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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The Middle East Respiratory Syndrome Coronavirus: An Emerging Virus of Global Threat</title><author><name sortKey="Khan, Gulfaraz" sort="Khan, Gulfaraz" uniqKey="Khan G" first="Gulfaraz" last="Khan">Gulfaraz Khan</name><affiliation><nlm:aff id="aff1">Department of Microbiology & Immunology, United Arab Emirates University, Abu Dhabi, United Arab Emirates</nlm:aff></affiliation></author><author><name sortKey="Sheek Hussein, Mohamud" sort="Sheek Hussein, Mohamud" uniqKey="Sheek Hussein M" first="Mohamud" last="Sheek-Hussein">Mohamud Sheek-Hussein</name><affiliation><nlm:aff id="aff2">Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Abu Dhabi, United Arab Emirates</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmc">7148737</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7148737</idno><idno type="RBID">PMC:7148737</idno><idno type="doi">10.1016/B978-0-12-819400-3.00008-9</idno><idno type="pmid">NONE</idno><date when="2019">2019</date><idno type="wicri:Area/Pmc/Corpus">000779</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000779</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The Middle East Respiratory Syndrome Coronavirus: An Emerging Virus of Global Threat</title><author><name sortKey="Khan, Gulfaraz" sort="Khan, Gulfaraz" uniqKey="Khan G" first="Gulfaraz" last="Khan">Gulfaraz Khan</name><affiliation><nlm:aff id="aff1">Department of Microbiology & Immunology, United Arab Emirates University, Abu Dhabi, United Arab Emirates</nlm:aff></affiliation></author><author><name sortKey="Sheek Hussein, Mohamud" sort="Sheek Hussein, Mohamud" uniqKey="Sheek Hussein M" first="Mohamud" last="Sheek-Hussein">Mohamud Sheek-Hussein</name><affiliation><nlm:aff id="aff2">Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Abu Dhabi, United Arab Emirates</nlm:aff></affiliation></author></analytic><series><title level="j">Emerging and Reemerging Viral Pathogens</title><imprint><date when="2019">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Middle East respiratory syndrome (MERS) is a viral respiratory illness caused by a coronavirus (CoV), first identified in Saudi Arabia in 2012. Since then, almost 2000 cases have been reported from 27 countries, with Saudi Arabia being the epicenter. This newly emerging virus is highly pathogenic and has a case mortality rate of 35%. It is similar to the CoV causing severe acute respiratory syndrome CoV (SARS-CoV) in that both belong to the genus beta CoVs that are of zoonotic origin and cause lower respiratory infection. The natural reservoir for MERS-CoV remains unknown. Serological studies indicate that most dromedary camels in the Middle East have been infected with this virus, and they maybe the potential intermediate host. However, the mode of transmission from camels to humans is poorly understood. The majority of confirmed human cases have resulted from human-to-human transmission, most probably via respiratory route. Patients most at risk of developing severe MERS-CoV infection appear to be those with underlying conditions such as diabetes, hypertension, obesity, cardiac diseases, chronic respiratory diseases, and cancer. Unlike SARS-CoV, MERS-CoV is considered an ongoing public health problem, particularly for the Middle East region. In this chapter, we outline the prevailing information regarding the emergence and epidemiology of this virus, its mode of transmission and pathogenicity, its clinical features, and the potential strategies for prevention.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Adney, D R" uniqKey="Adney D">D.R. Adney</name></author><author><name sortKey="Van Doremalen, N" uniqKey="Van Doremalen N">N. van Doremalen</name></author><author><name sortKey="Brown, V R" uniqKey="Brown V">V.R. Brown</name></author><author><name sortKey="Bushmaker, T" uniqKey="Bushmaker T">T. Bushmaker</name></author><author><name sortKey="Scott, D" uniqKey="Scott D">D. Scott</name></author><author><name sortKey="De Wit, E" uniqKey="De Wit E">E. de Wit</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alhamlan, F S" uniqKey="Alhamlan F">F.S. Alhamlan</name></author><author><name sortKey="Majumder, M S" uniqKey="Majumder M">M.S. Majumder</name></author><author><name sortKey="Brownstein, J S" uniqKey="Brownstein J">J.S. Brownstein</name></author><author><name sortKey="Hawkins, J" uniqKey="Hawkins J">J. Hawkins</name></author><author><name sortKey="Al Abdely, H M" uniqKey="Al Abdely H">H.M. Al-Abdely</name></author><author><name sortKey="Alzahrani, A" uniqKey="Alzahrani A">A. Alzahrani</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Al Hammadi, Z M" uniqKey="Al Hammadi Z">Z.M. Al Hammadi</name></author><author><name sortKey="Chu, D K W" uniqKey="Chu D">D.K.W. Chu</name></author><author><name sortKey="Eltahir, Y M" uniqKey="Eltahir Y">Y.M. Eltahir</name></author><author><name sortKey="Al Hosani, F" uniqKey="Al Hosani F">F. Al Hosani</name></author><author><name sortKey="Al Mulla, M" uniqKey="Al Mulla M">M. Al Mulla</name></author><author><name sortKey="Tarnini, W" uniqKey="Tarnini W">W. Tarnini</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ali, M" uniqKey="Ali M">M. Ali</name></author><author><name sortKey="El Shesheny, R" uniqKey="El Shesheny R">R. El-Shesheny</name></author><author><name sortKey="Kandeil, A" uniqKey="Kandeil A">A. Kandeil</name></author><author><name sortKey="Shehata, M" uniqKey="Shehata M">M. Shehata</name></author><author><name sortKey="Elsokary, B" uniqKey="Elsokary B">B. Elsokary</name></author><author><name sortKey="Gomaa, M" uniqKey="Gomaa M">M. Gomaa</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alraddadi, B M" uniqKey="Alraddadi B">B.M. Alraddadi</name></author><author><name sortKey="Watson, J T" uniqKey="Watson J">J.T. Watson</name></author><author><name sortKey="Almarashi, A" uniqKey="Almarashi A">A. Almarashi</name></author><author><name sortKey="Abedi, G R" uniqKey="Abedi G">G.R. Abedi</name></author><author><name sortKey="Turkistani, A" uniqKey="Turkistani A">A. Turkistani</name></author><author><name sortKey="Sadran, M" uniqKey="Sadran M">M. Sadran</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Al Tawfiq, J A" uniqKey="Al Tawfiq J">J.A. Al-Tawfiq</name></author><author><name sortKey="Kattan, R F" uniqKey="Kattan R">R.F. Kattan</name></author><author><name sortKey="Memish, Z A" uniqKey="Memish Z">Z.A. Memish</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Aly, M" uniqKey="Aly M">M. Aly</name></author><author><name sortKey="Elrobh, M" uniqKey="Elrobh M">M. Elrobh</name></author><author><name sortKey="Alzayer, M" uniqKey="Alzayer M">M. Alzayer</name></author><author><name sortKey="Aljuhani, S" uniqKey="Aljuhani S">S. Aljuhani</name></author><author><name sortKey="Balkhy, H" uniqKey="Balkhy H">H. Balkhy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Anthony, S J" uniqKey="Anthony S">S.J. Anthony</name></author><author><name sortKey="Gilardi, K" uniqKey="Gilardi K">K. Gilardi</name></author><author><name sortKey="Menachery, V D" uniqKey="Menachery V">V.D. Menachery</name></author><author><name sortKey="Goldstein, T" uniqKey="Goldstein T">T. Goldstein</name></author><author><name sortKey="Ssebide, B" uniqKey="Ssebide B">B. Ssebide</name></author><author><name sortKey="Mbabazi, R" uniqKey="Mbabazi R">R. Mbabazi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Arabi, Y M" uniqKey="Arabi Y">Y.M. Arabi</name></author><author><name sortKey="Balkhy, H H" uniqKey="Balkhy H">H.H. Balkhy</name></author><author><name sortKey="Hayden, F G" uniqKey="Hayden F">F.G. Hayden</name></author><author><name sortKey="Bouchama, A" uniqKey="Bouchama A">A. Bouchama</name></author><author><name sortKey="Luke, T" uniqKey="Luke