What is MERS? What you need to know

Middle East respiratory syndrome coronavirus (MERS-CoV), previously known as novel coronavirus (nCoV), is a viral respiratory illness, which was first reported in Saudi Arabia, in 2012. The source of MERS is currently unknown, though it is likely to have originated from an animal.

The MERS virus is currently spreading in South Korea. This, in combination with the fact that coronaviruses can often mutate, is leading to increased fears it could become a pandemic.

MERS-CoV is dissimilar to other coronaviruses; there is currently no vaccine.

Most confirmed cases of MERS-CoV have displayed symptoms of severe acute respiratory illness. Approximately 36% of reported patients with MERS have died.

Contents of this article:

1. MERS Outbreak updates
2. What is MERS-CoV?
3. What causes MERS-CoV?
4. Signs and symptoms
5. Who is most at risk?
6. Tests and diagnosis
7. Treatment and prevention
8. Confirmed cases and deaths

You will also see introductions at the end of some sections to any recent developments that have been covered by MNT's news stories. Also look out for links to information about related conditions.

Fast facts on MERS

Here are some key points about MERS-CoV. More detail and supporting information is in the main article.

• MERS-CoV was first reported in Saudi Arabia in 2012.
• MERS-CoV belongs to the coronavirus family.
• All cases have been linked to countries in and neighboring the Arabian Peninsula.
• Cases of MERS-CoV reported in other countries were travel-related and first developed in the Middle East.
• It is thought mammals play a role in the transmission of the virus - bats and camels remaining a high contender.
• In addition to humans, strains of MERS-CoV have been identified in camels in Qatar, Egypt and Saudi Arabia, and in a bat in Saudi Arabia.
• Doctors describe MERS-CoV as a flu-like illness with signs and symptoms of pneumonia.
• Sufferers of MERS-CoV will generally develop severe acute respiratory illness. Some people have reported mild respiratory illness with others showing no symptoms.
• There are no specific treatments for patients who become ill with MERS-CoV infection.
• Out of the confirmed cases of MERS-CoV, 36% have been fatal.

MERS Outbreak updates

June 5, 2015

In light of the recent outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV), WHO and the Republic of Korea's Ministry of Health and Welfare will conduct a joint mission in the Republic of Korea.

This joint mission is to gain information and review the situation in the Republic of Korea including the epidemiological pattern, the characteristic of the virus and clinical features.

Based on current data and WHO's risk assessment, there is no evidence to suggest sustained human-to-human transmission in communities and no evidence of airborne transmission.

June 2, 2015

The outbreak of MERS-CoV in the Republic of Korea continues to evolve. The Republic of Korea's first, or "index", case was confirmed on May 20, 2015.

To date, contact tracing has identified a total of 25 laboratory-confirmed cases, including the index case and among health care workers caring for him, patients who were being cared for at the same clinics or hospitals, and family members and visitors. Two of these confirmed cases have been fatal.

June 2, 2015

A total of 1,179 laboratory-confirmed cases of human infection with MERS-CoV have been reported to WHO since 2012, including at least 442 deaths.

What is MERS-CoV?

MERS-CoV belongs to the coronavirus family. Human coronaviruses were first classified in the mid 1960s. The coronavirus subgroups are referred to as alpha, beta, gamma and delta. There are currently six coronaviruses that can affect humans including:

MERS-CoV belongs to the coronavirus family. Human coronaviruses were first classified in the mid 1960s. MERS-CoV was first reported in 2012 in Saudi Arabia.

Alpha coronaviruses

• Human coronavirus 229E
• Human coronavirus NL63 (HCoV-NL63, New Haven coronavirus).

Beta coronaviruses

• Human coronavirus OC43
• Human coronavirus HKU1
• SARS-CoV
• Middle East respiratory syndrome coronavirus (MERS-CoV).

Coronaviruses typically infect one species type or those that are closely related. However, SARS-CoV infects both humans and animals including monkeys, Himalayan palm civets, raccoon dogs, cats, dogs, and rodents.

The common cold is a virally related syndrome. It is connected to over 100 separate viruses, including human coronavirus.

MERS-CoV is a species in lineage C of the genus beta coronavirus, which presently includes tylonycteris bat coronavirus HKU4 and pipistrellus bat coronavirus HKU5.

