Abstract
Two years have passed since the initial description of the Middle East respiratory syndrome coronavirus (MERS-CoV), yet the epidemic is far from being controlled. The high case fatality rate, the recent steep increase in reported cases, and the potential to cause a global pandemic during the upcoming Hajj season are serious concerns. Although a wealth of information about the pathophysiology, proposed animal reservoir, and intermediate host has been revealed, many questions remain unanswered. We herein review MERS-CoV, covering its proposed origins, route of transmission, treatment options, and future perspectives.
Highlights
Two years have passed since the initial description of the Middle East respiratory syndrome coronavirus (MERS-CoV), yet the epidemic is far from being controlled
Three lines of evidence currently support this theory: (1) the very close phylogenetic similarity with the bat Betacoronaviruses: BtCoV-HKU4 and BtCoV-HKU5 [6]; (2) closely related coronavirus sequences have been recovered from bats in Africa, Asia, the Americas, and Eurasia; and (3) MERS-CoV uses the evolutionary conserved dipeptidyl peptidase-4 (DPP4) protein in Pipistrellus pipistrellus bats for cell entry [7]
Most cases have been described in countries of the Arabian Peninsula, the increasing travel to the region and the Hajj season in Kingdom of Saudi Arabia (KSA) pose a threat of a potential global pandemic
Summary
Two years have passed since the initial description of the Middle East respiratory syndrome coronavirus (MERS-CoV), yet the epidemic is far from being controlled. MERS-CoV has been detected by reverse transcription PCR (RT-PCR) from the nasal swabs of three camels in Qatar and was linked to two confirmed human cases with high similarity upon sequencing, suggesting a possible respiratory mode of transmission [16]. Other factors may have contributed to the observed surge, including suboptimal infection control practices in affected hospitals in Saudi Arabia, as documented in a recent report of the WHO mission to Jeddah [33]. Another explanation for the seasonal variation may be that it coincides with camel birthing season, and younger camels seem to be more often infected than their older counterparts [34]. Seropositive camels for MERS-CoV were detected in Egypt, Kenya, Nigeria, Tunisia, and Ethiopia, suggesting that there may be MERS-CoV cases that are undetected in Africa [8,35,36]
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