Medicines for Middle East respiratory syndrome (MERS)

What it is

Middle East respiratory syndrome (MERS) is a respiratory illness caused by a coronavirus (MERS-CoV). It is rare but can be serious, and can cause severe illness and, in some cases, be fatal. MERS occurs mainly in and around the Arabian Peninsula (countries in the Middle East), and cases elsewhere have usually been linked to travel to that region. The virus is thought to spread to people from animals — particularly camels (dromedary camels), which can carry the virus — for example through close contact with infected camels or their products (such as unpasteurised camel milk); it can also spread from person to person, but this generally requires close contact, and has particularly occurred in healthcare settings and among close contacts and family members of infected people, rather than spreading easily in the general community. The symptoms of MERS can range from mild to severe, and many are respiratory: they can include fever, cough, and shortness of breath, and can progress to more severe illness, including pneumonia and breathing difficulties, particularly in people who are older or have other health conditions or weakened immune systems, who are more at risk of severe illness; some people may have milder illness or few symptoms. Because MERS is rare, occurs mainly in a specific region, and usually requires close contact to spread, the risk to most people — including most travellers — is low. For travellers to the Arabian Peninsula, the main relevance is awareness and taking sensible precautions to reduce the already low risk — such as avoiding close contact with camels, not consuming raw or unpasteurised camel products, practising good hand hygiene, and following any public health advice. There is no specific antiviral cure for MERS, so treatment of the serious cases is supportive care in hospital. Anyone who develops a fever and respiratory symptoms after travel to an affected area, particularly with relevant exposure, should seek medical advice and mention the travel. The key messages are that MERS is a rare but serious viral respiratory illness occurring mainly in and around the Arabian Peninsula (linked to camels), that the risk to most travellers is low, and that sensible precautions reduce it.

How it is treated

The approach to MERS centres on awareness and precautions for travellers to affected areas (to reduce the already low risk), and, for the rare cases, medical assessment and supportive care with infection-control measures; there is no specific antiviral cure. For most people, the practical relevance of MERS is awareness, as it is rare, occurs mainly in and around the Arabian Peninsula, and usually requires close contact to spread, so the risk to most people, including most travellers, is low. For travellers to affected areas, sensible precautions reduce the already low risk, and it is worth following travel and public health advice — measures include: avoiding close contact with camels (particularly for people who are older or have health conditions, who are more at risk of severe illness if infected); not consuming raw or unpasteurised camel milk or undercooked camel meat or products; practising good hand hygiene (washing hands regularly, especially after contact with animals); and general measures such as good respiratory and hand hygiene; travellers who are at higher risk of severe illness may be advised to take particular care. Anyone who develops a fever and respiratory symptoms (such as cough or shortness of breath) after travel to an affected area — particularly with relevant exposure (such as contact with camels or an unwell person) — should seek medical advice, mention the travel and exposure, and follow the advice given, as this is important for assessment and to protect others; anyone who is seriously unwell should seek urgent care. There is no specific antiviral treatment for MERS, so for the cases that occur, treatment is supportive — managing the symptoms and, for severe illness (such as pneumonia and breathing difficulties), supporting the person’s breathing and other body functions in hospital (which may include intensive care), while the illness runs its course; strict infection-control measures are used to prevent spread, particularly in healthcare settings, where transmission has notably occurred. Public health authorities monitor MERS and provide up-to-date advice, and respond to any cases. The reassuring messages are that MERS is rare and geographically limited (mainly in and around the Arabian Peninsula), that the risk to most travellers is low, that sensible precautions (avoiding close contact with camels, not consuming raw camel products, and good hygiene) reduce it, and that the rare cases are managed with supportive care and infection-control measures; so awareness, following travel and public health advice, taking precautions in affected areas, and — for anyone unwell after relevant travel — seeking medical advice and mentioning the travel are the key points for the public.