T">T. Luke</name></author><author><name sortKey="Baillie, J K" uniqKey="Baillie J">J.K. Baillie</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Assiri, A" uniqKey="Assiri A">A. Assiri</name></author><author><name sortKey="Al Tawfiq, J A" uniqKey="Al Tawfiq J">J.A. Al-Tawfiq</name></author><author><name sortKey="Al Rabeeah, A A" uniqKey="Al Rabeeah A">A.A. Al-Rabeeah</name></author><author><name sortKey="Al Rabiah, F A" uniqKey="Al Rabiah F">F.A. Al-Rabiah</name></author><author><name sortKey="Al Hajjar, S" uniqKey="Al Hajjar S">S. Al-Hajjar</name></author><author><name sortKey="Al Barrak, A" uniqKey="Al Barrak A">A. Al-Barrak</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Assiri, A" uniqKey="Assiri A">A. Assiri</name></author><author><name sortKey="Abedi, G R" uniqKey="Abedi G">G.R. Abedi</name></author><author><name sortKey="Al Masri, M" uniqKey="Al Masri M">M. Al Masri</name></author><author><name sortKey="Bin Saeed, A" uniqKey="Bin Saeed A">A. Bin Saeed</name></author><author><name sortKey="Gerber, S I" uniqKey="Gerber S">S.I. Gerber</name></author><author><name sortKey="Watson, J T" uniqKey="Watson J">J.T. Watson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Azhar, E I" uniqKey="Azhar E">E.I. Azhar</name></author><author><name sortKey="El Kafrawy, S A" uniqKey="El Kafrawy S">S.A. El-Kafrawy</name></author><author><name sortKey="Farraj, S A" uniqKey="Farraj S">S.A. Farraj</name></author><author><name sortKey="Hassan, A M" uniqKey="Hassan A">A.M. Hassan</name></author><author><name sortKey="Al Saeed, M S" uniqKey="Al Saeed M">M.S. Al-Saeed</name></author><author><name sortKey="Hashem, A M" uniqKey="Hashem A">A.M. Hashem</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Badawi, A" uniqKey="Badawi A">A. Badawi</name></author><author><name sortKey="Ryoo, S G" uniqKey="Ryoo S">S.G. Ryoo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Buliva, E" uniqKey="Buliva E">E. Buliva</name></author><author><name sortKey="Elhakim, M" uniqKey="Elhakim M">M. Elhakim</name></author><author><name sortKey="Minh, T" uniqKey="Minh T">T. Minh</name></author><author><name sortKey="Nguyen, N" uniqKey="Nguyen N">N. Nguyen</name></author><author><name sortKey="Elkholy, A" uniqKey="Elkholy A">A. Elkholy</name></author><author><name sortKey="Mala, P" uniqKey="Mala P">P. Mala</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chafekar, A" uniqKey="Chafekar A">A. Chafekar</name></author><author><name sortKey="Fielding, B C" uniqKey="Fielding B">B.C. Fielding</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chan, J F" uniqKey="Chan J">J.F. Chan</name></author><author><name sortKey="Lau, S K P" uniqKey="Lau S">S.K.P. Lau</name></author><author><name sortKey="To, K K W" uniqKey="To K">K.K.W. To</name></author><author><name sortKey="Cheng, V C C" uniqKey="Cheng V">V.C.C. Cheng</name></author><author><name sortKey="Woo, P C Y" uniqKey="Woo P">P.C.Y. Woo</name></author><author><name sortKey="Yuen, K Y" uniqKey="Yuen K">K.-Y. Yuen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chan, J F W" uniqKey="Chan J">J.F.-W. Chan</name></author><author><name sortKey="Yao, Y" uniqKey="Yao Y">Y. Yao</name></author><author><name sortKey="Yeung, M L" uniqKey="Yeung M">M.-L. Yeung</name></author><author><name sortKey="Deng, W" uniqKey="Deng W">W. Deng</name></author><author><name sortKey="Bao, L" uniqKey="Bao L">L. Bao</name></author><author><name sortKey="Jia, L" uniqKey="Jia L">L. Jia</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cho, S Y" uniqKey="Cho S">S.Y. Cho</name></author><author><name sortKey="Kang, J M" uniqKey="Kang J">J.-M. Kang</name></author><author><name sortKey="Ha, Y E" uniqKey="Ha Y">Y.E. Ha</name></author><author><name sortKey="Park, G E" uniqKey="Park G">G.E. Park</name></author><author><name sortKey="Lee, J Y" uniqKey="Lee J">J.Y. Lee</name></author><author><name sortKey="Ko, J H" uniqKey="Ko J">J.-H. Ko</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De Wit, E" uniqKey="De Wit E">E. de Wit</name></author><author><name sortKey="Van Doremalen, N" uniqKey="Van Doremalen N">N. van Doremalen</name></author><author><name sortKey="Falzarano, D" uniqKey="Falzarano D">D. Falzarano</name></author><author><name sortKey="Munster, V J" uniqKey="Munster V">V.J. Munster</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Drosten, C" uniqKey="Drosten C">C. Drosten</name></author><author><name sortKey="Meyer, B" uniqKey="Meyer B">B. Meyer</name></author><author><name sortKey="Muller, M A" uniqKey="Muller M">M.A. Müller</name></author><author><name sortKey="Corman, V M" uniqKey="Corman V">V.M. Corman</name></author><author><name sortKey="Al Masri, M" uniqKey="Al Masri M">M. Al-Masri</name></author><author><name sortKey="Hossain, R" uniqKey="Hossain R">R. Hossain</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Du, L" uniqKey="Du L">L. Du</name></author><author><name sortKey="Tai, W" uniqKey="Tai W">W. Tai</name></author><author><name sortKey="Zhou, Y" uniqKey="Zhou Y">Y. Zhou</name></author><author><name sortKey="Jiang, S" uniqKey="Jiang S">S. Jiang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Falzarano, D" uniqKey="Falzarano D">D. Falzarano</name></author><author><name sortKey="De Wit, E" uniqKey="De Wit E">E. de Wit</name></author><author><name sortKey="Rasmussen, A L" uniqKey="Rasmussen A">A.L. Rasmussen</name></author><author><name sortKey="Feldmann, F" uniqKey="Feldmann F">F. Feldmann</name></author><author><name sortKey="Okumura, A" uniqKey="Okumura A">A. Okumura</name></author><author><name sortKey="Scott, D P" uniqKey="Scott D">D.P. Scott</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Forni, D" uniqKey="Forni D">D. Forni</name></author><author><name sortKey="Cagliani, R" uniqKey="Cagliani R">R. Cagliani</name></author><author><name sortKey="Clerici, M" uniqKey="Clerici M">M. Clerici</name></author><author><name sortKey="Sironi, M" uniqKey="Sironi M">M. Sironi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gierer, S" uniqKey="Gierer S">S. Gierer</name></author><author><name sortKey="Bertram, S" uniqKey="Bertram S">S. Bertram</name></author><author><name sortKey="Kaup, F" uniqKey="Kaup F">F. Kaup</name></author><author><name sortKey="Wrensch, F" uniqKey="Wrensch F">F. Wrensch</name></author><author><name sortKey="Heurich, A" uniqKey="Heurich A">A. Heurich</name></author><author><name sortKey="Kr Mer Kuhl, A" uniqKey="Kr Mer Kuhl A">A. Krämer-Kühl</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Guery, B" uniqKey="Guery B">B. Guery</name></author><author><name sortKey="Poissy, J" uniqKey="Poissy J">J. Poissy</name></author><author><name sortKey="El Mansouf, L" uniqKey="El Mansouf L">L. el Mansouf</name></author><author><name sortKey="Sejourne, C" uniqKey="Sejourne C">C. Séjourné</name></author><author><name sortKey="Ettahar, N" uniqKey="Ettahar N">N. Ettahar</name></author><author><name sortKey="Lemaire, X" uniqKey="Lemaire X">X. Lemaire</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Haagmans, B L" uniqKey="Haagmans B">B.L. Haagmans</name></author><author><name sortKey="Al Dhahiry, S H S" uniqKey="Al Dhahiry S">S.H.S. Al Dhahiry</name></author><author><name sortKey="Reusken, C B E M" uniqKey="Reusken C">C.B.E.M. Reusken</name></author><author><name sortKey="Raj, V S" uniqKey="Raj V">V.S. Raj</name></author><author><name sortKey="Galiano, M" uniqKey="Galiano M">M. Galiano</name></author><author><name sortKey="Myers, R" uniqKey="Myers R">R. Myers</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Haagmans, B L" uniqKey="Haagmans B">B.L. Haagmans</name></author><author><name sortKey="Van Den Brand, J M A" uniqKey="Van Den Brand J">J.M.A. van den Brand</name></author><author><name sortKey="Raj, V S" uniqKey="Raj V">V.S. Raj</name></author><author><name