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The Middle East respiratory syndrome corona virus (MERS-CoV) is a novel corona virus (nCoV) first reported on 24 September 2012 on by Egyptian virologist Dr. Ali Mohamed Zaki in Jeddah, Saudi Arabia. He isolated and identified a previously unknown corona virus from the lungs of a 60-year-old male patient with acute pneumonia and acute renal failure.MERS-CoV is the sixth new type of corona virus like SARS but still distinct from it and from the common-cold corona virus. Until 23 May 2013, MERS-CoV had frequently been referred to as a SARS-like virus, or simply the novel corona virus, and colloquially on message boards as "Saudi SARS". The virus MERS-CoV belongs to the genus Betacoronavirus, as does SARS-CoV.
Origin It is not yet known if the infections are the result of a single zoonotic event with subsequent human-to-human transmission, or if the multiple geographic sites of infection represent multiple zoonotic events from a common unknown source. Among animal reservoirs, CoV has a large genetic diversity yet the samples from patients suggest a similar genome, and therefore common source, though the data are limited. It has been determined through molecular clock analysis, that virus from the EMC/2012 and England/Qatar/2012 date to early 2011 suggesting that these cases are descended from a single zoonotic event. It would appear the MERS-CoV has been circulating in the human population for greater than one year without detection and suggests independent transmission from an unknown source.
History of occurrence of Disease:
On 21 February 2013, WHO stated that there had been 13 laboratory-confirmed cases, 6 cases (4 fatal) from Saudi Arabia, 2 cases (both fatal) from Jordan, 2 cases from Qatar, and 3 from the UK. Most infections with human corona viruses are mild and associated with common colds. Some animal and human corona viruses, like MERSCoV, may cause severe and sometimes fatal infections in humans. MERS-CoV does not have many of the grave characteristics of SARS-CoV (severe acute respiratory syndrome) which caused fatal epidemics in southern China, Hong Kong and Canada in 2002 and 2003.[Fortunately, global surveillance of potential epidemics and preparation has improved since and because of the SARS epidemic. In November 2012, Dr. Zaki sent a virus sample to confirm his findings to EMC virologist Ron Fouchier, a leading corona virus researcher at the Erasmus Medical Center in Rotterdam. The second laboratory-proven case was in London confirmed by the UK Health protection Agency. The Health protection Agency named the virus the London1_novel CoV 2012.On 8 November 2012 in an article published in the New England Journal of Medicine Dr. Zaki and co-authors from the Erasmus Medical Center, published more
details, including a scientific name, Human Corona virus-Erasmus Medical Center (HCoV-EMC) which was then used in scientific literature. In the article, they noted four respiratory human corona viruses (HCoV) known to be endemic: 229E, OC43, NL63, and HKU1.In May 2013, the Corona virus Study Group of the International Committee on Taxonomy of Viruses adopted the official designation, the Middle East Respiratory Syndrome Corona virus (MERS-CoV),which was adopted by the World Health Organization to "provide uniformity and facilitate communication about the disease" to replace the unscientific designations Novel corona virus 2012 or simply 'novel corona virus' which were consistently used by WHO since 2012.10 of the 22 people who died and 22 of 44 cases reported were in Saudi Arabia and over 80% were male. This gender disparity is thought to be because most women in Saudi Arabia wear veils that cover the mouth and nose, decreasing their chances of being exposed to the virus. As of 19 June 2013, MERS has infected at least 60 people with cases reported in Jordan, Qatar, Saudi Arabia, the United Arab Emirates (UAE), Tunisia, Germany, the United Kingdom (UK), France and Italy. The death toll had risen to 38. Saudi officials have expressed great concern that when the Hajj, or pilgrimage to Mecca, occurs this Autumn, millions of Muslims from around the world may potentially be exposed to the virus from being in crowded streets around the Kaaba. MERS cases and deaths, April 2012 – present. Country or Region France Italy Jordan Qatar Saudi Arabia Tunisia UAE UK Total Source: CDC Natural reservoir. In September 2012, Ron Fouchier speculated that the virus might be an animal origin originating in bats. Sequencing and subsequent analysis indicated that the novel corona virus shared high sequence homology with both bat and porcine corona viruses, the highest of which were bat corona viruses HKU4 and HKU5 (about 94% similarity; carried by the genus Pipistrellus).An article published in the Emerging Infectious Disease Journal in March 2013 identified bat corona viruses carried by the genus Pipistrellus that differed from MERS-CoV by as little as 1.8%. There are several species of Pipistrellus in the Arabian Peninsula. The high potential for use of cavederived water and bat guano strongly suggests that they may be the pre-crossover Cases 2 3 2 2 71 2 6 3 91 Deaths 1 0 2 1 39 0 1 2 46 Fatality (%) 50(%) 0(%) 100(%) 50(%) 54(%) 0(%) 17(%) 67(%) 50(%)
