MERS-coronavirus: From discovery to intervention

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

Despite current implementation of rapid diagnostic and public health measures, new MERS-CoV cases are still continuously being reported. This suggests that multiple interventions targeting different affected groups would be necessary to stop these outbreaks, as summarized in Fig. 1 . As described in this review, different intervention Fig. 1 . Animals and humans potentially involved in the MERS outbreak and the intervention strategies that would apply to these different groups. Bats have been suggested to be one of the natural hosts of MERS-CoV, however the evidence supporting transmission of this virus from bats to other species is currently lacking. On the other hand, MERS-CoV has been isolated from both camels and humans. A combined One Health approach may be needed in order to stop ongoing outbreaks of MERS-CoV. approaches may be needed to limit the MERS-CoV outbreaks by treating MERS-CoV patients and by controlling both zoonotic and nosocomial transmission. Prophylactic drugs would be appropriate to use when immediate protection is required to limit the spread of the virus, for example to protect health care workers and family members of MERS-CoV patients. Camel contacts that have higher chances of infection, on the other hand, may benefit from the long term protection induced by vaccines. Such vaccination could also be applied to the animal host of MERS-CoV which has close contact with humans, mainly dromedary camels, to limit zoonotic transmission. Effective treatment strategies for severe human MERS-CoV patients are the most problematic to implement. These MERS-CoV patients may require a cocktail treatment regimen consisting of potent antivirals, immunomodulatory agents and other supportive treatments to control disease progression and improve the prognosis of this severe lung infection. Although Type I IFN remains a promising treatment, its beneficial effect in severe and fatal MERS-CoV patients might be limited due to the timing of the drug administration as it has a narrow effective therapeutic window of opportunity [21] . Further efforts to better understand MERS-CoV pathogenesis are needed to identify viral and host factors that play a significant role in the progression of MERS in humans and offer potential novel treatment and intervention options.