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MERS - Middle East Respiratory Syndrome

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What is MERS?

MERS, which stands for Middle East Respiratory Syndrome, is an infection of our respiratory system by the Middle East Respiratory Syndrome coronavirus (MERS-CoV). Coronaviruses in general are one of the viruses that are cause the common cold, but may cause more serious disease, e.g. Severe Acute Respiratory Syndrome (SARS) and MERS.

First reported in Saudi Arabia in September 2012, MERS has since been detected in China, Malaysia, the Philippines, the Republic of Korea and also the United States. The majority of these cases have occurred so far in Saudi Arabia, but the largest known outbreak outside the Arabian Peninsula has been in Republic of Korea.

What is the source of MERS-CoV?

MERS-CoV most likely originated from an animal source. It has been found in camels in several countries.  It is not yet fully understood how people become infected with MER-CoV, but indirect or direct contact with infected camels in the Middle East may be a cause.

What are the symptoms of MERS in human?

Typically, a person will exhibit fever, cough, and/or shortness of breath. Pneumonia is commonly associated and diagnosed on examination or with a chest X-ray. Occasionally,  gastrointestinal symptoms including diarrhoea have also been reported.

Severe illness can result in respiratory failure that requires mechanical ventilation and support in an intensive-care unit. Some patients also have organ failure, like kidney failure or septic shock. The virus appears to be more devastating in people with weakened immune systems, older people and those with chronic diseases such as diabetes, cancer and chronic lung disease. About slightly more than a third of reported patients with MERS have died.

Occasionally, a person infected with MERS may also appear fine with no symptoms (reports of people tested for MER-CoV during follow-up studies of contact of people with MERS appear asymptomatic).

How does the virus spread in humans?

MERS-CoV is contagious, but only to a limited extent. Like other coronavirus that causes colds, it is thought to spread through respiratory secretions like coughing.  However, the virus does not seem to pass easily from person to person unless there is close contact*. An example is family members or health care workers providing care to an infected patient. The majority of cases that resulted in human-to-human transmission are in the health care setting when strict hygiene measures are  neglected.

How can an infection with MERS be prevented?

There is no  vaccine currently available to prevent MERS infection. Practicing  good hygiene is very important.  

·       Wash your hands regularly with soap and water, for 20 seconds. Use a alcohol-based hand sanitizer if you have no access to water and soap.

·        Avoid close contact with sick people, or with people if you are sick.

·       Avoid touching your eyes, nose and mouth with unwashed hands.

·       Cover your mouth with a tissue or your sleeve when coughing or sneezing.

·       Avoid personal close contact, such as kissing, sharing cups or eating utensils with sick people.

·       See a doctor if you have a fever >38 degrees Celsius, cough or breathing difficulty. Inform them of your recent travel history.

For people at high risk for severe MERS (people with weakened immune systems, diabetes, kidney failure or chronic lung diseases) should see their doctors to get their regular immunizations updated (e.g. influenza and pneumococcal vaccines), and take additional precautions while traveling – avoid contacts with camels, consuming raw camel milk or camel meat.

How can the MERS infection in human be treated?

There is no specific antiviral treatment recommended. Patients with suspected MERS should seek immediate medical evaluation for diagnosis and prevention of further spread. For severe cases, treatment include supportive care for the function of vital organs (e.g. blood pressure, lung support).

Is is still safe to travel?

Currently there is no trade, travel restriction or special screenings at point of entries recommendation by the World Health Organisation (WHO).

The Centres for Disease Control and Prevention (CDC) currently do not recommend change of travel plans to Republic of Korea or the Arabian Peninsula because of MERS. Travellers are reminded to practice good hygiene measures in Republic of Korea or in the Arabian Peninsula. 

Ensure you are up-to-date with all your vaccination shots at least 4-6 weeks before travel.

*Close contact defined as within 2 metres or within the room for a prolonged period of time, while not wearing recommended personal protective equipment (gowns, gloves, respirator, eye protection) OR having direct contact with infectious secretions (being coughed on) while not wearing recommended personal protective equipment according to the CDC website.



Frequently Asked Questions on MERS. Extracted 5-7-2015. Updated 12-6-2015.

Middle East Respiratory Syndrome (MERS). About MERS. Extracted 5-7-2015. Updated 5-6-2015.

Frequently Asked Questions and Answers about MERS. Extracted 5-7-2015, updated 29-6-2015.


Prepared by the Pharmaceutical Society of Singapore Community Pharmacy Chapter. (Updated 15 Sept 2015)


We would like to thank Dr Shawn Vasoo (Associate Consultant, Dept of Infectious Diseases, Tan Tock Seng Hospital) for reviewing this article.