MERS-CoV is a species in lineage C of the genus beta coronavirus, which presently includes tylonycteris bat coronavirus HKU4 and pipistrellus bat coronavirus HKU5. Although it features in the same subgroup, MERS-CoV is different from the coronavirus that caused severe acute respiratory virus (SARS) in 2003. One parallel between MERS-CoV and SARS is that they both are similar to coronaviruses found in bats.

MERS-CoV appears most closely to resemble the not-yet-classified viruses from insectivorous European and African bats in the Vespertilionidae and Nycteridae families.

All cases have been linked to countries in and neighboring the Arabian Peninsula including:

• Bahrain
• Iraq
• Iran
• Israel
• Jordan
• Kuwait
• Lebanon
• Oman
• Palestine
• Qatar
• Saudi Arabia
• Syria
• United Arab Emirates (UAE)
• The West Bank
• Yemen.

Cases of MERS-CoV reported in other countries were travel-related and first developed in the Middle East. Countries that have declared cases are:

Middle East

• Egypt
• Iran
• Jordan
• Kuwait
• Lebanon
• Oman
• Qatar
• Saudi Arabia (KSA)
• United Arab Emirates (UAE)
• Yemen.

Europe

• Austria
• France
• Germany
• Greece
• Italy
• Netherlands
• Turkey
• United Kingdom.

Africa

• Algeria
• Tunisia.

Asia

• China
• Republic of Korea
• Malaysia
• Philippines.

Americas

• US.

What causes MERS-CoV?

The cause of MERS-CoV is not yet fully understood. Although not confirmed, the infection could be primarily zoonotic in nature, with limited human-to-human transmission. It is thought mammals play a role in the transmission of the virus - bats and camels remaining a high contender.

It is thought mammals play a role in the transmission of the virus - bats and camels remaining a high contender.

In addition to humans, strains of MERS-CoV have been identified in:

• Camels in Qatar, Egypt and Saudi Arabia
• A bat in Saudi Arabia.

MERS-CoV antibodies were found in camels across Africa and the Middle East, indicating that they had previously been infected with MERS-CoV or a closely related virus.

Researchers from three centers in the United States and two in Saudi Arabia conducted complete genetic sequences for MERS-CoV isolates generated from five camels, the results verified them identical to published sequences of human isolates.

Goats, cows, sheep, water buffalo, swine and wild birds have been tested for antibodies to MERS-CoV; none have yet been detected.

The findings above support the hypothesis that camels are a probable source of infection transfer to humans, while bats may be the ultimate reservoir of the virus. The high infectious dose would require very close contact between an infected camel and humans for instigation of human MERS-CoV infection by camels. It has been suggested the virus could infect humans by air, via camel milk or meat.

Experts have commented that although the respiratory route of transmission is the most likely, the paper has exhibited that MERS-CoV can survive in raw camel milk marginally longer than milk of other species, proposing the foodborne path of transmission should be investigated further.

Recent developments on MERS-CoV causes

MERS may have started in bats in Saudi Arabia

Researchers have discovered what they believe could be the animal origin of Middle East respiratory syndrome (MERS) - after examining a bat in Saudi Arabia near where the first person was infected with the mystery virus.

MERS coronavirus: are camels the carrier?

A European study published gives the first hint that camels could be a reservoir for the mysterious MERS virus.

Signs and symptoms of MERS

The most common signs and symptoms of MERS-CoV are:

• Fever 100 degrees F or higher
• Cough
• Breathing difficulties
• Chills
• Chest pain
• Body aches
• Sore throat
• Malaise - a general feeling of being unwell
• Headache
• Diarrhea
• Nausea/Vomiting
• Runny nose
• Renal (kidney) failure
• Pneumonia.

Doctors describe it as flu-like illness with signs and symptoms of pneumonia. Early reports described symptoms as similar to those found in SARS-CoV (severe acute respiratory syndrome) cases. However, SARS infections did not cause renal failure, unlike MERS-CoV.

Sufferers of MERS-CoV will generally develop severe acute respiratory illness. Some people have reported mild respiratory illness with others showing no symptoms.

Who is most at risk?

The following groups of people are more susceptible to MERS-CoV infections and complications:

• Patients with chronic diseases, such as diabetes, chronic lung disease and heart conditions
• The elderly
• Organ transplant recipients who are on immunosuppressive medications
• Other patients whose immune systems are weak, such as cancer patients undergoing treatment.

Out of the confirmed cases of MERS-CoV, 36% have been fatal.

