An Overview of the Middle Eastern Respiratory Syndrome (MERS)

Shops closed, streets empty, planes grounded—only the blue glow of our computers connected us to the outside world. We often blame the social isolation and rupture in our day-to-day life on a single agent: the coronavirus. However, there are many different strands of the coronavirus each with unique characteristics and behaviors depending on the area of the globe one may sample from. One of these strains causes Middle Eastern Respiratory Syndrome (MERS). In this article, we delve into what MERS is, the etiology of the disease, and how it is transmitted. 

MERS is a highly contagious respiratory infection whose causative agent is a virus, MERS-Cov. Five to six days after infection, an individual may experience anywhere from mild flu-like symptoms to severe symptoms such as angina (chest pain), fever, cough (with or without blood), body aches, chills, nausea, diarrhea, vomiting,  and shortness of breath. Furthermore, in these severe cases, fatal complications may occur such as pneumonia, renal failure, or contracting opportunistic infections due to the compromised immune system. In fact, according to the World Health Organization, MERS has a mortality rate of nearly 35.5% globally 

MERS originated in Saudi Arabia when the virus spread to humans from infected camels. Because MERS-Cov is a zoonotic virus, one that passes between animals (in this case camels) and humans, the majority of the outbreaks arise in the Middle East where there is a higher frequency of camels. The first incident of the virus in humans may have resulted from eating raw or undercooked meat, a lack of proper hygiene when interacting with sick animals, and/or close contact with infected animals. 

Ahmad, Tauseef. “Global Research Trends in MERS-CoV: A Comprehensive Bibliometric Analysis from 2012 to 2021.” Frontiers in Public Health, vol. 10, Frontiers Media, Aug. 2022, https://doi.org/10.3389/fpubh.2022.933333. Accessed 9 Oct. 2023.

MERS may spread throughout human populations through direct and indirect contact from aerosolized, respiratory droplets (coughing or sneezing). Consequently, if one is in close contact with an infected individual, it may increase the chances that they also obtain the virus. In a case study by a tertiary care hospital in Saudi Arabia, they examined six patients. One of them was a 74-year-old male with ischemic heart disease and heart failure. He was diagnosed 18 days after his exposure and was treated with Ribavirin and Interferon-α2b therapy a day after his diagnosis. Unfortunately, despite treatment, he developed renal failure, hemodynamic instability (abnormal blood pressure), and eventually passed away. Shown below is a chest x-ray of bilateral lung infiltrates (or the accumulation of particles denser than air in both lungs), signifying the man’s critical condition. In a broader perspective, the MERS epidemic from April 2012 to August 2023 has caused over 2.6 thousand laboratory-confirmed cases with over 900 associated deaths. 

Khalid, Mohammad, et al. “Middle Eastern Respiratory Syndrome Corona Virus (MERS CoV): Case Reports from a Tertiary Care Hospital in Saudi Arabia.” Annals of Saudi Medicine, vol. 34, no. 5, King Faisal Specialist Hospital and Research Centre, Sept. 2014, pp. 396–400, https://doi.org/10.5144/0256-4947.2014.396. Accessed 4 Oct. 2023.

Overall, MERS has had pervasive effects throughout Saudi Arabia and may continue to persist, though in a milder form. Though a specific MERS-Cov vaccine has not yet been developed, the antibody responses generated by the SARS-Cov-2 vaccine may significantly decrease the infection rate from MERS. This indicates that increasing the number of individuals vaccinated to generate herd immunity and employing other preventative measures such as hand washing, wearing masks, and sanitization, is the optimal route to take to break the chain of infection. Unfortunately, this ideal avenue was not taken, resulting in the loss of many lives before the virus evolved into a milder form. This virus was particularly impactful as Saudi Arabia houses the sacred city of Mecca, the city where Muslims religiously migrate to every year during Hajj, further accelerating the spread. From examining the characteristics, etiology, and transmission of the disease, I hope that society can learn from the tragic cases of MERS to construct a future where humanity can aptly control pervasive infections while minimizing the number of lives lost.   

Works Cited

Adhikari, Umesh, et al. “A Case Study Evaluating the Risk of Infection from Middle Eastern Respiratory Syndrome Coronavirus (MERS‐CoV) in a Hospital Setting through Bioaerosols.” Risk Analysis, vol. 39, no. 12, Wiley-Blackwell, Sept. 2019, pp. 2608–24, https://doi.org/10.1111/risa.13389. Accessed 4 Oct. 2023.

Ahmed, Anwar. “Estimating Survival Rates in MERS-CoV Patients 14 and 45 Days after Experiencing Symptoms and Determining the Differences in Survival Rates by Demographic Data, Disease Characteristics and Regions: A Worldwide Study.” Epidemiology and Infection, vol. 146, no. 4, Cambridge University Press, Dec. 2017, pp. 489–95, https://doi.org/10.1017/s095026881700293x. Accessed 2 Oct. 2023.

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Culvert, L. Lee, and Amy Hackney Blackwell. "Middle East Respiratory Syndrome Coronavirus." The Gale Encyclopedia of Emerging Diseases, edited by Deirdre S. Hiam, 2nd ed., Gale, 2023, pp. 350-353. Gale Health and Wellness, link.gale.com/apps/doc/CX8477100097/HWRC?u=j015915006&sid=bookmark-HWRC&xid=7a43668c. Accessed 2 Oct. 2023.

Killerby, Marie E., et al. "Middle East Respiratory Syndrome Coronavirus Transmission." Emerging Infectious Diseases, vol. 26, no. 2, Feb. 2020, pp. 191+. Gale Health and Wellness, link.gale.com/apps/doc/A615236168/HWRC?u=j015915006&sid=bookmark-HWRC&xid=f05590c4. Accessed 2 Oct. 2023.

“MERS Outbreaks.” World Health Organization - Regional Office for the Eastern Mediterranean, 2023, www.emro.who.int/health-topics/mers-cov/mers-outbreaks.html. Accessed 4 Oct. 2023.

Tawfiq, Jaffar A. Al-, and Ziad A. Memish. "Middle East respiratory syndrome coronavirus: epidemiology and disease control measures." Infection and Drug Resistance, vol. 7, annual 2014, pp. 281+. Gale Health and Wellness, link.gale.com/apps/doc/A400415094/HWRC?u=j015915006&sid=bookmark-HWRC&xid=1be7374f. Accessed 2 Oct. 2023.