sortKey="Volz, A" uniqKey="Volz A">A. Volz</name></author><author><name sortKey="Wohlsein, P" uniqKey="Wohlsein P">P. Wohlsein</name></author><author><name sortKey="Smits, S L" uniqKey="Smits S">S.L. Smits</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hastings, D L" uniqKey="Hastings D">D.L. Hastings</name></author><author><name sortKey="Tokars, J I" uniqKey="Tokars J">J.I. Tokars</name></author><author><name sortKey="Abdel Aziz, I Z A M" uniqKey="Abdel Aziz I">I.Z.A.M. Abdel Aziz</name></author><author><name sortKey="Alkhaldi, K Z" uniqKey="Alkhaldi K">K.Z. Alkhaldi</name></author><author><name sortKey="Bensadek, A T" uniqKey="Bensadek A">A.T. Bensadek</name></author><author><name sortKey="Alraddadi, B M" uniqKey="Alraddadi B">B.M. Alraddadi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hunter, J C" uniqKey="Hunter J">J.C. Hunter</name></author><author><name sortKey="Nguyen, D" uniqKey="Nguyen D">D. Nguyen</name></author><author><name sortKey="Aden, B" uniqKey="Aden B">B. Aden</name></author><author><name sortKey="Al Bandar, Z" uniqKey="Al Bandar Z">Z. Al Bandar</name></author><author><name sortKey="Al Dhaheri, W" uniqKey="Al Dhaheri W">W. Al Dhaheri</name></author><author><name sortKey="Abu Elkheir, K" uniqKey="Abu Elkheir K">K. Abu Elkheir</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Khan, G" uniqKey="Khan G">G. Khan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, J Y" uniqKey="Kim J">J.Y. Kim</name></author><author><name sortKey="Song, J Y" uniqKey="Song J">J.Y. Song</name></author><author><name sortKey="Yoon, Y K" uniqKey="Yoon Y">Y.K. Yoon</name></author><author><name sortKey="Choi, S H" uniqKey="Choi S">S.-H. Choi</name></author><author><name sortKey="Song, Y G" uniqKey="Song Y">Y.G. Song</name></author><author><name sortKey="Kim, S R" uniqKey="Kim S">S.-R. Kim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, K H" uniqKey="Kim K">K.H. Kim</name></author><author><name sortKey="Tandi, T E" uniqKey="Tandi T">T.E. Tandi</name></author><author><name sortKey="Choi, J W" uniqKey="Choi J">J.W. Choi</name></author><author><name sortKey="Moon, J M" uniqKey="Moon J">J.M. Moon</name></author><author><name sortKey="Kim, M S" uniqKey="Kim M">M.S. Kim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kutter, J S" uniqKey="Kutter J">J.S. Kutter</name></author><author><name sortKey="Spronken, M I" uniqKey="Spronken M">M.I. Spronken</name></author><author><name sortKey="Fraaij, P L" uniqKey="Fraaij P">P.L. Fraaij</name></author><author><name sortKey="Fouchier, R A" uniqKey="Fouchier R">R.A. Fouchier</name></author><author><name sortKey="Herfst, S" uniqKey="Herfst S">S. Herfst</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lee, S S" uniqKey="Lee S">S.S. Lee</name></author><author><name sortKey="Wong, N S" uniqKey="Wong N">N.S. Wong</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lu, G" uniqKey="Lu G">G. Lu</name></author><author><name sortKey="Hu, Y" uniqKey="Hu Y">Y. Hu</name></author><author><name sortKey="Wang, Q" uniqKey="Wang Q">Q. Wang</name></author><author><name sortKey="Qi, J" uniqKey="Qi J">J. Qi</name></author><author><name sortKey="Gao, F" uniqKey="Gao F">F. Gao</name></author><author><name sortKey="Li, Y" uniqKey="Li Y">Y. Li</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Luke, T" uniqKey="Luke T">T. Luke</name></author><author><name sortKey="Wu, H" uniqKey="Wu H">H. Wu</name></author><author><name sortKey="Zhao, J" uniqKey="Zhao J">J. Zhao</name></author><author><name sortKey="Channappanavar, R" uniqKey="Channappanavar R">R. Channappanavar</name></author><author><name sortKey="Coleman, C M" uniqKey="Coleman C">C.M. Coleman</name></author><author><name sortKey="Jiao, J A" uniqKey="Jiao J">J.-A. Jiao</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mackay, I M" uniqKey="Mackay I">I.M. Mackay</name></author><author><name sortKey="Arden, K E" uniqKey="Arden K">K.E. Arden</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Memish, Z A" uniqKey="Memish Z">Z.A. Memish</name></author><author><name sortKey="Al Tawfiq, J A" uniqKey="Al Tawfiq J">J.A. Al-Tawfiq</name></author><author><name sortKey="Makhdoom, H Q" uniqKey="Makhdoom H">H.Q. Makhdoom</name></author><author><name sortKey="Al Rabeeah, A A" uniqKey="Al Rabeeah A">A.A. Al-Rabeeah</name></author><author><name sortKey="Assiri, A" uniqKey="Assiri A">A. Assiri</name></author><author><name sortKey="Alhakeem, R F" uniqKey="Alhakeem R">R.F. Alhakeem</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Memish, Z A" uniqKey="Memish Z">Z.A. Memish</name></author><author><name sortKey="Al Tawfiq, J A" uniqKey="Al Tawfiq J">J.A. Al-Tawfiq</name></author><author><name sortKey="Makhdoom, H Q" uniqKey="Makhdoom H">H.Q. Makhdoom</name></author><author><name sortKey="Assiri, A" uniqKey="Assiri A">A. Assiri</name></author><author><name sortKey="Alhakeem, R F" uniqKey="Alhakeem R">R.F. Alhakeem</name></author><author><name sortKey="Albarrak, A" uniqKey="Albarrak A">A. Albarrak</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Memish, Z A" uniqKey="Memish Z">Z.A. Memish</name></author><author><name sortKey="Cotten, M" uniqKey="Cotten M">M. Cotten</name></author><author><name sortKey="Meyer, B" uniqKey="Meyer B">B. Meyer</name></author><author><name sortKey="Watson, S J" uniqKey="Watson S">S.J. Watson</name></author><author><name sortKey="Alsahafi, A J" uniqKey="Alsahafi A">A.J. Alsahafi</name></author><author><name sortKey="Al Rabeeah, A A" uniqKey="Al Rabeeah A">A.A. Al Rabeeah</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Menachery, V D" uniqKey="Menachery V">V.D. Menachery</name></author><author><name sortKey="Graham, R L" uniqKey="Graham R">R.L. Graham</name></author><author><name sortKey="Baric, R S" uniqKey="Baric R">R.S. Baric</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Meyerholz, D K" uniqKey="Meyerholz D">D.K. Meyerholz</name></author><author><name sortKey="Lambertz, A M" uniqKey="Lambertz A">A.M. Lambertz</name></author><author><name sortKey="Mccray, P B" uniqKey="Mccray P">P.B. McCray</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Milne Price, S" uniqKey="Milne Price S">S. Milne-Price</name></author><author><name sortKey="Miazgowicz, K L" uniqKey="Miazgowicz K">K.L. Miazgowicz</name></author><author><name sortKey="Munster, V J" uniqKey="Munster V">V.J. Munster</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mohd, H A" uniqKey="Mohd H">H.A. Mohd</name></author><author><name sortKey="Al Tawfiq, J A" uniqKey="Al Tawfiq J">J.A. Al-Tawfiq</name></author><author><name sortKey="Memish, Z A" uniqKey="Memish Z">Z.A. Memish</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Muller, M A" uniqKey="Muller M">M.A. Müller</name></author><author><name sortKey="Meyer, B" uniqKey="Meyer B">B. Meyer</name></author><author><name sortKey="Corman, V M" uniqKey="Corman V">V.M. Corman</name></author><author><name sortKey="Al Masri, M" uniqKey="Al Masri M">M. Al-Masri</name></author><author><name sortKey="Turkestani, A" uniqKey="Turkestani A">A. Turkestani</name></author><author><name sortKey="Ritz, D" uniqKey="Ritz D">D. Ritz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Oboho, I K" uniqKey="Oboho I">I.K. Oboho</name></author><author><name sortKey="Tomczyk, S M" uniqKey="Tomczyk S">S.M. Tomczyk</name></author><author><name sortKey="Al Asmari, A M" uniqKey="Al Asmari A">A.M. Al-Asmari</name></author><author><name sortKey="Banjar, A A" uniqKey="Banjar A">A.A. Banjar</name></author><author><name sortKey="Al Mugti, H" uniqKey="Al Mugti H">H. Al-Mugti</name></author><author><name sortKey="Aloraini, M S" uniqKey="Aloraini M">M.S. Aloraini</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Omrani, A S" uniqKey="Omrani A">A.S. Omrani</name></author><author><name sortKey="Al Tawfiq, J A" uniqKey="Al Tawfiq J">J.A. Al-Tawfiq</name></author><author><name sortKey="Memish, Z A" uniqKey="Memish Z">Z.A. Memish</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pebody, R G" uniqKey="Pebody R">R.G. Pebody</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Raj, V S" uniqKey="Raj V">V.S. Raj</name></author><author><name sortKey="Mou, H" uniqKey="Mou H">H. Mou</name></author><author><name sortKey="Smits, S L" uniqKey="Smits S">S.L. Smits</name></author><author><name sortKey="Dekkers, D H W" uniqKey="Dekkers D">D.H.W. Dekkers</name></author><author><name sortKey="Muller, M A" uniqKey="Muller M">M.A. Müller</name></author><author><name sortKey="Dijkman, R" uniqKey="Dijkman R">R. Dijkman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Reusken, C B E M" uniqKey="Reusken C">C.B.E.M. Reusken</name></author><author><name sortKey="Haagmans, B L" uniqKey="Haagmans B">B.L. Haagmans</name></author><author><name sortKey="Muller, M A" uniqKey="Muller M">M.A. Müller</name></author><author><name sortKey="Gutierrez, C" uniqKey="Gutierrez C">C. Gutierrez</name></author><author><name sortKey="Godeke, G J" uniqKey="Godeke G">G.