Tests and diagnosis

The polymerase chain reaction (PCR) test is used to detect and diagnose infectious disease and can confirm positive cases of MERS-CoV by means of a sample from the patient's respiratory tract.

A blood test can determine if an individual has previously been infected, by testing for MERS-CoV antibodies.

Recent developments on MERS-CoV diagnosis from MNT news

WHO: two confirmed US MERS cases, but still 'no public health emergency'

For the first time, the US has been confronted with two confirmed cases of the Middle East Respiratory Syndrome virus. Though public health officials are taking great steps to prevent spread of the illness, the World Health Organization say the conditions for a Public Health Emergency of International Concern have "not yet been met."

Difference Identified Between MERS-CoV And SARS

Research has identified the key differences between the Middle East respiratory syndrome coronavirus (MERS-CoV) and SARS.

CDC concludes Indiana MERS patient did not spread virus to Illinois business associate

After completing additional and more definitive laboratory tests, CDC officials have concluded that an Indiana MERS patient did not spread the virus to an Illinois associate during a business meeting they had before the patient became ill and was hospitalized.

Treatment and prevention

According to the US Centers for Disease Control and Prevention (CDC) and WHO (World Health Organization), there are no specific treatments for patients who become ill with MERS-CoV infection.

Most confirmed cases of MERS-CoV have displayed symptoms of severe acute respiratory illness, 36% of these patients have died.

All doctors can currently do is provide supportive medical care to help relieve the symptoms. Supportive care means providing treatment to prevent, control or relieve complications and side effects, as well as attempting to improve the patient's comfort and quality of life. Supportive care (supportive therapy) does not include treating or improving the illness/condition.

Travel advice has been provided to reduce the risk of MERS-CoV infection amongst travelers, which includes information such as:

• There is an increased chance of illness for those travelers with pre-existing chronic conditions
• There is an increased chance of illness for travelers suffering from flu and traveller's diarrhea
• Frequent hand-washing is advised with soap and water
• Avoid undercooked meat or food prepared under unhygienic conditions
• Ensure fruit and vegetables are properly washed before consumption
• If a traveller develops acute respiratory illness with fever, they should minimize close contact with others, wear a medical mask, sneeze into a sleeve, flexed elbow or tissue (making sure it is disposed of properly after use)
• If during 14 days after returning from travel acute respiratory illness with fever develops; medical attention should be sought immediately
• All cases should be reported to the local health authorities; they monitor for MERS-CoV.

While MERS-CoV is contagious, the virus does not appear to pass between humans without close contact, for example, caring for a patient without protective precaution. Therefore, guidance should be pursued from a health care professional if symptoms materialize.

With so little still known about the virus strain, any advice or recommendation should be considered temporary and subject to change.

Confirmed cases and deaths

The following figures are the total number of MERS-CoV cases and deaths as of June 9, 2015 as reported by WHO.

Total cases confirmed by the World Health Organization (WHO):

No. of cases	No. of deaths	Fatality %
1,236	445	36%

Recent developments on MERS-CoV treatment from MNT news

MERS lab strain could lead to vaccine

Scientists have developed a strain of the Middle East respiratory syndrome coronavirus (MERS-CoV) that could be used to develop a vaccine against the deadly pathogen.

Enzyme discovery holds promise for SARS, MERS vaccine

A study led by researchers from Purdue University in West Lafayette, IN, details a way of disabling a part of the virus involved in severe acute respiratory syndrome that allows it to hide from the immune system - a finding that may lead to the development of a vaccine against the disease.

The research team says their findings may also lead to the creation of a vaccine against Middle East respiratory syndrome (MERS) - a virus related to severe acute respiratory syndrome (SARS).

Continue to Read more ...