zoonotic reservoir. Zoonoses are an infectious disease that is transmitted between species. In the same study it was shown that MERS-CoV was capable of infecting bat and porcine cell lines in addition to human cells. This property would indicate a low barrier for transmission between hosts. On July 22, 2013, the World Organization for Animal Health (OIE) announced that "currently there is no strong evidence to suggest that camels are a source of infection for human cases of Middle East respiratory syndrome. Transmission. On 13 February 2013, WHO stated "the risk of sustained person-to-person transmission appears to be very low. There are four groupings of the corona viruses: alpha, beta, gamma and delta. Bat corona viruses are the gene pool for Group 1 or Alphacoronaviruses and Group 2 or Betacoronavirus. Avian corona viruses are the gene pool for Group 3 or Gammacoronaviruses and Deltacoronaviruses. To date, no known routine contact exists between humans and bats. There is speculation that an intermediate host is responsible for the sudden appearance of the virus in the human population. The European Centre for Disease Prevention and Control (ECDC), an independent agency of the European Union (EU) established in 2005 to strengthen Europe's defense against infectious diseases, is monitoring MERS-CoV. As of 29 May 2013, the World Health Organization is now warning that the MERS-CoV virus is a "threat to entire world. However, Dr. Anthony Fauci of the National Institutes of Health in Bethesda, Maryland stated that as of now MERS-CoV "does not spread in a sustained person to person way at all." Dr. Fauci stated that there is potential danger in that it is possible for the virus to mutate into a strain that does transmit from person to person. Signs and symptoms. Early reports compared the virus to severe acute respiratory syndrome, and it has been referred to as Saudi Arabia's SARS-like virus. Symptoms of MERS-CoV infection include renal failure and severe acute pneumonia, which often result in a fatal outcome. The first patient had a "7-day history of fever, cough, expectoration, and shortness of breath.MERS has an estimated incubation period of 12 days. Diagnosis: Several highly sensitive, confirmatory real-time RT-PCR assays exist for rapid identification of MERS-CoV from patient-derived samples (such as bronchoalveolar lavage or sputum): upE (targets elements upstream of the E gene) and 1A (targets the ORF1a gene). In addition, hemi-nested sequencing amplicons targeting RdRp (present in all corona viruses) and N gene (specific to MERS-CoV) fragments can be generated for confirmation via sequencing. Reports of potential polymorphisms in the N gene between isolates highlight the necessity for sequence-based characterization. Protocols for biologically safe immunofluorescence assays (IFA) have also been developed; however, antibodies against betacoronaviruses are known to cross-react
within the genus. This effectively limits their use to confirmatory applications. Although MERS-CoV has been shown to antagonize endogenous interferon production, treatment with exogenous types I and IIIIFN (IFN-α and IFN-λ, respectively) have effectively reduced viral replication in vitro. Prevention: It is believed that the existing SARS research may provide a useful template for developing vaccines and therapeutics against a MERS-CoV infection. Vaccine candidates based on the spike protein have been created by Novavax and Greffex, Inc, and are currently awaiting clinical trials. International scientists on Saturday warned India that the new SARS-like virus that has emerged in the Middle East could spread faster and wider during two international mass gatherings involving millions of people in the next few months. The MERS corona virus, which appears to have emerged in the Middle East in early 2012, has spread to several countries in Western Europe and North Africa where there have been localized clusters of cases. Worldwide about 80 cases have been confirmed, with a mortality rate of more than 50%.The team found that of the 16.8 million travelers who flew on commercial flights out of Saudi Arabia, Jordan, Qatar and the United Arab Emirates between June and November 2012 (the period starting one month before Ramzan and ending one month after the Haj), 51.6% had destinations in just eight countries India (16.3%), Egypt (10.4%), Pakistan (7.8%), Britain (4.3%), Kuwait (3.6%), Bangladesh (3.1%), Iran (3.1%) and Bahrain (2.9%). The first is Umrah, a pilgrimage that can be performed at any time of year but is considered particularly auspicious during the month of Ramadan, which this year began on July 9 and ends on August 7. The second is the Haj, a fiveday pilgrimage required of all physically and financially able Muslims at least once in their life. It takes place from October 13-18 this year and is expected to draw more than 3 million people. Collectively, India, Pakistan, Bangladesh, Afghanistan and Nepal represent the final destinations of nearly one-third of all international air travelers. Two cities from India Mumbai and Kozhikode were among the 12 like Cairo, Kuwait City, London, Bahrain, Beirut, Dhaka, Karachi, Manila, Istanbul and Jakarta that each received more than 350,000 commercial air travelers between June and November 2012 from the four countries where MERS cases have been traced back to. Many Nepalese migrant workers now working in the Middle East and other countries where this disease is being reported and daily hundreds and thousands workers migrate to this region for quest of job. They often travel back to home during their leave period or expiry of their work contract. There is likely introduction of this disease in Nepal. This is the only concern of public health workers. Hope Hajji Proceeding to Makka Madina will return safely.
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