۱٫ Introduction

۲٫ Origin and emergence of the virus

۳٫ Virus structure and cycle

۴٫ Transmission mechanisms and preventive measures

۵٫ Diagnostic laboratory testing

۶٫ Clinical presentation

۷٫ Treatment of MERS

۸٫ Vaccine development

۹٫ Conclusions

References

Abstract

Since the first case of human infection by the Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia in June 2012, more than 2260 cases of confirmed MERS-CoV infection and 803 related deaths have been reported since the 16th of October 2018. The vast majority of these cases (71%) were reported in Saudi Arabia but the epidemic has now spread to 27 countries and has not ceased 6 years later, unlike SARS-CoV that disappeared a little less than 2 years after emerging. Due to the high fatality rate observed in MERS-CoV infected patients (36%), much effort has been put into understanding the origin and pathophysiology of this novel coronavirus to prevent it from becoming endemic in humans. This review focuses in particular on the origin, epidemiology and clinical manifestations of MERS-CoV, as well as the diagnosis and treatment of infected patients. The experience gained over recent years on how to manage the different risks related to this kind of epidemic will be key to being prepared for future outbreaks of communicable disease.

Introduction

The first case of infection attributed to Middle East respiratory syndrome coronavirus (MERS-CoV) was detected in Saudi Arabia in June 2012 [1]. MERS-CoV then spread to several neighboring countries, mainly Jordan and Qatar (see Fig. 2), and imported cases of the disease were reported throughout the world in Asia, Africa, Europe and theAmericas [2].By the 16thof October 2018, 2260 con-firmed cases of infection with MERS-CoV had been documented in 27 countries by the World Health Organization (WHO) and were associated with 803 deaths [2]. The vast majority of the cases (73%) were reported in Saudi Arabia and only one widespread outbreak was observed outside of the Arabian peninsula in South Korea in 2015 [3] (Figs. 1 and 2). Due to the disease’s high fatality rate (36%) [2], much effort has been put into understanding the origin and pathophysiology of this novel coronavirus to prevent it from becoming endemic in humans.