CDC announce 2014 adult immunization schedule

The Center for Disease Control and Prevention's Advisory Committee on Immunization Practices has announced its recommended adult immunization schedule for 2014. Each year, the committee reviews the schedule, ensuring that current clinical recommendations are appropriately reflected.
Among the key changes to the schedule for 2014 include revised notes on administering vaccines for flu; tetanus, diphtheria, and accellular pertussis; human papillomavirus (HPV); zoster virus; pneumococcal disease and meningococcal disease.
The recommendations for flu have been amended to show that the recombinant influenza and inactivated influenza vaccines can now be used among people with a hives-only allergy to eggs, as these vaccines contain no egg protein.
New guidelines for the Haemophilus influenza type b (Hib) vaccine say it is recommended for adults at risk of Hib who have not been vaccinated before, with the exception of patients with HIV as their risk for Hib infection is low.
Patients who have undergone successful hematopoietic stem cell transplantation, meanwhile, are recommended to have a three-dose series of Hib vaccines, regardless of whether they have previously been vaccinated for Hib or not.
Hematopoietic stem cell transplantation is a procedure used to treat conditions that cause defects to the immune system or bone marrow, such as multiple myeloma, non-Hodgkin Lymphoma and Hodgkin disease.
The language concerning tetanus, diphtheria, accellular pertussis (Tdap) and tetanus, diphtheria (Td) vaccines has been adjusted to fit with the recommendations given in the Center for Disease Control and Prevention's (CDC's) pediatric immunization schedule.
The guidelines now recommend a single dose of the Tdap vaccine for patients aged 11 or older, who have not previously been vaccinated. It is also now suggested that the TD booster should be administered every 10 years after the initial vaccination.

HPV, shingles, pneumococcal disease and meningococcal disease

Although no changes have been made to the HPV recommendations, additional information has clarified timing between the second and third doses, and again the language has been modified to minimize discrepancies with the pediatric immunization guidelines.
In addition, it is no longer considered necessary for health care workers to receive the HPV or zoster virus (shingles) vaccines, and the guidelines have been updated to reflect this.
Elsewhere on Medical News Today, we look at a study addressing concerns from some parents that the HPV vaccine could lead to '"risky sexual behavior" in teenagers and young people.
For pneumococcal disease - the condition caused by the Streptococcus pneumoniae bacteria that can lead to pneumonia, blood infections and meningitis - there has been some clarification on the order vaccines should be administered, depending on whether people require both the pneumococcal conjugate (PCV13) and pneumococcal polysaccharide (PPSV23) vaccines.
Similarly, for meningococcal disease, further distinctions have been made between who should receive the meningococcal conjugate (MeanACWY-D) or meningococcal polysaccharide (MenACWY-CRM) vaccines.
Those who are interested in viewing the full schedule can do so on the website for the Annals of Internal Medicine.

Continue to Read more ...

Universal flu vaccine closer after natural immunity study

UK scientists believe they have taken a significant step closer to a universal flu vaccine that would protect against all strains of seasonal flu and curb future pandemics.
The team, led by researchers at Imperial College London, reports the achievement in Nature Medicine.
Lead investigator Professor Ajit Lalvani, from the National Heart and Lung Institute at Imperial, says:
"New strains of flu are continuously emerging, some of which are deadly, and so the Holy Grail is to create a universal vaccine that would be effective against all strains of flu."

Flu virus always changing surface proteins

Current flu vaccines spur the immune system to make antibodies that recognize proteins on the surface of the virus. When these are spotted in an immunized person, the immune system mounts an attack against the virus.
The difficulty with this approach is that the flu virus is always changing its surface proteins, so different vaccines have to be developed every year as new strains emerge, leaving vaccine developers inevitably one step behind.
But the core of the flu virus is more stable and changes little as strains evolve, and researchers conducting lab experiments have suggested some immune cells may already protect against flu because they recognize unchanging proteins in the virus.
For instance, a group of US scientists recently took a step toward a universal flu vaccine with animal tests that suggested their vaccine caused the animals' immune system to make antibodies to those parts of the flu virus that do not change from strain to strain.

'Natural experiment'

However, this latest study is the first to use a "natural experiment" in a real human pandemic, the 2009 swine flu pandemic.
Prof. Lalvani describes it as a unique opportunity to find out whether the immune system could recognize and protect us against new strains for which we lack antibodies.
He and his colleagues asked 342 volunteers to donate blood samples and undergo nasal swabs just as the pandemic got under way. They then tracked the volunteers by sending them email questionnaires about their health and any symptoms over the next two flu seasons. If any volunteers had flu symptoms, they took a nasal swab and sent it to the lab.
The team found the volunteers who caught the flu but had either no symptoms or only mild symptoms were those whose blood samples at the start of the 2009 swine flu pandemic had more CD8 T cells, a type of immune cell that kills viruses. Those who fell severely ill had fewer of these cells.

