Middle East respiratory syndrome

Middle East respiratory syndrome
Cynthia Goldsmith/Maureen Metcalfe/Azaibi Tamin · Public domain · source
Name	Middle East respiratory syndrome
Family	Coronaviridae
Genus	Betacoronavirus
Aliases	MERS
First reported	2012
Location	Saudi Arabia, Jordan

Contents

Middle East respiratory syndrome is a viral respiratory illness first identified in 2012 in Saudi Arabia and associated with outbreaks in Korea and other countries. The syndrome has been studied by institutions such as the World Health Organization, the Centers for Disease Control and Prevention, and the European Centre for Disease Prevention and Control. Research involves collaborations among laboratories like the National Institutes of Health, the Pasteur Institute, and the University of Hong Kong.

Virology

The causative agent is a betacoronavirus closely related to viruses characterized in studies at the University of Bonn, the University of Cambridge, and the Chinese Academy of Sciences. Genomic analyses by teams at the Wellcome Trust Sanger Institute, the Sanger Centre, and the Broad Institute revealed similarities to coronaviruses detected in Arabian Peninsula dromedary camels and to earlier coronaviruses investigated after the SARS outbreak associated with research groups at the Harvard Medical School and the University of California, San Francisco. Structural biology efforts using cryo-electron microscopy at the Max Planck Institute, the National Institute of Allergy and Infectious Diseases, and the Cold Spring Harbor Laboratory elucidated spike protein interactions with receptors identified in mammalian studies at the Rockefeller University and the Scripps Research Institute. Virus classification follows taxonomic work by the International Committee on Taxonomy of Viruses and molecular epidemiology frameworks used by the Global Initiative on Sharing All Influenza Data.

Outbreak investigations have linked cases to locations across the Middle East, Europe, Asia, and North America, with major clusters reported in facilities inspected by public health agencies like the Ministry of Health (Saudi Arabia), the Korean Centers for Disease Control and Prevention, and the Public Health England. Case series were published in journals affiliated with the Lancet, the New England Journal of Medicine, and the Journal of the American Medical Association and involved authors from the University of Oxford, Johns Hopkins University, and the Imperial College London. Surveillance networks such as those coordinated by the World Health Organization and the European Centre for Disease Prevention and Control track incidence, while modeling studies from research groups at the London School of Hygiene & Tropical Medicine and the Institute for Health Metrics and Evaluation estimate transmissibility and fatality ratios. Outbreak responses have required coordination with organizations including the United Nations and the Gulf Cooperation Council.

Patients present with febrile respiratory illness described in case reports from the King Faisal Specialist Hospital and case definitions issued by the World Health Organization and the Centers for Disease Control and Prevention. Clinical cohorts studied at the Mayo Clinic, the Cleveland Clinic, and the Sheba Medical Center documented symptoms ranging from cough and dyspnea to acute respiratory distress syndrome managed in intensive care units at hospitals such as St Thomas' Hospital and Massachusetts General Hospital. Laboratory diagnosis uses polymerase chain reaction assays developed by the National Institute for Biological Standards and Control, serologic methods validated by the European Medicines Agency, and antigen tests evaluated in collaborations with the Food and Drug Administration and university diagnostic laboratories including Johns Hopkins Hospital and the Karolinska University Hospital.

Zoonotic transmission investigations implicate dromedary camels studied by veterinary teams at the Islamic University of Madinah and the University of Pretoria, with viral reservoirs examined in fieldwork coordinated with the Food and Agriculture Organization and the World Organisation for Animal Health. Nosocomial transmission documented in reports from King Khalid University Hospital, Suwon St. Mary's Hospital, and other healthcare settings underscores infection control lessons used by agencies such as the Centers for Disease Control and Prevention and Public Health England. Pathogenesis research by laboratories at the National Institutes of Health, the Institut Pasteur, and the University of Texas Southwestern Medical Center explores host receptor interactions and immune responses, integrating findings from immunology groups at the Ragon Institute and the Dana-Farber Cancer Institute.

Prevention strategies recommended by the World Health Organization and national ministries like the Ministry of Health (United Arab Emirates) emphasize surveillance, infection prevention in hospitals modeled after protocols from the Joint Commission International, and veterinary measures guided by the World Organisation for Animal Health. International efforts include vaccine development programs at the Vaccine Research Center (NIAID), partnerships with pharmaceutical companies such as GlaxoSmithKline and Moderna, and clinical trial networks coordinated with the Coalition for Epidemic Preparedness Innovations and the European Vaccine Initiative. Travel advisories have been issued by entities like the United States Department of State and the European Commission during significant outbreaks, while One Health collaborations involve the Food and Agriculture Organization, the World Health Organization, and national research institutes.

Clinical management protocols developed at tertiary centers including the Royal Free Hospital, Rikshospitalet, and the Sheikh Khalifa Medical City emphasize supportive care, respiratory support used in studies at the Cleveland Clinic and Guy's and St Thomas' NHS Foundation Trust, and investigational therapeutics evaluated in trials run by the National Institutes of Health and the European Medicines Agency. Antiviral candidates investigated in preclinical and clinical studies include agents studied at the University of North Carolina at Chapel Hill and the University of Tokyo, while monoclonal antibodies and plasma therapies were developed in collaborations involving the Scripps Research Institute and biotech firms. Guidelines for hospital infection control and critical care have been promulgated by professional societies such as the Society of Critical Care Medicine and the Infectious Diseases Society of America.