IN THE NAME OF GOD

Qazvin university of medical science

Department of Immunology & Microbiology

JOURNAL CLUB & MSC SEMINAR

Present by : Sahar Amirkamali

Supervise by : Dr.M.Aslanimehr
BY:SAHAR AMIRKAMALI / DR.M.ASLANIMEHR 1
Coronavirus Classification

• Alpha
– human examples: hcov -229E, hcov -NL63
– pig, dog, and cat covs
• beta
– hcov -OC43, hcov -HKU1, hcov -SARS
– MHV, rat, pig and cow covs
– mers-cov
• gamma
– chicken and turkey covs
• delta
– bird covs
By:Sahar Amirkamali / Dr.M.Aslanimehr 2
 Coronaviruses (CoVs):

Features of Coronaviruses
Enveloped positive strand RNA
virushuman covs isolated in the
1960s.
six human covs (hcovs) have been
identified to date:
– hcov -229E
– hcov -OC43
– hcov -NL63
– hcov -HKU1
– sars-cov
– Middle east respiratory
syndrome
coronavirus (mers-cov)

By:Sahar Amirkamali / Dr.M.Aslanimehr 3

Non-sars Human Covs: Non-SARS Human CoVs:
Epidemiology Clinical Spectrum of
Illness

• Worldwide • Most often associated

• Winter and spring in with upper respiratory tract
temperate climates infections in children
• Exposure common in early • Pneumonia and lower
childhood tract infections in
• Droplet, contact, and immunocompromised
indirect contact individuals and the elderly
• Symptoms and viral loads • May play a role in
high first few days of illness exacerbations of underlying
• Incubation period 2–5 days respiratory diseases

By:Sahar Amirkamali / Dr.M.Aslanimehr 4

 Severe Acute Respiratory
Syndrome (SARS)
SARS
• First recognized Nov, 2002 as
sporadic cases in Guandong
province, China
• Outbreak period 2002–2003
• Hong Kong hotel contributed to
spread of virus to several
countries
• 8,098 probable SARS cases
–774 deaths (10%)
By:Sahar Amirkamali / Dr.M.Aslanimehr
Epidemiology
• incubation period 2-7 (max
10) days
• viral shedding peaks 6-10
days after onset of symptoms
• droplet spread
• less infectious than influenza
• Most transmission via close
contact with a symptomatic
person via large respiratory
droplets. Transmission by
fomites possible.
5
 Clinical course -
triphasic SARS - morbidity
Week 1
• fever, myalgia,
systemic symptoms • Most cases are in healthcare
that improve after a workers caring for SARS
few days
Week 2 patients and close family
• Fever returns, members of SARS patients
oxygen • overall mortality 15%
desaturation
• Later • mortality increases with age
• 20% get ARDS (> 65 years - 50% mortality)
needing ventilation
• children seem to develop
mild illness
By:Sahar Amirkamali / Dr.M.Aslanimehr 6
 SARS diagnosis
SARS - treatment
• Clinical findings of
an atypical
pneumonia not
attributed to other • Supportive
causes • avoid aerosol inducing
interventions
• PCR positive for SARS
• evidence base for anti-
CoV viral drugs lacking
• Seroconversion (gold • steroids may be helpful
standard)

By:Sahar Amirkamali / Dr.M.Aslanimehr 7

 Key points in
control of disease Personal
protective

• early case detection

• swift isolation
• Masks
• thorough control of infection
measures • Waterproof long
• vigorous identification and sleeved gowns
management of close contacts • Gloves
by home confinement
• public information for those at • Goggles
risk of infection • Centrally sourced
• education of health care and distributed
professionals

By:Sahar Amirkamali / Dr.M.Aslanimehr 8

By:Sahar Amirkamali / Dr.M.Aslanimehr 9
 Middle East Respiratory
Background Syndrome
• First identified in September, First Reported MERS-CoV Case
2012
• Cases retrospectively • 60 year-old man from Saudi Arabia
identified as early as March • 7 days of fever, cough, shortness of
2012 breath
• Different from other
coronaviruses in humans,
including SARS Second Case
• Most similar to • 49 year-old man from Qatar
coronaviruses found in bats –Recent travel to Saudi Arabia
–History of farm (camels and sheep) exposure
• 6 days of cough, myalgia and arthralgia
• Admitted to Qatari hospital with bilateral
pneumonia
• Transferred to London for respiratory and renal
By:Sahar Amirkamali / Dr.M.Aslanimehr 10
failure
 MERS-CoV
Origins