-J. Godeke</name></author><author><name sortKey="Meyer, B" uniqKey="Meyer B">B. Meyer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Reusken, C B E M" uniqKey="Reusken C">C.B.E.M. Reusken</name></author><author><name sortKey="Farag, E A B A" uniqKey="Farag E">E.A.B.A. Farag</name></author><author><name sortKey="Haagmans, B L" uniqKey="Haagmans B">B.L. Haagmans</name></author><author><name sortKey="Mohran, K A" uniqKey="Mohran K">K.A. Mohran</name></author><author><name sortKey="Godeke, G J" uniqKey="Godeke G">G.-J. Godeke</name></author><author><name sortKey="Raj, S" uniqKey="Raj S">S. Raj</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sabir, J S M" uniqKey="Sabir J">J.S.M. Sabir</name></author><author><name sortKey="Lam, T T Y" uniqKey="Lam T">T.T.-Y. Lam</name></author><author><name sortKey="Ahmed, M M M" uniqKey="Ahmed M">M.M.M. Ahmed</name></author><author><name sortKey="Li, L" uniqKey="Li L">L. Li</name></author><author><name sortKey="Shen, Y" uniqKey="Shen Y">Y. Shen</name></author><author><name sortKey="Abo Aba, S E M" uniqKey="Abo Aba S">S.E.M. Abo-Aba</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Doremalen, N" uniqKey="Van Doremalen N">N. van Doremalen</name></author><author><name sortKey="Bushmaker, T" uniqKey="Bushmaker T">T. Bushmaker</name></author><author><name sortKey="Munster, V J" uniqKey="Munster V">V.J. Munster</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Virlogeux, V" uniqKey="Virlogeux V">V. Virlogeux</name></author><author><name sortKey="Fang, V J" uniqKey="Fang V">V.J. Fang</name></author><author><name sortKey="Park, M" uniqKey="Park M">M. Park</name></author><author><name sortKey="Wu, J T" uniqKey="Wu J">J.T. Wu</name></author><author><name sortKey="Cowling, B J" uniqKey="Cowling B">B.J. Cowling</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Widagdo, W" uniqKey="Widagdo W">W. Widagdo</name></author><author><name sortKey="Begeman, L" uniqKey="Begeman L">L. Begeman</name></author><author><name sortKey="Schipper, D" uniqKey="Schipper D">D. Schipper</name></author><author><name sortKey="Van Run, P R" uniqKey="Van Run P">P.R. van Run</name></author><author><name sortKey="Cunningham, A A" uniqKey="Cunningham A">A.A. Cunningham</name></author><author><name sortKey="Kley, N" uniqKey="Kley N">N. Kley</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Woo, P C Y" uniqKey="Woo P">P.C.Y. Woo</name></author><author><name sortKey="Lau, S K P" uniqKey="Lau S">S.K.P. Lau</name></author><author><name sortKey="Li, K S M" uniqKey="Li K">K.S.M. Li</name></author><author><name sortKey="Poon, R W S" uniqKey="Poon R">R.W.S. Poon</name></author><author><name sortKey="Wong, B H L" uniqKey="Wong B">B.H.L. Wong</name></author><author><name sortKey="Tsoi, H" uniqKey="Tsoi H">H. Tsoi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yu, P" uniqKey="Yu P">P. Yu</name></author><author><name sortKey="Xu, Y" uniqKey="Xu Y">Y. Xu</name></author><author><name sortKey="Deng, W" uniqKey="Deng W">W. Deng</name></author><author><name sortKey="Bao, L" uniqKey="Bao L">L. Bao</name></author><author><name sortKey="Huang, L" uniqKey="Huang L">L. Huang</name></author><author><name sortKey="Xu, Y" uniqKey="Xu Y">Y. Xu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zaki, A M" uniqKey="Zaki A">A.M. Zaki</name></author><author><name sortKey="Van Boheemen, S" uniqKey="Van Boheemen S">S. van Boheemen</name></author><author><name sortKey="Bestebroer, T M" uniqKey="Bestebroer T">T.M. Bestebroer</name></author><author><name sortKey="Osterhaus, A D M E" uniqKey="Osterhaus A">A.D.M.E. Osterhaus</name></author><author><name sortKey="Fouchier, R A M" uniqKey="Fouchier R">R.A.M. Fouchier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zielecki, F" uniqKey="Zielecki F">F. Zielecki</name></author><author><name sortKey="Weber, M" uniqKey="Weber M">M. Weber</name></author><author><name sortKey="Eickmann, M" uniqKey="Eickmann M">M. Eickmann</name></author><author><name sortKey="Spiegelberg, L" uniqKey="Spiegelberg L">L. Spiegelberg</name></author><author><name sortKey="Zaki, A M" uniqKey="Zaki A">A.M. Zaki</name></author><author><name sortKey="Matrosovich, M" uniqKey="Matrosovich M">M. Matrosovich</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zumla, A" uniqKey="Zumla A">A. Zumla</name></author><author><name sortKey="Chan, J F W" uniqKey="Chan J">J.F.W. Chan</name></author><author><name sortKey="Azhar, E I" uniqKey="Azhar E">E.I. Azhar</name></author><author><name sortKey="Hui, D S C" uniqKey="Hui D">D.S.C. Hui</name></author><author><name sortKey="Yuen, K Y" uniqKey="Yuen K">K.-Y. Yuen</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="chapter-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Emerging and Reemerging Viral Pathogens</journal-id><journal-title-group><journal-title>Emerging and Reemerging Viral Pathogens</journal-title></journal-title-group></journal-meta><article-meta><article-id pub-id-type="pmc">7148737</article-id><article-id pub-id-type="publisher-id">B978-0-12-819400-3.00008-9</article-id><article-id pub-id-type="doi">10.1016/B978-0-12-819400-3.00008-9</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>The Middle East Respiratory Syndrome Coronavirus: An Emerging Virus of Global Threat</article-title></title-group><contrib-group><contrib contrib-type="author" id="au0010"><name><surname>Khan</surname><given-names>Gulfaraz</given-names></name><xref rid="aff1" ref-type="aff">1</xref></contrib><contrib contrib-type="author" id="au0015"><name><surname>Sheek-Hussein</surname><given-names>Mohamud</given-names></name><xref rid="aff2" ref-type="aff">2</xref></contrib></contrib-group><aff id="aff1"><label>1</label>Department of Microbiology & Immunology, United Arab Emirates University, Abu Dhabi, United Arab Emirates</aff><aff id="aff2"><label>2</label>Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Abu Dhabi, United Arab Emirates</aff><contrib-group><contrib contrib-type="editor"><name><surname>Ennaji</surname><given-names>Moulay Mustapha</given-names></name></contrib></contrib-group><aff>Laboratory of Virology, Microbiology, Quality, Biotechnologies/Eco-Toxicology and Biodiversity, Faculty of Sciences and Techniques, Mohammedia, University Hassan II of Casablanca, Casablanca, Morocco</aff><pub-date pub-type="pmc-release"><day>20</day><month>9</month><year>2019</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="ppub"><year>2020</year></pub-date><pub-date pub-type="epub"><day>20</day><month>9</month><year>2019</year></pub-date><fpage>151</fpage><lpage>167</lpage><permissions><copyright-statement>Copyright © 2020 Elsevier Inc. All rights reserved.