Corona Virus Infection (MERS_COV) Middle East Respiratory Syndrome (MERS) is a viral respiratory illness The virus was first reported in 2012 in Saudi Arabia. It is different from any other coronaviruses that have been found in people before Coronaviruses were first described in the 1960s from the nasal cavities of patients with the common cold. These viruses were subsequently named human coronavirus 229E and human coronavirus OC43. Countries in or near the Arabian Peninsula with MERS cases: Bahrain, Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, United Arab Emirates (UAE), and Yemen.

Countries outside of the Arabian Peninsula with travel-associated MERS cases: Algeria, Austria, China, Egypt, France, Germany, Greece, Italy, Malaysia, Netherlands, Philippines, Republic of Korea, Thailand, Tunisia, Turkey, United Kingdom (UK), and United States of America (USA).

How many human coronaviruses are there? From the mid 1960s until 2002, we only knew about two coronaviruses - HCoV-229E and HCoV-OC43. Then SARS-CoV was discovered in 2002/2003, adding another human coronavirus to the list. By the end of 2004, a fourth human coronavirus was discovered. Various research groups refer to it as NL63 (New Haven coronavirus). In 2005, a fifth human coronavirus was discovered at the University of Hong Kong in two patients with pneumonia. They named it HKU1 In 2012, the Novel Coronavirus was discovered, as described earlier in this text. It is most commonly known as NCoV or Novel coronavirus 2012. Another coronavirus was discovered in a patient who presented with pneumonia and renal (kidney) failure - known as HCoV-EMC/2012.

The following human coronaviruses are currently known to virologists: HCoV-229E HCoV-OC43 SARS-CoV NL63/NL/New Haven coronavirus HKU1-CoV MERS-CoV.

Reservoir: Transmission The main reservoir are bats . It can infect camels, By turn it is transmitted to human and cause the infection Transmission MERS-CoV, like other coronaviruses, is thought to spread from an infected person’s respiratory secretions, such as through coughing. About 20% of cases from person to person transmission. However, the precise ways the virus spreads are not currently well understood. The largest known outbreak of MERS outside the Arabian Peninsula occurred in the Republic of Korea in 2015 and was associated with a traveler returning from the Arabian Peninsula. In Gulf countries it can affect peoples in contact with camels.

What is the incubation period of a MERS-CoV infection? The incubation period (the time between infection and start of symptoms) is about five days, but it can occasionally be up range from two to 14 days. Coronavirus symptoms Cold- or flu-like symptoms usually set in from two to four days after coronavirus infection, and they are typically mild. Symptoms include:Sneezing,Runny nose,Fatigue,Cough,Fever (rare)Sore throat

Initially, the illness resembles influenza with fever and a mild cough Initially, the illness resembles influenza with fever and a mild cough. The breathing disorder often progresses to severe shortness of breath (dyspnea) and inability to maintain oxygenation (hypoxia). Progression may be rapid, or it may take several days. Severely affected people develop a potentially fatal form of respiratory failure, known as (ARD or ARDS). In addition to attacking the alveoli in the lungs, the virus also infects other organs in the body, causing kidney failure, (pericarditis), or severe systemic bleeding from (disseminated intravascular coagulation). People with compromised immune systems such as severe rheumatoid arthritis or organ transplantation may not experience respiratory symptoms but can have fever or diarrhea.

Peoples at risk: . Extremities of age . Chronic chest or heart diseases. .Diabetes Mellitus. . Health care personnel's . .peoples in contact with camels. . Peoples with low immunity. . Peoples travelling to gulf countries.

Diagnosis: .. PCR assays are done with respiratory, serum, or stool samples and can quickly indicate if a person has an active infection with MERS-CoV. .. Serology testing uses serum 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 or has an active MERS-CoV infection for approximately 14 or more days. Serology for MERS-CoV often 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.

What is the treatment for MERS-CoV? Because MERS-CoV is caused by a similar virus as SARS, the management of MERS-CoV has been extrapolated from experience with the 2002 SARS outbreak and some limited experimental data. Like SARS, patients with MERS-CoV often require oxygen supplementation, and severe cases require mechanical ventilation and intensive-care-unit support. No medication has been proven to treat MERS-CoV, and treatment is based upon the patient's medical condition. Several medications have been tried in both SARS and MERS-CoV without conclusive benefits, and further research is to be done. Management of the individual with MERS is aided by infectious disease, pulmonary, and critical-care specialists.

What is the prognosis of MERS-CoV? What are complications of MERS-CoV? MERS is associated with a rapidly progressive severe respiratory illness, and mortality compared to the SARS-CoV outbreak of 2003 is very high. Since 2012, the MERS outbreak in Saudi Arabia has slowly continued with a total of 933 individuals diagnosed with 401 deaths as of March 2015, for a mortality rate of about 50%.  Pneumonia and kidney failure are complications of MERS-CoV.

Prevention: Travelers to the Arabian Peninsula and surrounding countries, and their close contacts, may protect themselves by taking simple measures that help to prevent the spread of germs. Frequent hand hygiene using soap and water, or an alcohol-based hand sanitizer, avoidance of close contact with sick people, and avoidance of touching one's eyes, nose, and mouth can prevent the spread of viruses. Caregivers of patients who are not hospitalized should perform frequent hand hygiene as stated above and wear a face mask for direct care until the patient has recovered. In the Arabian Peninsula and surrounding countries where MERS-CoV has been found, (WHO) recommends precautions in handling live camels or their raw meat and dairy products. Anyone who does so, should frequently wash hands and consider using respiratory protection, as well as barriers to protect skin and clothing. Clothing worn during handling of camels or their products should be kept away from household contacts and washed daily. All products intended for human consumption should be cooked thoroughly or pasteurized.