Middle Eastern Respiratory Syndrome - Coronavirus (MERS-CoV) infection management and control

  • Middle Eastern Respiratory Syndrome is a viral respiratory disease caused by a coronavirus that first emerged in humans in September 2012; MERS-CoV.
  • MERS-CoV is a zoonotic disease, which means it is transmitted from animals to humans. Human to human transmission has occurred in healthcare facilities, among family members and co-workers of those who are infected.
  • The likely reservoir is the dromedary camel, and all known cases are associated with countries on or near the Arabian Peninsula.
  • Most cases of MERS-CoV infections have had contact with camels or camel products, such as camel milk or meat.

Symptoms

Symptoms of MERS-CoV range from asymptomatic or mild respiratory symptoms through to severe acute lower respiratory distress and multi-organ failure. Patients typically present with:

  • fever, cough, and shortness of breath
  • myalgia and chills
  • less commonly with symptoms including nausea, vomiting, diarrhoea, sore throat, and arthralgia.

Those who are older or have chronic disease, such as renal or cardiovascular disease, cancer, or chronic lung disease may be at higher risk of developing severe disease.

Early symptoms of the disease may be difficult to distinguish from other acute respiratory infections.

Transmission

Most cases of MERS are zoonotic, meaning transmission from the host animal to humans.

While direct contact with dromedary camels or their products has been strongly associated with cases, there have been clusters of cases with no known exposure to camels.

Cases where human to human transmission have occurred have been in situations where there is close contact with infected cases, such as caring for infected patients in healthcare settings. It is not known if the mode of transmission was via respiratory droplets, direct contact or via fomites. Mucous membrane inoculation and enteric routes are possible transmission pathways in human-to-human spread.

For more information about MERS-CoV please see Middle East respiratory syndrome information by the Australian Government Department of Health and Aged Care.

Infection control

Patients who present with acute respiratory symptoms should always be triaged as high priority and isolated using the recommended precautions as per the Queensland Health Acute Respiratory Illness – Infection prevention and control guideline and the Australian Guidelines for the Prevention and Control of Infection in Healthcare. Assessment should always include travel history. Where a history of travel to the Middle East or other region where MERS-CoV has known recent infections, it should be considered a possible diagnosis.

For more information about MERS and and MERS-CoV please see The Commonwealth Department of Health information for healthcare professionals.

Notification

MERS-CoV is a notifiable condition under the Public Health Regulation (2018). It is notifiable upon:

  • pathological request
  • provisional diagnosis
  • pathology diagnosis.

It is also a controlled notifiable condition.

For more information about notifications, case definitions and other notification resources, please see the Communicable disease control guidance – Middle East Respiratory Syndrome Coronavirus (MERS-CoV): http://disease-control.health.qld.gov.au/Condition/762/middle-east-respiratory-syndrome-coronavirus

Public Health Units https://www.health.qld.gov.au/system-governance/contact-us/contact/public-health-units/default.asp

Public Health Regulation (2018) https://www.legislation.qld.gov.au/view/html/inforce/current/sl-2018-0117

Cleaning

Where possible, single use, single patient use or equipment dedicated to the patient for the length of their stay should be used. Where this is not possible, reusable equipment should be cleaned using a TGA approved disinfectant that is appropriate for the equipment.

Environmental cleaning should be carried out routinely and on discharge of a patient from the environment.

For more information about cleaning please refer to local cleaning policies, and section 3.1.3 and 3.1.4 of the Australian guidelines for the prevention and control of infection in healthcare (2019): https://app.magicapp.org/app#/guideline/6572

More Resources

Communicable Diseases Network Australia guidelines: http://www.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-mers-cov.htm

Information on how to manage a suspected MERS case in a hospital setting: https://www.health.gov.au/resources/publications/information-about-mers-for-health-professionals

Information on managing a suspected MERS case in a general practice: https://www.health.gov.au/resources/publications/information-about-mers-for-health-professionals

Centers for Disease Control and Prevention (USA) resources for MERS: https://www.cdc.gov/coronavirus/mers/index.html

World Health Organization MERS resources: https://www.who.int/news-room/fact-sheets/detail/middle-east-respiratory-syndrome-coronavirus-(mers-cov)

Last updated: 1 November 2023