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder>Elsevier Inc.</copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract id="ab0010"><p>Middle East respiratory syndrome (MERS) is a viral respiratory illness caused by a coronavirus (CoV), first identified in Saudi Arabia in 2012. Since then, almost 2000 cases have been reported from 27 countries, with Saudi Arabia being the epicenter. This newly emerging virus is highly pathogenic and has a case mortality rate of 35%. It is similar to the CoV causing severe acute respiratory syndrome CoV (SARS-CoV) in that both belong to the genus beta CoVs that are of zoonotic origin and cause lower respiratory infection. The natural reservoir for MERS-CoV remains unknown. Serological studies indicate that most dromedary camels in the Middle East have been infected with this virus, and they maybe the potential intermediate host. However, the mode of transmission from camels to humans is poorly understood. The majority of confirmed human cases have resulted from human-to-human transmission, most probably via respiratory route. Patients most at risk of developing severe MERS-CoV infection appear to be those with underlying conditions such as diabetes, hypertension, obesity, cardiac diseases, chronic respiratory diseases, and cancer. Unlike SARS-CoV, MERS-CoV is considered an ongoing public health problem, particularly for the Middle East region. In this chapter, we outline the prevailing information regarding the emergence and epidemiology of this virus, its mode of transmission and pathogenicity, its clinical features, and the potential strategies for prevention.</p></abstract><kwd-group id="kys0010"><title>Keywords</title><kwd>MERS-CoV</kwd><kwd>respiratory infection</kwd><kwd>camels</kwd><kwd>Middle East</kwd><kwd>zoonosis</kwd></kwd-group></article-meta></front><body><sec id="s0010"><title>Abbreviations</title><p id="p0065"><def-list><def-item><term id="d0010">BtCoV</term><def><p id="p0070">bat coronavirus</p></def></def-item><def-item><term id="d0015">CoV</term><def><p id="p0075">coronavirus</p></def></def-item><def-item><term id="d0020">DPP4</term><def><p id="p0080">dipeptidyl peptidase 4</p></def></def-item><def-item><term id="d0025">HCoV</term><def><p id="p0085">human coronavirus</p></def></def-item><def-item><term id="d0030">MERS-CoV</term><def><p id="p0090">Middle East respiratory syndrome coronavirus</p></def></def-item><def-item><term id="d0035">PCR</term><def><p id="p0095">polymerase chain reaction</p></def></def-item><def-item><term id="d0040">PPE</term><def><p id="p0100">personal protective equipment</p></def></def-item><def-item><term id="d0045">SARS</term><def><p id="p0105">severe acute respiratory syndrome</p></def></def-item></def-list></p></sec><sec id="s0015"><title>Background and Overview</title><p id="p0110">Middle East respiratory syndrome coronavirus (CoV) (MERS-CoV) is a newly emerging zoonotic viral respiratory illness. Dromedary camels are thought to be the primary source of infection (<xref rid="bib19" ref-type="bibr">de Wit et al., 2016</xref>). The first case of infection in humans was reported in June 2012 in Saudi Arabia from a 60-year-old man who later died of severe pneumonia and renal failure (<xref rid="bib60" ref-type="bibr">Zaki et al., 2012</xref>, <xref rid="bib30" ref-type="bibr">Khan, 2013</xref>). From 2012 to the end of 2017, the World Health Organization reported that a total of 2123 laboratories confirmed the cases of MERS-CoV infection and at least 740 deaths in 27 countries (case fatality rate 35%). Although sizable outbreaks have been noted in several countries, the latest being in South Korea (186 cases and 35 deaths) (<xref rid="bib9" ref-type="bibr">Arabi et al., 2017</xref>), the vast number of cases (>80%) have been reported from Saudi Arabia (<xref rid="f0010" ref-type="fig">Fig. 8.1</xref>) (<xref rid="bib55" ref-type="bibr">WHO, 2017</xref>).<fig id="f0010"><label>Figure 8.1</label><caption><p>Confirmed global cases of MERS-CoV (2012–17). <italic>MERS-CoV</italic>, Middle East respiratory syndrome coronavirus.</p></caption><graphic xlink:href="f08-01-9780128194003"></graphic><attrib><italic>Source</italic>: Adopted from WHO, 2017. Confirmed global cases of MERS-CoV. <<ext-link ext-link-type="uri" xlink:href="http://www.who.int/emergencies/mers-cov/epi-17-november-2017.png?ua=1" id="interref1">http://www.who.int/emergencies/mers-cov/epi-17-november-2017.png?ua=1</ext-link>> (retrieved 07.03.18.).</attrib></fig></p><p id="p0115">This newly emerging, highly pathogenic respiratory virus is closely related to the virus that caused an outbreak of severe acute respiratory syndrome (SARS) in 2002–03. Both viruses are beta CoVs of zoonotic origin and cause similar clinical presentations. Although the natural reservoir of MERS-CoV infection and mode of transmission to humans is not known, one factor appears to be common to all primary cases; they are epidemiologically linked to the Middle East region. Most secondary cases, on the other hand, have occurred as a result of human-to-human transmission. Indeed, several well-documented outbreaks have occurred in healthcare settings, often in elderly men with comorbidities (<xref rid="bib9" ref-type="bibr">Arabi et al., 2017</xref>, <xref rid="bib15" ref-type="bibr">Chafekar and Fielding, 2018</xref>). Unlike SARS-CoV, MERS-CoV is an ongoing public health threat, particularly for the Middle East. The fact that there is no effective antiviral drug or approved vaccine available against MERS-CoV makes the threat even more worrisome (<xref rid="bib62" ref-type="bibr">Zumla et al., 2016</xref>).</p><sec id="s0020"><title>The Virus and Its Replication</title><p id="p0120">MERS-CoV is an enveloped, single-strand, and positive-sense RNA virus, which belongs to the Coronaviridae family. Although CoVs are very common and can infect a variety of different animals, including cats, pigs, and bats, they rarely jump species barrier and infect humans. Human CoVs (HCoVs) were first isolated in mid-1960s, and until 2002, only two viruses, namely, HCoV-229E and HCoV-OC43, were known to infect humans (<xref rid="bib23" ref-type="bibr">Forni et al., 2017</xref>). Currently, six CoVs have been shown to infect humans. Except for MERS-CoV and SARS-CoV, all others are associated with mild illnesses resembling common cold.</p><p id="p0125">CoVs are grouped into four genera, α, β, γ, and δ. The β-CoVs are further subgrouped in four lineages or clades, A–D (<xref rid="bib23" ref-type="bibr">Forni et al., 2017</xref>, <xref rid="bib43" ref-type="bibr">Milne-Price et al., 2014</xref>). Although MERS-CoV and SARS-CoV belong to the same genus and both cause severe lower respiratory tract infection in humans, phylogenetic and sequencing data suggests that MERS-CoV is in fact more closely related to several bat CoVs (BtCoVs) than to SARS-CoV (<xref rid="f0015" ref-type="fig">Fig. 8.2</xref>) (<xref rid="bib23" ref-type="bibr">Forni et al., 2017</xref>, <xref rid="bib43" ref-type="bibr">Milne-Price et al., 2014</xref>). These findings suggest that MERS-CoV probably is originated from a BtCoV