'Blueprint' for vaccine - make more CD8 T cells

The researchers believe a vaccine that spurs the immune system to make more CD8 T cells could protect against serious disease from all flu viruses, including those that cross into human populations from birds and pigs.
Prof. Lalvani says the findings provide a "blueprint" for developing a universal flu vaccine:
"The immune system produces these CD8 T cells in response to usual seasonal flu. Unlike antibodies, they target the core of the virus, which doesn't change, even in new pandemic strains."

"We already know how to stimulate the immune system to make CD8 T cells by vaccination. Now that we know these T cells may protect, we can design a vaccine to prevent people getting symptoms and transmitting infection to others."

Such a vaccine could significantly limit seasonal flu and protect people against future pandemics, he adds.
It would be a different approach to conventional vaccines, which stimulate the immune system to develop antibodies in response to exposure to parts of a virus.
Researchers writing in PLOS Pathogens earlier this year, suggested a more effective route to a universal flu vaccine would be to combine T cell vaccines and antibody vaccines.
According to the World Health Organization (WHO), annual flu epidemics result in about three to five million cases of severe illness, and between one quarter and half a million deaths worldwide.

Continue to Read more ...

Beware Of Deadly New Virus, CDC Warns Officials

Coronaviruses viewed under an electron microscope, with their crown-, or halo-like (corona) appearance

State and health officials have been warned about a deadly virus which has so far killed 8 of 14 infected people in the Middle East and the United Kingdom. The CDC (Centers for Disease Control and Prevention) explained that this virulent coronavirus is part of the same family of viruses as the common cold and SARS.

Experts believe this new coronavirus comes from the Middle East. Of the four confirmed infections in the United Kingdom, three occurred among people who had travelled to the Middle East, one of whom was a family member of an infected person, he had no history of recent travel and had never been to the Middle East. This means that it has become human-transmissible; infected humans can pass it on to other people.

One of the family members, the one who had not travelled, died. According to UK authorities, the patient had an underlying condition that may have increased susceptibility to respiratory infections.

The novel virus is a coronavirus, part of the same virus family as SARS (severe acute respiratory syndrome) and the common cold. During the SARS epidemic of 2003/2004, 10% of infected people were killed. This new coronavirus has a death rate of over 50% (8 out of 14 infected people have died).

"Corona" is Latin for "crown" or "halo". Coronaviruses have halo-like projections on their surfaces.




Scientists working at the Health Protection Agency, UK, say that the new coronavirus (N-CoV) is not the same as SARS-CoV (the virus that causes SARS), but is similar to it. N-CoV is similar to a coronavirus found in bats.

According to the CDC, no cases of infection with the new coronavirus have been reported in the USA.

The first case of the novel coronavirus infection was diagnosed Qatar, the patient was taken to the United Kingdom for treatment in September 2012.

According to Professor John Watson, head of the respiratory diseases department at Britain's Health Protection Agency:

"The routes of transmission to humans of the novel coronavirus have not yet been fully determined, but the recent UK experience provides strong evidence of human-to-human transmission in at least some circumstances.

The three recent cases in the UK represent an important opportunity to obtain more information about the characteristics of this infection in humans and risk factors for its acquisition, particularly in the light of the first ever recorded instance of apparently lower severity of illness in one of the cases. The risk of infection in contacts in most circumstances is still considered to be low and the risk associated with novel coronavirus to the general UK population remains very low. The HPA will continue to work closely with national and international health authorities and will share any further advice with health professionals and the public if and when more information becomes available."

The CDC is advising doctors and health care authorities in the USA to be watchful for any patients who have been to the Middle East during the past 10 days with unexplained respiratory infections.

The CDC has set up a Coronavirus Website with infection updates.

What are the signs and symptoms of novel coronavirus infection?

According to the World Health Organization (WHO), the following signs and symptoms were reported in the confirmed cases of human illness:

• acute severe respiratory illness
• breathing problems
• fever
• shortness of breath

Virtually all patients develop pneumonia. In some patients there is kidney failure.

WHO and the HPA emphasize that with only 14 cases to go by, the features of the infection may change.

Novel coronavirus less human transmissible than SARS

Experts from the UK and WHO say that although the signs and symptoms of N-CoV are similar to those found in S-CoV (the virus that causes SARS), the novel coronavirus is much less human transmissible.

Nobody knows how widespread N-CoV is. Except for one person - the patient in the UK who caught the infection from a family member - how the others became infected is still a mystery. Health authorities do not know whether N-CoV infection resulted from close contact with infected animals or people.

