct contact with infectious secretions (e.g., being coughed on) while not wearing recommended personal protective equipment (i.e., gowns, gloves, respirator, eye protection–see Infection Prevention and Control Recommendations). Data to inform the definition of close contact are limited. At this time, brief interactions, such as walking by a person, are considered low risk and do not constitute close contact.

MERS in the U.S.

The MERS situation in the U.S. represents a very low risk to the general public in this country. Only two patients in the U.S. have ever tested positive for MERS-CoV infection—both in May 2014—while more than 500 have tested negative. CDC continues to closely monitor the situation.

In May 2014, CDC confirmed two unlinked imported cases of MERS in the United States – one to Indiana, the other to Florida. Both cases were among healthcare providers who lived and worked in Saudi Arabia. Both traveled to the U.S. from Saudi Arabia, where they are believed to have been infected. Both were hospitalized in the U.S. and later discharged after fully recovering.

CDC and other public health partners continue to closely monitor the MERS situation. We recognize the potential for MERS-CoV to spread further and cause more cases in the United States and globally. In preparation for this, we have

Improved the way we collect data about MERS cases
Increased lab testing capacity in states to detect cases
Developed guidance and tools for health departments to conduct public health investigations when MERS cases are suspected or confirmed
Provided recommendations for healthcare infection control and other measures to prevent disease spread
Provided guidance for flight crews, Emergency Medical Service (EMS) units at airports, and U.S. Customs and Border Protection (CPB) officers about reporting ill travelers to CDC
Disseminated up-to-date information to the general public, international travelers, and public health partners
Used Advanced Molecular Detection (AMD) methods to sequence the complete virus genome on specimens from the two U.S. MERS cases to help evaluate and further describe the characteristics of MERS-CoV.

First U.S. Case (Indiana)

On May 2, 2014, the first U.S. case of MERS was confirmed in a traveler who came to the U.S. (Indiana) from Saudi Arabia, via London and Chicago. The traveler is a U.S. citizen who lives and works as a healthcare provider in Saudi Arabia at a hospital in which MERS patients had received care.

On or around April 18, the traveler began feeling unwell and developed a low-grade fever while still in Saudi Arabia.
On April 24, the traveler departed Riyadh, Saudi Arabia and traveled by plane to London, England, then to Chicago, Illinois. The traveler then took a bus from Chicago to Indiana.
On April 27, the traveler experienced increasing fever and developed respiratory symptoms including runny nose, coughing and shortness of breath.
On April 28, the traveler went to an emergency department of a hospital in Indiana, and was admitted to that hospital on the same day. The patient later tested positive for infection with MERS-CoV.
On May 9, health officials verified that the patient tested negative for active MERS-CoV infection, was no longer symptomatic, and posed no threat to the community; the patient was considered to be fully recovered and was discharged from the hospital.

Second U.S. Case (Florida)

On May 11, 2014, the second U.S. case of MERS was confirmed in a traveler who also came to the U.S. (Orlando) from Saudi Arabia, via London, Boston and Atlanta. This traveler is also a healthcare provider who lives and works in Saudi Arabia. The case is unlinked to the first U.S. case of MERS.

On May 1, the patient traveled by plane from Jeddah, Saudi Arabia to London, England; to Boston, Massachusetts; to Atlanta, Georgia; and to Orlando, Florida.
The patient began feeling unwell on May 1 during the flight from Jeddah, Saudi Arabia to London and continued to feel unwell on subsequent flights with reported symptoms including muscle aches, fever, chills, and a slight cough.
The patient continued to have intermittent fevers, nausea, and severe muscle aches while in Orlando.
On May 9, the patient went to the emergency department of a hospital in Florida and was admitted to that hospital the same day. The patient later tested positive for infection with MERS-CoV.
On May 18, health officials verified that the patient tested negative for active MERS-CoV infection, was no longer symptomatic, and posed no threat to the community; the patient was considered to be fully recovered and was discharged from the hospital.

Frequently Asked Questions and Answers

Q: What is MERS?

A: Middle East Respiratory Syndrome (MERS) is a viral respiratory illness. Learn about MERS.

Q: Why is it sometimes called MERS-CoV?

