Comment: Report of first two cases of imported MERS-CoV into US. Report also summarizes current recommendations regarding case description/patient evaluation, specimen procurement and testing.
Comment: Guidance from the CDC Visit URL link for most up to date information.
Comment: Coordinating site including MERS-CoV, SARS and other coronaviruses with public health implications. Includes link to interim case definition for MERS-CoV infection.
Comment: A review compiling outbreaks and likely reasons why they occurred. Most would be likely prevented with simple isolation and infection control measures.
Comment: Based on data from outbreaks, 2 to 3 nasopharyngeal samples are needed to produce the highest yield of positive results for MERS-CoV. In addition, 2 negative results 48 hours apart with clinical improvement or stabilization are needed to clear patients from MERS-CoV.
Comment: As isolation and infection control is the best way to prevent spread, simple procedures and protocols are important to limit spread in healthcare facilities.
Comment: First report of a large patient population summarizing MERS-CoV kinetics and antibody response. The study shows the kinetics of the virus in the upper and lower respiratory tract, stool, urine and blood samples.
Comment: Mortality among cases reported so far = ~ 40% including both community- and hospital-acquired cases. More severe cases seen especially in patients with co-morbidities. Now into the third year, it appears to be endemic and therefore a low-level but persistent public health threat.
Comment: Of 2014 cases in KSA, most had links to hospital care implicating transmission in an arena where opportunities for prevention exist.
Comment: Report from the Kingdom of Saudi Arabia with the most cases, and an uptick in Spring 2014 (and again ongoing 2015). Viral studies don’t suggest the virus is mutating and appear consistent in outbreaks and nosocomial transmission.
Comment: This is a summary of infection control and prevention of MERS transmission in healthcare settings.
Comment: This is a concise review summarizing different aspects of MERS in a healthcare setting including clinical presentation and management.
Comment: This review shed lights on the different aspects of the transmission and phylogenetic evolution of MERS-CoV.
Comment: Report from the Kingdom of Saudi Arabia examines 17 cases and 82 controls. Cases were more likely to have high BMI, normal WBC count on admission and interstitial infiltrates along with high moratligy rate (76% v. 15%, p < 0.001).
Comment: Sequence data from human cases and samples from dromedary camels are identical (in Saudi Arabia), suggesting that camels are indeed a reservoir (known from other studies) and source of some spread to humans.
Comment: This review summarizes the epidemiology and different strategies for the control of the virus.
Comment: Most patients diagnosed to date have had healthcare involvement and hence co-morbidities. Patients were mostly adults in the 47 described (46 adults, one child) with laboratory-confirmed MERS-CoV disease were identified; 36 (77%) were male (male:female ratio 3·3:1). 28 patients died, a 60% case-fatality rate. The case-fatality rate rose with increasing age. Only two of the 47 cases were previously healthy; most patients (45 [96%]) had underlying co-morbid medical disorders, including diabetes (32 [68%]), hypertension (16 [34%]), chronic cardiac disease (13 [28%]), and chronic renal disease (23 [49%]).
Gastrointestinal symptoms were noted in a significant minority including diarrhea, vomiting and abdominal pain.
Comment: Initial recommendations for investigating potential cases.
Comment: Clearly implicating the potential for MERS to cause a serious spread of disease in closer quarters such as hospitals, an outbreak in an eastern province of Saudi Arabia (spring 2013) with 21/23 cases due to person-person spread in healthcare environments. The mortality rate was 65% which may speak to patients with pre-existing illness acquiring.
Comment: An outbreak in Al-Hasa, part of eastern Saudi Arabia implicates direct person-to-person spread.
Comment: The first description of virus, first called HCoV-EMC but now referred to as MERS-CoV, and related but not the cause of SARS, a related coronavirus.
Comment: Investigators help confirm that this is a sister virus to SARS, and that virus appears to efficiently replicate in cell lines of human, pig and bat origin.
Comment: This study summarizes the implication of global MERS cases with links between cases in Saudi Arabia and Qatar.
Comment: This is a nice review of travel implications with comparisons between SARS and MERS-CoV.
Comment: As with other respiratory viral infections, it seems that asymptomatic patients shedding virus may contribute to spread. This makes control more difficult.
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