In an official communiqué in February 2013, WHO asked all Member States to continue their surveillance for severe acute respiratory infections and to carefully review unusual patterns. Patients with unexplained pneumonias should be tested, as should those with unexplained severe, progressive/complicated respiratory illness who do not respond to treatment.

WHO, the HPA and the CDC do not advise screening people at points of entry, or implementing any travel or trade restrictions.

Written by Christian Nordqvist

Continue to Read more ...

Novel Coronavirus Might Spread Between Humans, Says World Health Organization

The Novel Coronavirus (nCoV) is emerging as a major challenge for countries across the world and experts from the various governments that have been affected are desperately looking for some form of guidance. A new report by the World Health Organization (WHO) reveals that the virus may be able to spread by human-to-human contact.

In fact, WHO has just been invited by the The Ministry of Health of the Kingdom of Saudi Arabia to try and help them fully assess nCoV and come up with recommendations and ways to try and tackle it.

Novel Coronavirus infection is a relatively new disease in humans; there are still many questions that remain unanswered, says WHO. It is going to take some time before we fully understand nCoV.

What we know about nCoV so far

Coronaviruses affect the upper respiratory tract of birds and mammals, although they may also affect the gastrointestinal tract. They are quite common and are responsible for about one third of all common colds.

The Novel Coronavirus is a new coronavirus strain that began infecting people in the Middle East last year.

It was first identified around the beginning of 2012 when a man in Saudi Arabia became sick with symptoms that appeared to be very similar to SARS - he died in June 2012.

Three months later, a patient from Qatar became ill after a trip to Saudi Arabia. He was transported to the UK for further treatment. Lab tests were conducted which confirmed that the patients were both infected with nCoV.

Since then, nCoV infection has killed 18 people in the Middle East.

NCoV and it's similarity to SARS

Another well known virus that was similarly caused by a Coronavirus was the famous SARS CoV infection which first emerged in the Guangdong Province in southern China in November 2002.

Even though SARS and nCoV belong to the same family, the effects they have on human cells differ substantially. nCoV disrupts more human genes more aggressively and frequently than the SARS coronavirus did.

NCoV is also proving to have a higher fatality rate than SARS, its 50% death rate is a lot higher than the 9.5% rate during the 2002/2003 SARS pandemic that was responsible for the deaths of 774 out of 8,098 confirmed cases of human infection in 37 countries.

Understanding nCoV

WHO reports that "we know nCoV has infected people since 2012, but we don't know where this virus lives. We know that when people get infected, many of them develop severe pneumonia. What we don't know is how often people might develop mild disease."

Older men with existing medical conditions appear to be particularly vulnerable to nCoV infection. WHO warned that this trend may change over time.

One of the main concerns WHO, other health organizations and government bodies have about the virus is how it is being transmitted. A WHO official recently stated that the nCoV is likely able to spread from human-tohuman.

WHO wrote in an online communique:

"Of most concern, however, is the fact that the different clusters seen in multiple countries increasingly support the hypothesis that when there is close contact this novel coronavirus can transmit from person-to-person.

This pattern of person-to- person transmission has remained limited to some small clusters and so far, there is no evidence that this virus has the capacity to sustain generalized transmission in communities."

WHO praises the Saudi Arabian government for its diligent surveillance system and control measures; this could be why so many cases have been identified in the country.

Continue to Read more ...

Beware Of Deadly New Virus, CDC Warns Officials

Coronaviruses viewed under an electron microscope, with their crown-, or halo-like (corona) appearance

State and health officials have been warned about a deadly virus which has so far killed 8 of 14 infected people in the Middle East and the United Kingdom. The CDC (Centers for Disease Control and Prevention) explained that this virulent coronavirus is part of the same family of viruses as the common cold and SARS.

Experts believe this new coronavirus comes from the Middle East. Of the four confirmed infections in the United Kingdom, three occurred among people who had travelled to the Middle East, one of whom was a family member of an infected person, he had no history of recent travel and had never been to the Middle East. This means that it has become human-transmissible; infected humans can pass it on to other people.

One of the family members, the one who had not travelled, died. According to UK authorities, the patient had an underlying condition that may have increased susceptibility to respiratory infections.

The novel virus is a coronavirus, part of the same virus family as SARS (severe acute respiratory syndrome) and the common cold. During the SARS epidemic of 2003/2004, 10% of infected people were killed. This new coronavirus has a death rate of over 50% (8 out of 14 infected people have died).

