MERS-CoV (Middle East Respiratory Syndrome Coronavirus) is a virus that appeared for the first time in Saudi Arabia in April 2012. Highly similar viruses have been found in bats, which may be the natural reservoir, although the dromedary is thought to be the intermediate host responsible for introduction into the human population.
Occasional transmissions to humans probably occurred during contact with dromedaries or via the consumption of raw camel’s milk. Person-to-person transmission occurs during close physical contact, via respiratory secretions.
The virus multiplies primarily in the lower respiratory tract, causing fever, a cough, breathing difficulties and sometimes gastro-intestinal problems. Diagnosis may be delayed by the non-specific nature of these symptoms, particularly in countries seeing this type of virus for the first time.
The incubation period is between 5 and 15 days. In Middle Eastern countries in which people are frequently in contact with dromedaries, some people may carry the virus without presenting symptoms.
MERS-CoV may be fatal in patients weakened by pre-existing pathologies, such as diabetes, renal failure, chronic pulmonary infection, or in those who are immunodepressed. The mortality rate is estimated at around 30%.
MERS-CoV was identified for the first time in humans in Saudi Arabia in April 2012. Cases or outbreaks were subsequently reported in several countries throughout the Middle East. Since then there have been 1,219 cases, resulting in 449 deaths. Several cases have been reported in Europe, including two in France in 2013. The two cases were appropriately isolated at the University Hospital in Lille, thus preventing the virus from spreading.
In South Korea, the first confirmed case of MERS-CoV was recorded on May 20, 2015, in a patient returning from the Middle East. This case directly or indirectly contaminated over a hundred people in the hospitals in which it was treated. The fact that a large number of people pass through care institutions has exacerbated transmission. As of June 16, 2015, no case has been declared outside the hospital environment.
Treatment and prevention
To date no specific treatment is available to fight MERS-CoV. Patient care focuses solely on symptom relief.
In terms of prevention, and in the absence of a vaccine, it is advisable to avoid close contact with infected people in the Middle East, to avoid contact with dromedaries and their secretions and to refrain from consuming camel products (milk and meat). Elementary hygiene rules, such as regular hand washing, should also be observed.
The Institut Pasteur International Network
Institut Pasteur Korea
With the agreement of the Korean government, Institut Pasteur Korea uses screening technologies in its high security laboratories to test existing therapeutic molecules already approved by the health authorities. Institut Pasteur Korea has a laboratory specializing in respiratory viruses, and can also call upon the expertise of the Pasteur Research Pole in Hong Kong. In addition, Institut Pasteur Korea is able to work in collaboration with the Institut Pasteur in Paris, whose scientists already have relevant expertise, particularly in sequencing the virus. Institut Pasteur in Korea stands ready to work in collaboration with WHO and other international partners.
At the Institut Pasteur
Pasteur Center for Global Health (CGH)
The Center for Global Health, headed by Prof. Arnaud Fontanet and launched in September 2014, aims at strengthening the Institut Pasteur International Network’s global health activities implemented around the world. By observing a wide range of human populations, vectors and pathogens in highly diverse environments, the CGH aims at improving the knowledge of infectious diseases and developing field-adapted solutions to improve the health of populations worldwide.
The CGH has three main axes of intervention: research, training and outbreak investigation.
The CGH outbreak investigation task force
The international outbreak investigation task force gathers scientists of different disciplines spread around the world to respond to and investigate infectious disease outbreaks. The task force utilizes Institut Pasteur’s expertise and members are deployed at an early stage of an infectious disease outbreak upon request from national authorities and international organizations. Members of the outbreak investigation task force are deployed to rapidly respond to infectious disease outbreaks and carry out research into epidemics.
During an outbreak, the role of the outbreak investigation task force is to support local governments during infectious disease outbreaks, to coordinate the collection and analysis of microbiological and epidemiological data as early as possible and to pave the way for ambitious research projects that will support the management of health crises and the development of future strategies for prevention. The task force also develops epidemiological, basic and translational research on emerging pathogens.
Recently, the task force has been deployed to Sierra Leone for Ebola, to Saudi Arabia for MERS-CoV and for the recent MERS-CoV outbreak in Korea.
Molecular Genetics of RNA Viruses Unit
The Molecular Genetics of RNA Viruses Unit at the Institut Pasteur, led by Sylvie van der Werf, intervenes at the request of the health authorities to assist in the epidemiological and virological monitoring of new respiratory viruses in France. Samples are sent to the unit’s scientists, who then carry out diagnostic procedures.
Laboratory for Urgent Response to Biological Threats
The Laboratory for Urgent Response to Biological Threats (CIBU - in french) at the Institut Pasteur is led by Jean-Claude Manuguerra. The CIBU operates 24/7 and was set up towards the end of 2002 on the initiative of the French General Directorate of Health and the Institut Pasteur. It was designed to react immediately in real time in the event of an epidemic, to detect and identify the causative pathogenic agent(s) as early as possible.
Since 2012, when the virus made its appearance, the CIBU has intervened both on a national level, alongside the Molecular Genetics of RNA Viruses Unit, and on an international level in the fight against the MERS-CoV epidemic. The scientists are asked to diagnose suspected cases in France and also in countries that are not equipped to perform this type of testing. The CIBU is also called upon by WHO to perform diagnostic activities.
Over the longer term, the scientists are studying developments in respiratory viruses that render them transmissible to humans from their natural reservoir in animals.