Abu Dhabi

The World Health Organization (WHO) on Monday (July 24) confirmed a case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in a 28-year-old male from Al Ain City in Abu Dhabi after being notified by the United Arab Emirates (UAE) government, earlier this month (July 10). 

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The patient had visited a private medical centre multiple times between June 3 and 7, complaining of vomiting, right flank pain and dysuria (pain when passing urine). 

By 13 June, he was in critical condition and referred to an intensive care unit (ICU) at a specialised government tertiary hospital where he was put on mechanical ventilation. 

Despite having no history or direct or indirect contact with dromedaries, goats, or sheep, the man's nasopharyngeal swab tested positive for MERS-CoV in a polymerase chain reaction (PCR) analysis on 23 June. 

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As soon as the test result returned positive, the UAE health officials identified all 108 contacts of the patient and monitored them for 14 days from the last date of exposure to the MERS-CoV patient. Fortunately, no secondary case was identified. 

Prior to the patient's case, the last MERS-CoV infection was reported in November 2021 in the UAE. Meanwhile, the first case in the Gulf country was reported on July 2013. Since then, 94 cases have been reported with 12 associated deaths, leading to a 13 per cent Case Fatality Ratio (CFR).  

Since the case was reported, the Abu Dhabi Public Health Centre (ADPHC) has updated its definition of the disease, strengthened surveillance activities to identify possible cases and conducted several workshops. 

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What is MERS?

In layman's terms, Middle East Respiratory Syndrome (MERS) is a respiratory infection of humans and dromedaries caused by a novel coronavirus called the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). It was first identified in Saudi Arabia in 2012. 

Notably, coronaviruses are a large family of viruses that cause diseases ranging from the common cold to Severe Acute Respiratory Syndrome (SARS). 

Akin to COVID-19, a person having underlying chronic medical conditions such as diabetes, renal failure, chronic lung disease and weak immune system exhibits severe symptoms of the virus. They are at increased fatality risk than the healthy population.

"Clinical severity may be related to MERS-CoV's ability to infect a broad range of cells with DPP4 expression, evade the host innate immune response, and induce cytokine dysregulation," Clinical Microbiology Reviews (CMR) noted in its assessment. 

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What are the origins of the virus?

Despite being discovered over a decade ago, scientists are unsure about the origins of the zoonotic virus. However, according to different studies involving research of the virus genomes, MERS-Cov could have originated in bats and was transmitted to camels sometime in the distant past. 

"Human-to-human transmission is possible, but only a few such transmissions have been found among family members living in the same household. In health care settings, however, human-to-human transmission appears to be more frequent," WHO states in its report. 

What are the symptoms?

WHO states that typical MERS symptoms include fever, cough and shortness of breath. Pneumonia is common, but not always present. Gastrointestinal symptoms, including diarrhoea, have also been reported.

If the illness persists, it can lead to respiratory failure which may necessitate the use of mechanical ventilation and immediate access to an intensive care unit.  

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How is it treated?

Cutting a long story short, there is no specific treatment available for the virus. Unlike SARS which has been actively researched and has several vaccines, including mRNA-based, MERS-CoV does not have a vaccine. Most of the times, the treatment is supportive and engineered based on the patient's medical condition. 

"Supportive treatment with extracorporeal membrane oxygenation and dialysis is often required in patients with organ failure. Antivirals with potent in vitro activities include neutralising monoclonal antibodies, antiviral peptides, interferons, mycophenolic acid, and lopinavir," CMR stated in a study.  

What precautions to take? 

As a thumb rule, one should avoid visiting places with animals and that includes farms, markets, and barns, especially where dromedary camels are present.

However, if one does end up being present in such places, one should practice general hygiene measures, including thorough hand washing, before and after touching animals. Contact with sick animals should be avoided at all costs. 

How many cases have been recorded?

MERS-CoV cases have been detected in 27 countries since 2012, according to WHO figures. During this time, a total of 2,605 cases and 936 associated deaths have been reported, the data showed. 

WHO estimates that 35 per cent of patients with MERS-CoV may have died since its discovery. After the discovery of the case in UAE where the patient did not have any co-morbidities, the WHO has notified member states to maintain strong surveillance of the virus for any potential epidemic. 

(With inputs from agencies)

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