• Several studies have • Therefore , these people

identified mers-cov in high should avoid contact with
proportion of camels. camels,should not drink
• Until more is understood raw camel milk or camel
urine, and should not eat
about MERS, people with
meat that has not been
diabetes, renal failure,
properly cooked.
chronic lung disease, and
• Identical gene segment found
immunocompromised
in one bat.
persons are considered at
• Mode of transmission unclear
high risk of severe disease
–Respiratory? Foodborne?
from MERS-CoV infection. –Few primary cases with direct
camel contact
By:Sahar Amirkamali / Dr.M.Aslanimehr 11
 Clinical Transmission

• • Range of presentations* • (19% of all cases)

–62% severe respiratory illness –mostly healthcare
–5% mild symptoms workers–many
–21% asymptomatic
• Data from early cases
• with no or minor symptoms
–High mortality
–Lower respiratory tract • many clusters identified
illness, fever –healthcare
• Data from more recent cases –household (estimated 1.3%
–Lower mortality secondary attack rate)
–Higher proportion with upper
respiratory tract illness
• No vaccine, no specific
treatment

By:Sahar Amirkamali / Dr.M.Aslanimehr 12

 Epidemiology Current Status*

• 614 cases*
• Case demographics –181 deaths (29%)
–65% male • Majority of case in Saudi
–Median age 49 years (9 Arabia
months–94 years) • Other affected countries
• Incubation period 2–14 –United Arab Emirates,
days Qatar, Oman, Jordan,
• Infectious period Kuwait, Yemen, Lebanon
–Under investigation –UK, France, Turkey, Tunisia,
–Not believed contagious Italy, Greece, Malaysia,
before onset USA, Egypt, Netherlands

By:Sahar Amirkamali / Dr.M.Aslanimehr 13

 Infection Control Environmental
Infection Control
• • Healthcare settings • Follow standard
–Contact, droplet and procedures, per hospital
airborne isolation policy and manufacturers’
• Gowns, gloves and eye instructions, for cleaning
protection and/or disinfection of:
• Negative-pressure • – Environmental surfaces
airborne infection isolation and equipment
–Surgical mask when out of
room • – Textiles and laundry
• Home • – Food utensils and
–Follow guidance for ill dishware
persons, care givers and
close contacts
By:Sahar Amirkamali / Dr.M.Aslanimehr 14
 Laboratory Testing Approach to Serology
• • Lower respiratory • • Identify and generate
specimens (sputum, candidate cov antigens
bronchoalveolar lavage, – using proteins from
endotracheal) are a priority similar bat viruses
respiratory specimen for RT • develop ELISA-based
-PCR testing. assay
• Respiratory (lower and • evaluate assay with an
upper tracts), stool, and extensive panel of negative
serum specimens. (specificity) and positive
• Specimen collection at sera (sensitivity)
different times.

By:Sahar Amirkamali / Dr.M.Aslanimehr 15

 Therapeutics
Vaccines

.MERS CoV: Interferon alpha

2b + ribavirin in vitro1.
.SARS vaccines were in
.Recent study in Macaque
development
monkeys2.
.No clear data on human
.Possible MERS vaccines:
treatment .
VLP/nanoparticles with S
protein
. Individuals with MERS can
seek medical care to help
.Constitutive expression of S
relieve symptoms
protein in cell culture
Developmental stages
. For severe cases, current
treatment includes care to
support vital organ functions

By:Sahar Amirkamali / Dr.M.Aslanimehr 16

By:Sahar Amirkamali / Dr.M.Aslanimehr 17
By:Sahar Amirkamali / Dr.M.Aslanimehr 18
 Related Studies
• 2014 ,Jean Kaoru Millet and Gary R. Whittaker1, Host cell entry of Middle
East respiratory syndromecoronavirus after two-step, furin-mediated
activationof the spike protein.

2014, Yang Yang, Receptor usage and cell entry of bat coronavirus
HKU4provide insight into bat-to-human transmission ofMERS coronavirus

Assiri A,MERS-CoV Investigation Team. Hospital Outbreak of Middle East

Respiratory Syndrome Coronavirus. N Engl J Med. 2013 Jun 19. [Epub
ahead of print].

Guery B,the MERS-CoV study group. Clinical

features and viral diagnosis of two cases of infection with Middle East
Respiratory Syndrome coronavirus: a report of nosocomial transmission.
Lancet. 2013 May 30.

http://emergency.cdc.gov/coca

By:Sahar Amirkamali / Dr.M.Aslanimehr 19

By:Sahar Amirkamali / Dr.M.Aslanimehr 20