ancestor (<xref rid="bib47" ref-type="bibr">Omrani et al., 2015</xref>, <xref rid="bib16" ref-type="bibr">Chan et al., 2015a</xref>, <xref rid="bib17" ref-type="bibr">Chan et al., 2015b</xref>). The fact that CoVs are RNA viruses exhibiting high rates of mutation and recombination, and a propensity to cross species barrier, increases the risk of new variants emerging with higher virulence and transmission (<xref rid="bib41" ref-type="bibr">Menachery et al., 2017</xref>, <xref rid="bib52" ref-type="bibr">Sabir et al., 2015</xref>).<fig id="f0015"><label>Figure 8.2</label><caption><p>Phylogenetic tree (not to scale) of coronaviruses with representatives from each of the four genera, α, β, γ, and δ. Coronaviruses infect numerous species, including bat (Bt), beluga whale (BW), chicken (IBV), feline (FIPV), swine (TGEV), mink (M), murine (MHV), thrush (Th), bulbul (Bu), munia (Mun), and Humans (HCoV).</p></caption><graphic xlink:href="f08-02-9780128194003"></graphic><attrib><italic>Source</italic>: Adapted from Milne-Price, S., Miazgowicz, K.L., Munster, V.J., 2014. The emergence of the Middle East respiratory syndrome coronavirus. Pathog. Dis. 71 (2), 119–134. doi:10.1111/2049-632X.12166.</attrib></fig></p><p id="p0130">The replication cycle of MERS-CoV consists of a number of important steps: attachment and entry into host cell, uncoating and release of viral RNA, transcription and translation of viral specific genes, replication of viral genomic RNA, and assembly and release of progeny virions from the infected cell. As is typical of most RNA viruses, all of these steps take place in the cytoplasm of the host cell (<xref rid="bib19" ref-type="bibr">de Wit et al., 2016</xref>). The initial attachment of MERS-CoV to its susceptible host cells is mediated by the viral envelop spike glycoprotein S binding to its cellular receptor, CD26 (also known as dipeptidyl peptidase 4, DPP4) (<xref rid="bib35" ref-type="bibr">Lu et al., 2013</xref>, <xref rid="bib49" ref-type="bibr">Raj et al., 2013</xref>). A number of different cell types express DPP4 and hence are susceptible to MERS-CoV infection including pneumocytes, alveolar macrophages, bronchial epithelia, vascular endothelium, as well as a subset of mononuclear cells (<xref rid="bib42" ref-type="bibr">Meyerholz et al., 2016</xref>, <xref rid="bib59" ref-type="bibr">Yu et al., 2017</xref>). Following attachment, the virus enters the susceptible cell by fusion of its envelope with the plasma membrane and/or via receptor-mediated endocytosis (<xref rid="bib19" ref-type="bibr">de Wit et al., 2016</xref>). Once in the cytoplasm of the target cell, the virus particle uncoats and the positive-sense viral RNA binds to ribosomes, and the viral RNA-dependent RNA polymerase is translated. This enzyme in turn transcribes full-length negative-sense RNA that forms the template for the production of positive-sense viral genome. The viral polymerase also generates various individual mRNAs that are translated into viral proteins. Viral structural proteins and viral genomic RNA are assembled into new virus particles in the rough endoplasmic reticulum-Golgi intermediate compartment and eventually released out of the cell by exocytosis. From the infected host, it appears that the virus is shed in nasal secretions (<xref rid="bib1" ref-type="bibr">Adney et al., 2014</xref>). Interestingly, in bats, a recent study revealed that DPP4 receptor is rarely expressed in epithelial cells of respiratory tract, but highly expressed in epithelial cells of intestinal tract, indicating that fecal–oral is probably the main mode of transmission in bats (<xref rid="bib57" ref-type="bibr">Widagdo et al., 2017</xref>). Of all the documented cases to date, there is no evidence for the transmission of the virus from bats or their droppings directly to humans. We also have limited data on the survival of the virus outside its host. When the virus was added to milk from dromedary camels, goats, or cow and stored at 4°C or 22°C, the virus could be recovered up to 72 and 48 hours, respectively (<xref rid="bib53" ref-type="bibr">van Doremalen et al., 2013</xref>). Pasteurization of the milk, however, completely destroyed MERS-CoV infectivity (<xref rid="bib53" ref-type="bibr">van Doremalen et al., 2013</xref>) (<xref rid="t0010" ref-type="table">Table 8.1</xref>).<table-wrap position="float" id="t0010"><label>Table 8.1</label><caption><p>Major Features of Middle East Respiratory Syndrome Coronavirus.</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="bottom">Feature</th><th valign="bottom">Comment</th><th valign="bottom">References</th></tr></thead><tbody><tr><td>General features of the virus</td><td><list list-type="simple" id="li0010"><list-item id="u0010"><label>•</label><p id="p0010">Enveloped, ssRNA (+), nonsegmented virus, genome size 30 kb</p></list-item><list-item id="u0015"><label>•</label><p id="p0015">Member of the Coronaviridae family, genus β-coronavirus, group C</p></list-item></list></td><td><xref rid="bib60" ref-type="bibr">Zaki et al. (2012)</xref></td></tr><tr><td>Source of human infection</td><td><list list-type="simple" id="li0015"><list-item id="u0020"><label>•</label><p id="p0020">Human–human: most common and often nosocomial</p></list-item><list-item id="u0025"><label>•</label><p id="p0025">Dromedary camel–human: can occur but not common</p></list-item></list></td><td><xref rid="bib20" ref-type="bibr">Drosten et al. (2014)</xref>; <xref rid="bib38" ref-type="bibr">Memish et al., 2014a</xref>, <xref rid="bib39" ref-type="bibr">Memish et al., 2014b</xref>, <xref rid="bib40" ref-type="bibr">Memish et al., 2014c</xref>; <xref rid="bib48" ref-type="bibr">Pebody (2013)</xref>; <xref rid="bib3" ref-type="bibr">Alhamlan et al. (2017)</xref>; <xref rid="bib32" ref-type="bibr">Kim et al. (2017)</xref></td></tr><tr><td>Mode of transmission to humans</td><td>Droplets, aerosols, inhalation, and ingestion of camel milk</td><td><xref rid="bib33" ref-type="bibr">Kutter et al. (2018)</xref>; <xref rid="bib53" ref-type="bibr">van Doremalen et al. (2013)</xref></td></tr><tr><td>Cell tropism and receptor</td><td><list list-type="simple" id="li0020"><list-item id="u0030"><label>•</label><p id="p0030">Pneumocytes, alveolar macrophages, bronchial epithelial cells</p></list-item><list-item id="u0035"><label>•</label><p id="p0035">Can infect cells from humans, monkeys, bats, and pigs</p></list-item><list-item id="u0040"><label>•</label><p id="p0040">Infects via DPP4, also called CD26</p></list-item></list></td><td><xref rid="bib24" ref-type="bibr">Gierer et al. (2013)</xref>; <xref rid="bib35" ref-type="bibr">Lu et al. (2013)</xref>; <xref rid="bib49" ref-type="bibr">Raj et al. (2013)</xref>; <xref rid="bib59" ref-type="bibr">Yu et al. (2017)</xref>; <xref rid="bib61" ref-type="bibr">Zielecki et al. (2013)</xref></td></tr><tr><td>Lab detection</td><td><list list-type="simple" id="li0025"><list-item id="u0045"><label>•</label><p id="p0045">RT-PCR is commonly used for rapid diagnosis</p></list-item><list-item id="u0050"><label>•</label><p id="p0050">Virus can be propagated in Vero and LLC-MK2 cells</p></list-item></list></td><td><xref rid="bib37" ref-type="bibr">Mackay and Arden (2015)</xref>; <xref rid="bib38" ref-type="bibr">Memish et al., 2014a</xref>, <xref rid="bib39" ref-type="bibr">Memish et al., 2014b</xref>, <xref rid="bib40" ref-type="bibr">Memish et al., 2014c</xref></td></tr><tr><td>Prevention and control</td><td><list list-type="simple" id="li0030"><list-item id="u0055"><label>•</label><p id="p0055">Currently no approved vaccine available</p></list-item><list-item id="u0060"><label>•</label><p id="p0060">Hand hygiene, wearing PPE, isolate those at risk</p></list-item></list></td><td><xref rid="bib31" ref-type="bibr">Kim et al. (2015)</xref>; <xref rid="bib37" ref-type="bibr">Mackay and Arden (2015)</xref></td></tr></tbody></table><table-wrap-foot><fn><p><italic>DPP4</italic>, Dipeptidyl peptidase 4; <italic>RT-PCR</italic>, real-time polymerase chain reaction; <italic>PPE</italic>, personal protective equipment.