Intended for healthcare professionals


Middle East respiratory syndrome

BMJ 2016; 355 doi: (Published 12 October 2016) Cite this as: BMJ 2016;355:i5281
  1. Sarah Shalhoub, infectious diseases consultant1,
  2. Ali S Omrani, adult infectious diseases consultant2
  1. 1King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
  2. 2King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
  1. Correspondence to: S Shalhoub sarah.shalhoub{at}

What you need to know

  • Consider Middle East respiratory syndrome (MERS) when a severe respiratory illness occurs in the two weeks after residence in or travel to the Middle East or areas of outbreak, or close contact with infected individuals

  • Most cases are the result of human-to-human transmission, with peaks of confirmed cases occurring during nosocomial outbreaks

  • Clinical presentation ranges from asymptomatic to severe, rapidly progressive, potentially fatal pneumonia

  • Confirmation of infection requires specialised laboratory testing including real-time reverse transcription polymerase chain reaction (RT-PCR) on respiratory samples

  • Treatment is supportive, but promising virus-specific therapies are under investigation

Middle East respiratory syndrome (MERS) is an acute viral respiratory tract infection caused by the novel betacoronavirus Middle East respiratory syndrome coronavirus (MERS-CoV) (fig 1). Cases have been limited to the Arabian Peninsula and its surrounding countries (fig 2), and to travellers from the Middle East or their contacts. The clinical spectrum of infection varies from no symptoms or mild respiratory symptoms to severe, rapidly progressive pneumonia, acute respiratory distress syndrome, septic shock, or multiorgan failure resulting in death.

Fig 1 Electron micrograph of Middle East respiratory syndrome coronavirus (MERS-CoV)

Fig 2 Countries with confirmed cases of Middle East respiratory syndrome (MERS) 2012-16. (Adapted from World Health Organization (WHO)1)

Who gets it?

Ninety eight percent of cases have been reported in adults (defined as age >14 years).2 Although infection has been reported in different age groups within the adult population, the median age of patients ranges from 50 to 67 years.3 4 5 Age ≥50 years is associated with a higher risk of mortality.6 7 Over 65% of cases reported have been in men.8 Infection in children is rare, although the reason for this is unknown.9 10

The majority of reported cases are a result of human-to-human transmission rather than camel-to-human transmission. …

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