"Corona" is Latin for "crown" or "halo". Coronaviruses have halo-like projections on their surfaces.




Scientists working at the Health Protection Agency, UK, say that the new coronavirus (N-CoV) is not the same as SARS-CoV (the virus that causes SARS), but is similar to it. N-CoV is similar to a coronavirus found in bats.

According to the CDC, no cases of infection with the new coronavirus have been reported in the USA.

The first case of the novel coronavirus infection was diagnosed Qatar, the patient was taken to the United Kingdom for treatment in September 2012.

According to Professor John Watson, head of the respiratory diseases department at Britain's Health Protection Agency:

"The routes of transmission to humans of the novel coronavirus have not yet been fully determined, but the recent UK experience provides strong evidence of human-to-human transmission in at least some circumstances.

The three recent cases in the UK represent an important opportunity to obtain more information about the characteristics of this infection in humans and risk factors for its acquisition, particularly in the light of the first ever recorded instance of apparently lower severity of illness in one of the cases. The risk of infection in contacts in most circumstances is still considered to be low and the risk associated with novel coronavirus to the general UK population remains very low. The HPA will continue to work closely with national and international health authorities and will share any further advice with health professionals and the public if and when more information becomes available."

The CDC is advising doctors and health care authorities in the USA to be watchful for any patients who have been to the Middle East during the past 10 days with unexplained respiratory infections.

The CDC has set up a Coronavirus Website with infection updates.

What are the signs and symptoms of novel coronavirus infection?

According to the World Health Organization (WHO), the following signs and symptoms were reported in the confirmed cases of human illness:

• acute severe respiratory illness
• breathing problems
• fever
• shortness of breath

Virtually all patients develop pneumonia. In some patients there is kidney failure.

WHO and the HPA emphasize that with only 14 cases to go by, the features of the infection may change.

Novel coronavirus less human transmissible than SARS

Experts from the UK and WHO say that although the signs and symptoms of N-CoV are similar to those found in S-CoV (the virus that causes SARS), the novel coronavirus is much less human transmissible.

Nobody knows how widespread N-CoV is. Except for one person - the patient in the UK who caught the infection from a family member - how the others became infected is still a mystery. Health authorities do not know whether N-CoV infection resulted from close contact with infected animals or people.

In an official communiqué in February 2013, WHO asked all Member States to continue their surveillance for severe acute respiratory infections and to carefully review unusual patterns. Patients with unexplained pneumonias should be tested, as should those with unexplained severe, progressive/complicated respiratory illness who do not respond to treatment.

WHO, the HPA and the CDC do not advise screening people at points of entry, or implementing any travel or trade restrictions.

Continue to Read more ...

SARS-like Virus Infects Human, UK

A novel coronavirus infection has been confirmed in a UK patient who had recently returned from Pakistan and the Middle East, the UK Health Protection Agency announced. Coronaviruses are causes of severe respiratory infections, such as SARS (Severe Acute Respiratory Syndrome) as well as the common cold.

The HPA (Health Protection Agency) says the patient is in a Manchester hospital receiving intensive care treatment. This case brings the total number of cases confirmed worldwide to 10 (two of them diagnosed in the United Kingdom).

Below is a list of where the ten confirmed laboratory cases of SARS occurred:

• 5 - Saudi Arabia, of whom three died.
• 2 - Jordan. Both of them died.
• 2 - UK. One a Qatari, the other one a British citizen. They are both currently receiving treatment.
• 1 - Germany. Made a full recovery and was discharged from hospital. The patient was from Qatar.

Update (February 13^th) - on Wednesday, February 13^th, the Health Protection Agency confirmed another case of novel coronavirus infection in the UK. This time the patient, a British citizen, had no recent history of travel and no history of travel to the Middle East at all. This latest case points to a human-to-human transmission of the novel coronavirus.

Head of respiratory disease at the HPA, Professor John Watson, said:

"The HPA is providing advice to healthcare workers to ensure the patient under investigation is being treated appropriately and that healthcare staff who are looking after the patient are protected. Contacts of the case are also being followed up to check on their health.

Our assessment is that the risk associated with novel coronavirus to the general UK population remains extremely low and the risk to travellers to the Arabian Peninsula and surrounding countries remains very low. No travel restrictions are in place but people who develop severe respiratory symptoms, such as shortness of breath, within ten days of returning from these countries should seek medical advice and mention which countries they have visited.