</p></fn></table-wrap-foot></table-wrap></p></sec><sec id="s0025"><title>Epidemiology and Geographic Distribution</title><p id="p0135">The current prevalent view is that MERS-CoV is a zoonotic virus that entered the human population in the Arabian Peninsula, via direct or indirect contact with infected dromedary camels. Studies indicate that the virus had been circulating in the camel population for decades, and only recently “jumped” the species barrier to infect humans. What are the factors that precipitated the virus to cross the species barrier are unknown. Most of the confirmed cases of MERS-CoV infection in humans have been via person-to-person transmission. The epidemiological elements in the transmission of MERS-CoV appear to be factors related to the virus, the host, and the environment. Cases have occurred as sporadic infections, family clusters, or outbreaks in healthcare settings (<xref rid="bib32" ref-type="bibr">Kim et al., 2017</xref>, <xref rid="bib46" ref-type="bibr">Oboho et al., 2015</xref>). Although the infection is limited and nonsustained, outbreaks in healthcare settings have been particularly extensive and worrisome. The nonspecific initial symptoms, late diagnosis, and inadequate infection control measures have all contributed to the outbreaks in healthcare settings (<xref rid="bib46" ref-type="bibr">Oboho et al., 2015</xref>, <xref rid="bib29" ref-type="bibr">Hunter et al., 2016</xref>, <xref rid="bib32" ref-type="bibr">Kim et al., 2017</xref>). Although MERS-CoV cases have been detected in many countries around the world, almost all have been directly or indirectly linked to the Middle East region (<xref rid="t0015" ref-type="table">Table 8.2</xref>). One of the most notable outbreaks outside the Middle East occurred in South Korea in May 2015 (<xref rid="bib32" ref-type="bibr">Kim et al., 2017</xref>, <xref rid="bib34" ref-type="bibr">Lee and Wong, 2015</xref>). A single infected man returning from the Middle East caused a hospital outbreak in which 185 individuals were infected (<xref rid="bib32" ref-type="bibr">Kim et al., 2017</xref>). The epidemiological pattern observed in the Korean outbreak was similar to that observed in the Middle East; more males than females were affected, most of the 38 patients who died had underlying conditions such as respiratory disorders, cancer, hypertension, cardiovascular problems, or diabetes (<xref rid="bib32" ref-type="bibr">Kim et al., 2017</xref>). It is noteworthy that the death rate was lower in the cases from South Korea compared to those reported from Saudi Arabia (23% vs 47%) (<xref rid="bib54" ref-type="bibr">Virlogeux et al., 2016</xref>). The reason for this is not clear.<table-wrap position="float" id="t0015"><label>Table 8.2</label><caption><p>The Leading Countries Affected by Middle East Respiratory Syndrome Coronavirus Infection.</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="bottom">Country</th><th valign="bottom">Number of cases</th><th valign="bottom">% of total cases (2040)</th></tr></thead><tbody><tr><td>Saudi Arabia</td><td>1672</td><td align="char">82.0</td></tr><tr><td>Korea</td><td>185</td><td align="char">9.0</td></tr><tr><td>United Arab Emirates</td><td>83</td><td align="char">4.1</td></tr><tr><td>Qatar</td><td>19</td><td align="char">0.9</td></tr><tr><td>Jordan</td><td>28</td><td align="char">1.4</td></tr><tr><td>Others</td><td>53</td><td align="char">2.6</td></tr></tbody></table><attrib>Based on data from WHO, n.d. MERS-CoV global summary and assessment of risk. <<ext-link ext-link-type="uri" xlink:href="http://www.who.int/emergencies/mers-cov/risk-assessment-july-2017.pdf" id="interref2">http://www.who.int/emergencies/mers-cov/risk-assessment-july-2017.pdf</ext-link>> (retrieved 21.07.17.) (<xref rid="bib56" ref-type="bibr">WHO, n.d</xref>.). Laboratory confirmed cases as of July 2017.</attrib></table-wrap></p><p id="p0140">Although more than 80% of MERS-CoV cases have occurred in Saudi Arabia, the virus clearly has the potential of spreading to other countries. Thus there is an obvious need to detect, respond, and contain any outbreak of MERS-CoV cases if we want to prevent the global spread of the virus. Unfortunately, this is easier said than done. There are a number of risk factors prevalent in some of the countries of the Middle East which support the emergence and reemergence of infectious diseases (<xref rid="bib14" ref-type="bibr">Buliva et al., 2017</xref>). These risk factors include political instability, famine and war, less developed healthcare infrastructure, weak public health and surveillance systems, increased population growth and mobility, climate change, and urbanization (<xref rid="bib14" ref-type="bibr">Buliva et al., 2017</xref>). In order to prevent the emergence and spread of infectious diseases such as MERS-CoV, it is essential to address the underlying causes and risk factors. Needless to say, these are major challenges for any country, let alone the Eastern Mediterranean Region. To successfully address these challenges, it will require not only funding, establishment of robust and effective surveillance systems, and national and international corporations but also above all, peace and security in the region.</p></sec><sec id="s0030"><title>Source of Infection and Transmission</title><p id="p0145">Infection with MERS-CoV, in its initial description, resembled “SARS-like” illness (<xref rid="bib16" ref-type="bibr">Chan et al., 2015a</xref>, <xref rid="bib17" ref-type="bibr">Chan et al., 2015b</xref>). Further analysis of the epidemiological, virological, and clinical aspects of MERS-CoV and SARS-CoV revealed important differences between the two viruses. Identifying unique aspects of MERS-CoV helped to explain how the epidemic evolved and the steps that could be taken to prevent its spread (<xref rid="bib16" ref-type="bibr">Chan et al., 2015a</xref>, <xref rid="bib17" ref-type="bibr">Chan et al., 2015b</xref>). Serological studies have indicated that most dromedary camels in Africa and the Middle East, but not other animals such as sheep, goats, and cows, were seropositive for MERS-CoV (<xref rid="bib50" ref-type="bibr">Reusken et al., 2013</xref>). Moreover, seroprevalence in dromedary camels appears to vary, with high rates reported in animals from Egypt, Ethiopia, Nigeria, and Sudan and lower rates in animals from Tunisia (<xref rid="bib4" ref-type="bibr">Ali et al., 2017</xref>). Intriguingly, dromedaries from Australia, Canada, the United States, Germany, Netherlands, and Japan have been reported to be seronegative for MERS-CoV (<xref rid="bib47" ref-type="bibr">Omrani et al., 2015</xref>). Importantly, population-based seroepidemiologic studies indicated that the seroprevalence of the virus was several folds higher in people who have been exposed to camels compared to those in the general population (<xref rid="bib45" ref-type="bibr">Müller et al., 2015</xref>). Worldwide, it is estimated that there are around 30 million camels of which 95% are dromedaries. Dromedary camels are very popular in the Middle East where they are used not only for their meat and milk but also for cultural and recreational purposes. Whether camels are the primary reservoir for MERS-CoV infection in humans or merely an intermediate host for the transmission of the virus from a yet unidentified host remains to be proven (<xref rid="f0020" ref-type="fig">Fig. 8.3</xref>) (<xref rid="bib37" ref-type="bibr">Mackay and Arden, 2015</xref>, <xref rid="bib44" ref-type="bibr">Mohd et al., 2016</xref>).
