Cited by 518SARS-CoV-2 and COVID-19 ResearchViral Infections and Outbreaks ResearchAnimal Virus Infections Studies

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Middle East Respiratory Syndrome

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Arabi, Yaseen M., Balkhy, Hanan H., Hayden, Frederick G., Bouchama, Abderrezak, Luke, Thomas, Baillie, J. Kenneth, Al-Omari, Awad, Hajeer, Ali H., Senga, Mikiko, Denison, Mark R., Nguyen-Van-Tam, Jonathan S., Shindo, Nahoko, Bermingham, Alison, Chappell, James D., Van Kerkhove, Maria D., Fowler, Robert A.·2017·New England Journal of Medicine

DOI 10.1056/nejmsr1408795PMC PMC5362064

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Abstract

Between September 2012 and January 20, 2017, the World Health Organization (WHO) received reports from 27 countries of 1879 laboratory-confirmed cases in humans of the Middle East respiratory syndrome (MERS) caused by infection with the MERS coronavirus (MERS-CoV) and at least 659 related deaths. Cases of MERS-CoV infection continue to occur, including sporadic zoonotic infections in humans across the Arabian Peninsula, occasional importations and associated clusters in other regions, and outbreaks of nonsustained human-to-human transmission in health care settings. Dromedary camels are considered to be the most likely source of animal-to-human transmission. MERS-CoV enters host cells after binding the dipeptidyl peptidase 4 (DPP-4) receptor and the carcinoembryonic antigen–related cell-adhesion molecule 5 (CEACAM5) cofactor ligand, and it replicates efficiently in the human respiratory epithelium. Illness begins after an incubation period of 2 to 14 days and frequently results in hypoxemic respiratory failure and the need for multiorgan support. However, asymptomatic and mild cases also occur. Real-time reverse-transcription–polymerase-chain-reaction (RT-PCR) testing of respiratory secretions is the mainstay for diagnosis, and samples from the lower respiratory tract have the greatest yield among seriously ill patients. There is no antiviral therapy of proven efficacy, and thus treatment remains largely supportive; potential vaccines are at an early developmental stage. There are multiple gaps in knowledge regarding the evolution and transmission of the virus, disease pathogenesis, treatment, and prospects for a vaccine. The ongoing occurrence of MERS in humans and the associated high mortality call for a continued collaborative approach toward gaining a better understanding of the infection both in humans and in animals. MERS-CoV was first identified in September 20121 in a patient from Saudi Arabia who had hypoxemic respiratory failure and multiorgan illness. Subsequent cases have included infections in humans across the Arabian Peninsula, occasional importations and associated clusters in other regions, and outbreaks of nonsustained human-to-human transmission in health care settings (Fig. 1).

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Authors: Arabi, Y. M., Balkhy, H. H., Hayden, F. G., Bouchama, A., Luke, T., Baillie, J. K., Al-Omari, A., Hajeer, A. H., Senga, M., Denison, M. R., Nguyen-Van-Tam, J. S., Shindo, N., Bermingham, A., Chappell, J. D., Van Kerkhove, M. D., & Fowler, R. A.
Affiliations: Alfaisal University (SA)
ORCID: Arabi, Yaseen M.
Balkhy, Hanan H.
Hayden, Frederick G.
Bouchama, Abderrezak
Baillie, J. Kenneth
Hajeer, Ali H.
Senga, Mikiko
Denison, Mark R.
Shindo, Nahoko
Chappell, James D.
Fowler, Robert A.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2017-02-09
Volume: 376
Issue: 6
Pages: 584-594
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmsr1408795
PMC: PMC5362064
OpenAlex: W2586093485
Cited by: 518
References: 70
Citations by year: 2026: 9 · 2025: 7 · 2024: 22 · 2023: 21 · 2022: 41 · 2021: 126 · 2020: 220 · 2019: 26 · 2018: 23 · 2017: 20
FWCI: 60.81
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Nottingham ePrints (University of Nottingham) (submittedVersion, cc-by)
Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
Funders: U.S. Department of Defense
Heart and Stroke Foundation of Canada
World Health Organization
Vanderbilt University
Intensive Care Foundation
Wellcome Trust (103258/Z/13/Z, 103258, 103258/Z/13/A)
Australian Government
Public Health England
University of Toronto
King Abdullah International Medical Research Center
Alfaisal University
King Saud bin Abdulaziz University for Health Science
Directorate for Biological Sciences
School of Medicine, Vanderbilt University
U.S. Navy
Biotechnology and Biological Sciences Research Council (BBS/E/D/20241866, BBS/E/D/20241864, BBS/E/D/20241863)
Naval Medical Research Center
Topics: Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
Health Sciences › Medicine › Infectious Diseases › Viral Infections and Outbreaks Research
Life Sciences › Agricultural and Biological Sciences › Animal Science and Zoology › Animal Virus Infections Studies
Keywords: MERS, MERS-CoV, Camelus dromedarius, human-to-human transmission, healthcare-associated outbreaks, case fatality, CLEC5A, respiratory failure, asymptomatic infection, antiviral therapy, vaccine development, One Health, viral evolution, pathogenesis
MeSH terms: Animals, Disease Models, Animal, Humans, Middle East, Risk Factors, Coronavirus Infections, Disease Transmission, Infectious, Middle East Respiratory Syndrome Coronavirus

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