Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

Middle East Respiratory Syndrome (MERS) is a serious respiratory disease caused by Middle East Respiratory Syndrome coronavirus (MERS-CoV). MERS-CoV was first reported in Saudi Arabia in 2012. Since then, it has spread to other countries, including the United States.

Most people infected with MERS-CoV develop severe respiratory illness and have symptoms including fever, cough, shortness of breath, and breathing difficulties. Many patients with MERS have developed severe complications including pneumonia and kidney failure.

MERS-CoV has been shown to spread between people who are in close contact. All reported cases of MERS in the United States have been linked to international travel to countries in the Arabian Peninsula.


About MERS

 Causes and transmission

MERS-CoV is part of the coronavirus family. Like many coronaviruses, it spreads from person to person through respiratory droplets. MERS-CoV has spread from infected people to others through close contact, such as caring for or living with an infected person. It can also spread from infected people to health care workers. Experts are still studying how MERS-CoV spreads but have not seen any ongoing transmission in the community.

Only a few cases of MERS have ever been reported in the United States. All of the cases of MERS in the United States have been linked to international travel to countries in and around the Arabian Peninsula. These countries include: Bahrain, Iran, Iraq, Israel, the West Bank and Gaza, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE) and Yemen.

People at higher risk for MERS include:

 Signs and symptoms

Most people with MERS have severe respiratory illness with symptoms including:

  • Fever
  • Cough
  • Shortness of breath or other breathing difficulties

Some people also have diarrhea, nausea, and/or vomiting. Symptoms of MERS start to appear about five to six days after exposure, but can range from 2 to 14 days. Many people with MERS develop severe complications such as pneumonia and kidney failure. The Centers for Disease Control and Prevention (CDC) reports that about three or four people out of every 10 with MERS have died.

People at higher risk for severe complications from MERS include people with:

  • Diabetes
  • Cancer
  • Chronic lung disease
  • Chronic heart disease
  • Chronic kidney disease

If you develop a fever or symptoms of respiratory illness, such as a cough or shortness of breath, within 14 days after traveling from countries in or near the Arabian Peninsula, call a doctor and let them know about your recent travel. While you are sick, stay home from work or school.

 Treatment

There is no specific antiviral treatment recommended for individuals with MERS. People with MERS often receive medical care to help relieve their symptoms. For severe cases, treatment includes care to support vital organ functions.

 Prevention

Currently, there is not a vaccine to prevent against MERS. Continue to take everyday actions that protect them against all respiratory illnesses:

  • Wash your hands frequently with soap and water for 20 seconds. Use an alcohol-based hand sanitizer if soap and water is not available.
  • 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.
  • Clean and disinfect frequently touched surfaces and objects, such as doorknobs.
  • Stay home when sick.

 Resources

Information for providers

MERS is a Category I reportable condition in Wisconsin. Clinicians must report suspected and confirmed MERS cases immediately by telephone to the patient’s local or tribal health department. Reporting should be completed within 24 hours upon recognition of a case.

Interim Local Health Departments MERS-CoV investigation short form (PDF)

 Testing information

Currently, PCR testing of specimens for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is available in Wisconsin only at the Wisconsin State Laboratory of Hygiene (WSLH) and at the CDC. Currently available diagnostic tests for seasonal coronaviruses are not suitable for detecting MERS CoV.

To increase the likelihood of detecting MERS-CoV, CDC recommends collection of specimens from different sites, for example, a nasopharyngeal swab and a lower respiratory tract specimen, such as (induced) sputum, bronchoalveolar lavage, bronchial wash, or tracheal aspirate. Lower respiratory tract specimens should be a priority for collection and polymerase chain reaction (PCR) testing. The Division of Public Health will approve test requests if a patient meets the criteria described in the case definition.

Case definition

Clinical Features

AND

Epidemiologic Risk

Severe Illness
Fever and pneumonia or acute respiratory distress syndrome (based on clinical or radiological evidence)

and

A history of travel from countries in or near the Arabian Peninsula¹ within 14 days before symptom onset, or close contact² with a symptomatic traveler, who developed fever and acute respiratory illness (not necessarily pneumonia) within 14 days after traveling from countries in or near the Arabian Peninsula.¹
– or –
A history of being in a health care facility (as a patient, worker, or visitor) in the Republic of Korea within 14 days before symptom onset. (New Guidance)
– or –
A member of a cluster of patients with severe acute respiratory illness (e.g., fever and pneumonia requiring hospitalization) of unknown etiology, in which MERS-CoV is being evaluated, in consultation with state and local health departments in the US.

Milder illness
Fever and symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath)

and

A history of being in a health care facility (as a patient, worker, or visitor) within 14 days before symptom onset in a country or territory in or near the Arabian Peninsula,¹ in which recent health care-associated cases of MERS have been identified.
– or –
Close contact² with a confirmed MERS case while the case was ill.

1Countries 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.

2Close 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., health care personnel, household members) while not wearing recommended personal protective equipment (i.e., gowns, gloves, respirator, eye protection; 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).

 Provider resources

 Contact information

Thomas Haupt, Influenza Surveillance Coordinator
Division of Public Health
Bureau of Communicable Diseases
Phone 608-266-5326
Fax 608-261-4976

Last Revised: August 9, 2022