A: MERS-CoV is the acronym for Middle East Respiratory Syndrome Coronavirus, the virus that causes MERS. When referring to the virus and not the illness, CDC uses this acronym. When referring to the illness, CDC uses MERS. The virus was first reported in 2012 in Saudi Arabia. It is different from any other coronaviruses that have been found in people before.

Countries with Lab-Confirmed MERS Cases

Countries in or near the Arabian Peninsula with Cases

Saudi Arabia
United Arab Emirates (UAE)
Qatar
Oman
Jordan
Kuwait
Yemen
Lebanon
Iran

Countries with Travel-associated Cases

United Kingdom (UK)
France
Tunisia
Italy
Malaysia
Philippines
Greece
Egypt
United States of America (USA)
Netherlands
Algeria
Austria
Turkey
Germany
Republic of Korea
China
Thailand

Q: What is the source of MERS-CoV

A: We don’t know for certain where the virus came from. However, it likely came from an animal source. In addition to humans, MERS-CoV has been found in camels in several countries. It is possible that some people became infected after contact with camels, although more information is needed to figure out the possible role that camels and other animals may play in the transmission of MERS-CoV.

Q: What are the symptoms and complications that MERS can cause?

A: Read about MERS symptoms and complications.

Q: How does the virus spread?

A: Learn about how MERS-CoV spreads.

Q: Has anyone in the United States gotten infected?

A: Get the most up-to-date information about MERS in the U.S.

Q: What is CDC doing about MERS?

A: CDC works 24/7 to protect people’s health. It is the job of CDC to be concerned and move quickly whenever there is a potential public health problem. CDC continues to closely monitor the MERS situation globally. CDC is working with the World Health Organization and other partners to better understand the virus, how it spreads, the source, and risks to the public’s health. We recognize the potential for MERS-CoV to spread further and cause more cases in the United States and globally. In preparation for this, we have:

Improved the way we collect data about MERS cases
Increased lab testing capacity in states to detect cases
Developed guidance and tools for health departments to conduct public health investigations when MERS cases are suspected or confirmed
Provided recommendations for healthcare infection control and other measures to prevent disease spread
Provided guidance for flight crews, Emergency Medical Service (EMS) units at airports, and U.S. Customs and Border Protection (CPB) officers about reporting ill travelers to CDC
Disseminated up-to-date information to the general public, international travelers, and public health partners
Used Advanced Molecular Detection (AMD) methods to sequence the complete virus genome on specimens from cases to help evaluate and further describe the characteristics of MERS-CoV. (See U.S. MERS story: Decoding MERS Coronavirus: AMD Provides Quick Answers.)

Q: Am I at risk for MERS-CoV infection in the United States?

A: The MERS situation in the U.S. represents a very low risk to the general public in this country. Only two patients in the U.S. have tested positive for MERS-CoV infection—both in May 2014 after recently traveling from Saudi Arabia—while more than 500 have tested negative. CDC continues to closely monitor the situation. Read to find out if you are at increased risk for MERS-CoV infection.

Q: How can I help protect myself?

A: Visit the MERS prevention and treatment page to learn about how to protect yourself from respiratory illnesses, like MERS.

Also see Interim Guidance for Preventing MERS-CoV from Spreading in Homes and Communities, intended for caregivers, household members, and other close contacts of people confirmed to have, or being evaluated for, MERS-CoV infection.

Q: What should I do if I had close contact with someone who has MERS?

A: If you have had close contact(1) with a confirmed MERS case within the last 14 days without using the recommended infection control precautions, you should contact a healthcare provider for an evaluation. See People Who May Be at Increased Risk for MERS.

It’s important to note, however, that most people who had close contact with someone who had MERS did not get infected or become ill. We are still learning about MERS-CoV and how it spreads.

Q: Can I still travel to the Arabian Peninsula or neighboring countries where MERS cases have occurred?

A: Read CDC’s travel notices on MERS in the Arabian Peninsula and MERS in the Republic of Korea.

Q: What if I recently traveled to the Arabian Peninsula or neighboring countries and got sick?

A: If you develop a fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after traveling from countries in or near the Arabian Peninsula(2), you should call ahead to a healthcare provider and mention your recent travel. While sick, stay home from work or school and delay future travel to reduce the possibility of spreading illness to others. See People Who May Be at Increased Risk for MERS.

