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Middle East Respiratory Syndrome
Open accessAbstract
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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“Our findings are similar to studies reporting the bacteria implicated in secondary infections in patients with MERS-CoV and SARS-CoV.8 , 46 , 47”
From Co-infections in people with COVID-19: a systematic review and meta-analysis. (2020) · cites this paper as [46]
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Metadata
- 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
- 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
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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