MERS-coronavirus: From discovery to intervention

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

Coronaviruses (CoV) are known to cause mild upper respiratory tract infections in humans. This paradigm was challenged when severe acute respiratory syndrome (SARS)-CoV emerged in 2002. SARS-CoV causes mainly lower respiratory tract infections, such as bronchitis and pneumonia. Approximately 10% of SARS-CoV patients developed severe complications and succumbed to this disease. This virus originated from bats and was transmitted to humans through civet cats, highlighting its zoonotic capacity. It spread worldwide and infected 8000 individuals within a year, but was fortunately contained in 2003. There is currently no evidence of SARS-CoV circulating in the human population [1] . However, a SARS-like CoV that is able to directly infect human cells has been recently identified in horseshoe bats in China [2] ; therefore, continuous surveillance for these viruses remains necessary. A decade after the SARS-CoV epidemic, another novel CoV was isolated from a 60-year-old Saudi Arabian man who presented with acute pneumonia. He subsequently developed acute respiratory distress syndrome and renal failure with a fatal outcome [3] . This virus, later called the Middle East respiratory syndrome (MERS)-CoV, attracted public interest due to its resemblance to SARS-CoV. So far, at least 1800 individuals have been infected with an~35% fatality rate. Different from SARS, some individuals infected by MERS-CoV remain asymptomatic or develop only mild clinical manifestations [4, 5] . Efforts to develop effective preventive and therapeutic intervention strategies are One Health 3 (2017) [11] [12] [13] [14] [15] [16] currently ongoing. Current interventions are mainly based on setting up surveillance studies and public health measures that include patient isolation and quarantine [1] . Although these actions resulted in successful containment of the SARS outbreak, MERS-CoV still remains a problem, mainly in the Arabian Peninsula. The widespread circulation of MERS-CoV in dromedary camels is most likely the driving force of these outbreaks as novel zoonotic introductions of MERS-CoV may occur frequently. Therefore, different intervention approaches may be necessary to treat MERS patients, control zoonotic and nosocomial transmission. Here we describe the affected groups in the ongoing MERS-CoV outbreak and how distinct intervention strategies for each of them may curb the spread of the virus.