Q: What should I do if I had close contact with a recent traveler from the Arabian Peninsula?

A: If you have had close contact(1) with someone within 14 days after they traveled from a country in or near the Arabian Peninsula(2), and the traveler has/had fever and symptoms of respiratory illness, such as cough or shortness of breath, you should monitor your health for 14 days, starting from the day you were last exposed to the ill person. If you develop fever and symptoms of respiratory illness, such as cough or shortness of breath, you should call ahead to a healthcare provider and mention your recent contact with the traveler. While sick, stay home from work or school and delay future travel to reduce the possibility of spreading illness to others. See People Who May Be at Increased Risk for MERS.

Q: Does the U.S. detain arriving travelers who are believed to have MERS?

A: CDC may detain individuals arriving in the U.S. or traveling between states who are believed to be infected with a quarantinable disease, including MERS, as of July 31, 2014, per amended U.S. Executive Order 13295. “Isolation” is used to separate ill people who have a contagious disease from those who are healthy; “quarantine” is used to separate and restrict the movement of well people who may have been exposed to a contagious disease to see if they become ill. See About Quarantine and Isolation.

Q: Is there a vaccine?

A: Currently, there is no vaccine available to protect against MERS.

Q: What are the treatments?

A: Learn about MERS treatment.

Q: Should I be tested for MERS?

A: If you develop a fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after travel from a country in or near the Arabian Peninsula(2), or if you have had close contact(1) with someone showing these symptoms who has recently traveled from this area, or if you develop these symptoms within 14 days after being in a healthcare facility (as a patient, worker, or visitor) in the Republic of Korea, you should call ahead to a healthcare provider and mention your recent travel or close contact. Your healthcare provider will work with your state’s public health department to test you for MERS.

Q: How do you test a person for MERS?

A: There are two main ways to determine if a person is, or has been, infected with MERS-CoV.

One type of test, conducted by state and CDC labs, is called PCR, or polymerase chain reaction, assays.
- PCR tests are done with respiratory samples and can quickly indicate if a person has active infection with MERS-CoV.
A second type of test, conducted by CDC lab, is called serology testing.
- Serology testing uses blood samples and is designed to look for antibodies to MERS-CoV that would indicate a person had been previously infected with the virus and developed an immune response.
- Serology for MERS-CoV includes three separate tests – (1) a screening test called ELISA or enzyme-linked immunosorbent assay, (2) a confirmatory test called IFA or Immunofluorescent assay, and (3) a slower, but more definitive confirmatory test called the neutralizing antibody assay.

Q: What should healthcare providers and health departments do?

A: For recommendations and guidance on the case definitions; infection control, including personal protective equipment guidance; home care and isolation; case investigation; and specimen collection and shipment, see Information for Healthcare Professionals.

Q: Is MERS-CoV the same as the SARS virus?

A: No. MERS-CoV is not the same coronavirus that caused severe acute respiratory syndrome (SARS) in 2003. However, like the SARS virus, MERS-CoV is most similar to coronaviruses found in bats. CDC is still learning about MERS.

Footnotes

Close contact is defined as a) being within approximately 6 feet (2 meters) or within the room or care area for a prolonged period of time (e.g., healthcare personnel, household members) while not wearing recommended personal protective equipment (i.e., gowns, gloves, respirator, eye protection–see Infection Prevention and Control Recommendations); or b) having direct contact with infectious secretions (e.g., being coughed on) while not wearing recommended personal protective equipment (i.e., gowns, gloves, respirator, eye protection–see Infection Prevention and Control Recommendations). Data to inform the definition of close contact are limited. At this time, brief interactions, such as walking by a person, are considered low risk and do not constitute close contact.
Countries considered in the Arabian Peninsula and neighboring include: Bahrain,; Iraq; Iran; Israel, the West Bank, and Gaza; Jordan; Kuwait; Lebanon; Oman; Qatar, Saudi Arabia; Syria; the United Arab Emirates (UAE); and Yemen.

Credits to http://www.cdc.gov/coronavirus/mers/

Be careful MERS VIRUS is as deadly EBOLA