Fullest clinical report of Saudi MERS points to important differences with SARS cases to date

July 25, 2013

The new research, published in The Lancet Infectious Diseases, also reveals some important differences with severe acute respiratory syndrome (SARS).

MERS emerged a year ago in Saudi Arabia and almost all those infected have been reported there, or have been linked to people who contracted the virus there.

The new analysis, the largest case series to date, includes 47 cases (46 adults, 1 child) of confirmed MERS infections from Saudi Arabia between Sept 1, 2012, and June 15, 2013.

By combining clinical records, laboratory results, and imaging findings with demographic data, the authors noted a trend of older patients, more men, and patients with underlying medical conditions who succumb to the disease.

As with SARS, MERS infections presented with a wide spectrum of symptoms. Most patients admitted to hospital exhibited fever (98%), chills/rigors (87%), cough (83%), shortness of breath (72%), and (32%). A quarter of patients also experienced , including diarrhoea and vomiting.

However, in contrast to SARS, the majority of cases (96%) occurred in people with underlying chronic medical conditions including diabetes (68%), high blood pressure (34%), (28%), and chronic renal disease (49%).

"Despite sharing some clinical similarities with SARS (eg, fever, cough, incubation period), there are also some important differences such as the rapid progression to respiratory failure, up to 5 days earlier than SARS"*, explains Professor Ziad Memish, the Deputy Minister for Public Health from the Kingdom of Saudi Arabia, who led the research.

"In contrast to SARS, which was much more infectious especially in healthcare settings and affected the healthier and the younger age group, MERS appears to be more deadly with 60% of patients with co-existing dying, compared with the 1% toll of SARS. Although this high mortality rate with MERS is probably spurious due to the fact that we are only picking up severe cases and missing a significant number of milder or asymptomatic cases, so far there is little to indicate that MERS will follow a similar path to SARS."

According to co-author Professor Ali Zumla from University College London, "The recent identification of milder or asymptomatic cases of MERS in health care workers, children, and family members of contacts of MERS cases indicates that we are only reporting the tip of the iceberg of severe cases and there is a spectrum of milder clinical disease which requires urgent definition. Ultimately the key will be to identify the source of MERS infection, predisposing factors for susceptibility to infection, and the predictive factors for poor outcome. Meanwhile infection control measures within hospitals seem to work."

Writing in a linked Comment, Professor Christian Drosten from the University of Bonn Medical Centre in Germany points to the urgent need for accurate diagnostic tests to help focus control efforts and minimise the risk of spread to others, "To ascertain relevant data for MERS epidemiology, we need to develop serological assays using samples from well defined groups of patients, such as described here. Population-based antibody testing could establish the extent of MERS-CoV infection, instead of only seeing the tip of the iceberg represented by admitted, such as those summarised in this important paper."

Explore further: France reports new suspected cases of MERS virus

More information: The Lancet Infectious Diseases www.thelancet.com/journals/laninf/article/PIISS1473-3099(13)70204-4/abstract

Related Stories

France reports new suspected cases of MERS virus

June 11, 2013

French medical authorities on Tuesday reported two new suspected cases of infection with the SARS-like virus MERS which has killed more than 30 people worldwide, the bulk of them in Saudi Arabia.

France says new suspected cases of MERS virus

June 12, 2013

France's health ministry said Wednesday that a man suspected of having contracted MERS had tested negative for the SARS-like virus which has killed more than 30 people, mostly in Saudi Arabia.

MERS virus in Saudi poses hospital threat: study

June 20, 2013

The deadly MERS coronavirus which has emerged in Saudi Arabia poses a threat to hospitals because it spreads rapidly and carries a high mortality rate, according to a study out Thursday.

Saudi declares new death from MERS virus

June 24, 2013

A Saudi man has died from the MERS virus, bringing the kingdom's death toll from the SARS-like infection to 34, the ministry of health said on Monday.

Two new MERS deaths in Saudi: ministry

July 7, 2013

A Saudi man and a child have died from the MERS virus, bringing the number of deaths from the respiratory infection in the kingdom to 38, the health ministry said on Sunday.

Recommended for you

The 'love hormone' may quiet tinnitus

September 23, 2016

(HealthDay)—People suffering from chronic ringing in the ears—called tinnitus—may find some relief by spraying the hormone oxytocin in their nose, a small initial study by Brazilian researchers suggests.

Bile acid uptake inhibitor prevents NASH / fatty liver in mice

September 21, 2016

Drugs that interfere with bile acid recycling can prevent several aspects of NASH (nonalcoholic steatohepatitis) in mice fed a high-fat diet, scientists from Emory University School of Medicine and Children's Healthcare of ...

Arthritis drug may help with type of hair loss

September 22, 2016

(HealthDay)—For people who suffer from a condition that causes disfiguring hair loss, a drug used for rheumatoid arthritis might regrow their hair, a new, small study suggests.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.