MERS-coronavirus: From discovery to intervention

Widagdo, W.; Okba, Nisreen M.A.; Stalin Raj, V.; Haagmans, Bart L.

During the SARS-CoV outbreak in Hong Kong, active surveillance followed by proper quarantine measures was shown to be highly effective in limiting the spread of the virus to other susceptible individuals [4] . One important factor that helped to contain the outbreak relates to the fact that the virus rarely causes subclinical infection and virus excretion peaked approximately 10 days after the onset of symptoms, allowing successful containment when SARS patients are diagnosed early after disease onset [4, 49, 50] . Recent data from the MERS-CoV outbreak in South Korea also showed that viral shedding in severe cases peaked in the second week after the onset of disease [51] . Therefore, similar to SARS, rapid identification of MERS-CoV patients, followed by proper quarantine measures, should be sufficient to significantly limit the spread of the virus, especially in hospital settings where most MERS outbreaks occur. Indeed, this strategy has been reported to be useful in controlling the MERS-CoV outbreak in South Korea [37] . Most likely, such approaches had not been properly applied in the earlier outbreaks in Saudi Arabia. The fact that more recent MERS cases reported in 2016 from this region mostly seem to be restricted to primary cases with a history of camel contact but less to nosocomial outbreaks may indicate that more effective control measures have been implemented to contain the spread of the virus.