Since the first case of novel coronavirus was diagnosed in the UK in September 2012, the HPA has maintained increased vigilance for illness caused by this virus, working closely with national and international authorities including the WHO and the European Centre for Disease Prevention and Control (ECDC). We have also produced updated guidance for health professionals in the UK on the investigation and management of possible cases."

The HPA now has a range of lab tests which it developed to test for coronavirus infection when patients with severe respiratory infection have an unexplainable cause. Professor Maria Zambon, director of reference microbiology services at the HPA, said that the tests are available for use at some frontline HPA labs.

In November 2012, the HPA published the full genome sequence of a coronavirus from the first UK patients, allowing researchers globally to more deeply understand the diversity of this virus. Having access to its full genome will help the scientific community determine the virus' origin, as well as develop strategies for prevention and treatment, Professor Zambon explained.

What is SARS?

SARS, which stands for Severe Acute Respiratory Syndrome, is a highly contagious and potentially fatal form of lung infection (pneumonia), according to the National Health Service (NHS), UK. However, in September 2012, the WHO (World Health Organization) said the novel coronavirus cannot spread easily from human-to-human. SARS is caused by the SARS Coronavirus (SARS CoV). Several coronaviruses are associated with infections in animals and humans.

Scientists and doctors know about two human coronaviruses that caused mild respiratory infections, including the common cold. This kind of virus also includes strains that can cause SARS.

The first case of SARS was recorded in 2002 in the Guangdong province of southern China. The infection rapidly became a pandemic and led to over 8,000 cases and 774 deaths before it was eventually brought under control.

The signs and symptoms of SARS include:

• Flu-like symptoms which start within two to ten days after infection
• Muscle pain
• Loss of appetite
• High fever
• Headaches
• Extreme tiredness
• Diarrhea
• Chills
• Three to seven days after these signs and symptoms start, the infection spreads to the lungs and airways, and the patient experiences a dry cough, breathing difficulties and a progressive drop in blood-oxygen levels - in very severe cases this can become life-threatening.

Experts believe a coronavirus strain which only infected small mammals mutated and became transmissible to humans. The SARS infection spread rapidly among humans in China, and then to other Asian countries. Other countries also reported confirmed cases of SARS, including many in Toronto, Canada and four in the UK.

Areas around the world that were affected by SARS in 2002-2003

In July 2003, the SARS pandemic was finally brought under control. WHO (World Health Organization) says this was thanks to a policy of isolating suspected infected people, and screening all airplane passengers travelling from affected countries.

The 2002/2003 SARS pandemic killed approximately 10% of infected people, and 1 in every 2 infected patients over 65 years of age.

A small laboratory in China was involved in another small SARS outbreak in 2004. WHO said this was caused by somebody coming into direct contact with a virus sample, rather than human-to-human or animal-to-human transmission.

How does SARS spread?

Like the common cold or influenza (flu), SARS is an airborne virus that spreads in small droplets of water that people cough or sneeze into the air. People can become infected by inhaling the droplets.

SARS can also spread by touching surfaces that an infected person had previously touched, such as door handles. Infected people who do not wash their hands after going to the toilet (passing stools) can also spread the infection by touch. That is why good hand hygiene is so important in stemming the spread of infection.

Those caring for or living with somebody infected with SARS are most at risk of developing the infection, according to studies carried out during the 2002/2003 pandemic.

What are the treatment options for SARS?

According to the National Health Service (NHS, UK) and the HPA, there is no cure for SARS. However, scientists are currently researching on a vaccine.

Current treatment focuses on supporting the patient with:

• Steroids to reduce inflammation in the lungs
• Breathing assistance, for example using a ventilator to deliver oxygen
• Antiviral drugs
• Antibiotics for treating pneumonia

Zoonotic virus, related to SARS, could repeatedly pass from animals to humans. A new type of coronavirus that is starting to worry public health authorities can infect cells from bats and humans alike, a fact that could make it easily animal-to-human transmissible (zoonotic), researchers from the University of Bonn Medical Centre, Germany, reported in the journal mBio.

Known as hCoV-EMC, the new coronavirus is believed to be the cause of five human deaths and many other cases of disease that originated in the Middle East. Laboratory tests show that hCov-EMC uses a different receptor in the human body than the SARS virus and can infect cells in a wide range of pigs and bat species. This means that there is not much we can do to stop the virus from jumping from animals to humans repeatedly.

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