The ‘Middle East Respiratory Syndrome coronavirus’ (MERS-CoV) is a fairly new type of coronavirus that was discovered in September 2012 and which may cause severe symptoms, in particular among people who suffer from underlying conditions. The virus owes its name to the region where it presented itself for the first time and where most cases have been found: the Middle East.

There has been an outbreak of the virus in the Middle East (Saudi Arabia, the United Arab Emirates, Qatar, Oman and Jordan). Since the discovery of the virus in 2012, worldwide over 600 patients (16 May 2014) with a laboratory-confirmed infection of MERS-CoV have been reported to the World Health Organization (WHO), 181 of whom have died. After having been infected, some people returned from the Middle East to Asia, Africa, Europe and America, where the diagnosis was determined. The MERS coronavirus has been diagnosed in two patients in the Netherlands. Since April 2014, there has been a strong increase in the number of confirmed cases in the Middle East, due to a continuous source of infections in the Middle East. In addition, doctors are now better able to recognise the clinical picture, as a result of which they are finding patients more often, and the disease has spread in hospitals where patients were admitted.
The MERS coronavirus is sometimes compared to the SARS virus; the SARS virus is also a coronavirus, however, MERS-CoV and the SARS virus are two different types of coronaviruses, each with their own characteristics.

Signs of disease

Many coronaviruses can cause respiratory infections in humans and animals. Usually these are simply symptoms of a cold. The MERS coronavirus is a special type of coronavirus that may present a more serious clinical picture with very severe respiratory symptoms, also referred to as Acute Respiratory Distress Syndrome (ARDS). Patients suffer from fever, coughing, shortness of breath and respiratory problems. Due to the seriousness of these symptoms, these people are admitted to hospital. Some patients suffer from diarrhoea. The clinical picture is less serious among healthy and younger people.

How do people get ill?

It is not entirely clear as yet how people contract the virus and a great deal of research is now being carried out. The virus is also found among dromedary camels in the Middle East. It is suspected that the virus is mainly transferred from these animals to people. Transfer from human to human is rare and usually occurs in hospital.

Travellers to the Middle East

The risk of travellers becoming ill is very low. No travel warning has been issued for the Middle East, but travellers should take hygienic measures, however, and avoid contact with sick people, animals (in particular dromedary camels) and animal waste. Eating or drinking raw animal products (such as dromedarie camel milk) is not recommended. Travellers to the Middle East who start coughing, experience shortness of breath, and fever or diarrhoea during their journey, or within two weeks after it, are advised to contact their GP. The usual travel recommendations for hygiene and for the Middle East can be found on the LCR website.

Notifiable diseases

Because the MERS coronavirus was discovered a relatively short time ago, there is limited information as to how the virus is spread. The government focuses on tracking all possible patients with the MERS coronavirus in the Netherlands as soon as possible to prevent any further spread of the virus. The MERS coronavirus has thus been included as a notifiable disease in group A for care providers in the hospital, meaning that a specialist in the hospital is obliged to immediately report a patient who is suspected of being contaminated with the MERS coronavirus to the Municipal Health Service.