<fig id="f0020"><label>Figure 8.3</label><caption><p>Source of infection and route of transmission of MERS-CoV. Dotted lines indicate possible, but not laboratory confirmed, direction of transmission. Solid lines indicate laboratory-documented direction of transmission. Most cases have occurred in healthcare settings, in patients with underlying medical problems. <italic>MERS-CoV</italic>, Middle East respiratory syndrome coronavirus.</p></caption><graphic xlink:href="f08-03-9780128194003"></graphic></fig></p><p id="p0150">Accumulating serologic and molecular evidence indicates that the virus in dromedaries is genetically similar to MERS-CoV in humans, supporting the notion that dromedary camels could be the potential source of infection to human (<xref rid="bib26" ref-type="bibr">Haagmans et al., 2013</xref>, <xref rid="bib38" ref-type="bibr">Memish et al., 2014a</xref>, <xref rid="bib39" ref-type="bibr">Memish et al., 2014b</xref>, <xref rid="bib40" ref-type="bibr">Memish et al., 2014c</xref>, <xref rid="bib52" ref-type="bibr">Sabir et al., 2015</xref>). Indeed, MERS-CoV antibodies have been isolated in dromedary camels across the Arabian peninsula, North Africa, and Eastern Africa dating from as far back as the 1990s (<xref rid="bib43" ref-type="bibr">Milne-Price et al., 2014</xref>, <xref rid="bib47" ref-type="bibr">Omrani et al., 2015</xref>). This finding suggests that MERS-CoV may have been circulating in dromedaries for over 20 years before it was first recognized as a cause of human infection (<xref rid="bib7" ref-type="bibr">Aly et al., 2017</xref>). In a recent study, a fatal case of MERS-CoV infection was reported in an individual who had direct contact with a dromedary camel (<xref rid="bib12" ref-type="bibr">Azhar et al., 2014</xref>). Sequence analysis of the virus isolated from the case and the camel was identical, clearly indicating that MERS-CoV can indeed be transmitted from camels to human (<xref rid="bib12" ref-type="bibr">Azhar et al., 2014</xref>). It appears that active infection with release of the virus in nasal secretions, particularly during the incubation period, is important for the transmission of the virus to humans (<xref rid="bib5" ref-type="bibr">Alraddadi et al., 2016</xref>). Where and how the camels acquired the infection remains unknown. It has been hypothesized that bats could be the potential source (<xref rid="f0020" ref-type="fig">Fig. 8.3</xref>) (<xref rid="bib8" ref-type="bibr">Anthony et al., 2017</xref>, <xref rid="bib44" ref-type="bibr">Mohd et al., 2016</xref>, <xref rid="bib47" ref-type="bibr">Omrani et al., 2015</xref>). Indeed, MERS-CoV-like viruses have been identified in certain species of bats (<xref rid="bib8" ref-type="bibr">Anthony et al., 2017</xref>, <xref rid="bib58" ref-type="bibr">Woo et al., 2006</xref>). The bats are present in most parts of the world and often infected with various zoonotic viruses. Thus it is plausible that at some point in the past, camels acquired the infection from bats, leading to a sustained infection in the camel population (<xref rid="f0020" ref-type="fig">Fig. 8.3</xref>). MERS-CoV RNA has been identified in the milk, nasal secretion, and feces of dromedary camels (<xref rid="bib47" ref-type="bibr">Omrani et al., 2015</xref>). Since camels and humans are often in close contact, particularly in the Arab Gulf States, humans would be at increased risk of contracting the virus from actively infected animals (<xref rid="bib37" ref-type="bibr">Mackay and Arden, 2015</xref>, <xref rid="bib51" ref-type="bibr">Reusken et al., 2015</xref>). Indeed, MERS-CoV seropositivity in shepherds and those working in slaughterhouses in Saudi Arabia has been reported to be an order of magnitude higher than in the general population (<xref rid="bib9" ref-type="bibr">Arabi et al., 2017</xref>). Although possible, no evidence currently exists to support the transmission of MERS-CoV from bats to humans directly. What is certain is that transmission of the virus can occur from camels to humans, but the process is still not fully understood (<xref rid="bib2" ref-type="bibr">Al Hammadi et al., 2015</xref>, <xref rid="bib38" ref-type="bibr">Memish et al., 2014a</xref>, <xref rid="bib39" ref-type="bibr">Memish et al., 2014b</xref>, <xref rid="bib40" ref-type="bibr">Memish et al., 2014c</xref>). One possibility is that some species of CoVs from camels and humans could recombine leading to the emergence of a new virus that can infect both, camels and human (<xref rid="bib52" ref-type="bibr">Sabir et al., 2015</xref>).</p><p id="p0155">Most MERS-CoV infections in humans occur through human-to-human contact (<xref rid="bib9" ref-type="bibr">Arabi et al., 2017</xref>, <xref rid="bib62" ref-type="bibr">Zumla et al., 2016</xref>). Available data on epidemiologic observations suggest that human-to-human transmission occurs primarily through close contact with an infected individual. The mode of transmission is presumed to be via respiratory droplets or aerosols, with higher risk in situations where aerosols are generated, and inadequate personal protection or proper room ventilation is not present (<xref rid="bib33" ref-type="bibr">Kutter et al., 2018</xref>). In the South Korean outbreak a total of 185 individuals were infected; 136 of whom were directly infected by just 3 cases, the so-called super spreaders. Late diagnosis, lack of infection control measures, poor communication and healthcare management procedures, and failure to quarantine the “super spreaders” were identified as major factors contributing to this large nosocomial outbreak (<xref rid="bib32" ref-type="bibr">Kim et al., 2017</xref>).</p></sec><sec id="s0035"><title>Clinical Features and Diagnosis</title><p id="p0160">CoV is a common cause of mild respiratory tract infection manifesting as common cold. It is estimated that approximately one-third of all upper respiratory tract infections in adults are due to CoVs. SARS-CoV and MERS-CoV are the exceptions. Both of these viruses have a high propensity to infect the lower respiratory track and lead to severe disease and death (<xref rid="bib19" ref-type="bibr">de Wit et al., 2016</xref>). The finding that both of these viruses, but in particular, MERS-CoV, are able to evade the body’s immune responses and infect a broad range of cells, explaining the widespread infection and development of severe disease (<xref rid="bib37" ref-type="bibr">Mackay and Arden, 2015</xref>). It is noteworthy that, even in the absence of viral shedding in the upper respiratory tract, most symptomatic patients have abnormal chest radiographs (<xref rid="f0025" ref-type="fig">Fig. 8.4</xref>) (<xref rid="bib10" ref-type="bibr">Assiri et al., 2013</xref>, <xref rid="bib19" ref-type="bibr">de Wit et al., 2016</xref>).<fig id="f0025"><label>Figure 8.4</label><caption><p>A typical case of MERS-CoV infection. A 65-year-old man presented with severe respiratory distress. The chest X-ray taken during the admission in ICU shows bilateral ground glass opacities, more in the right compared to the left side. <italic>MERS-CoV</italic>, Middle East respiratory syndrome coronavirus.</p></caption><graphic xlink:href="f08-04-9780128194003"></graphic><attrib><italic>Source</italic>: Courtesy of Dr. Karuna M Das, Departmental of Radiology, College of Medicine and Health Sciences, UAE University.</attrib></fig></p><p id="p0165">The incubation period for MERS-CoV infection is about 5–6 days with most patients showing symptoms within 14 days of exposure (<xref rid="bib19" ref-type="bibr">de Wit et al., 2016</xref>, <xref rid="bib54" ref-type="bibr">Virlogeux et al., 2016</xref>). The initial clinical symptoms of MERS-CoV infection can range from asymptomatic to low-grade fever, cough, sore throat, myalgia, and less frequently diarrhea and vomiting. Progression to more severe disease is characterized by the symptoms of shortness of breath, severe pneumonia, respiratory distress syndrome, multiorgan failure, and death (<xref rid="bib9" ref-type="bibr">Arabi et al., 2017</xref>, <xref rid="bib19" ref-type="bibr">de Wit et al., 2016</xref>, <xref rid="bib25" ref-type="bibr">Guery et al., 2013</xref>). The severity of the infection appears to vary depending on the age of the patient and any underlying conditions. Adults over the age of 50 years and with comorbidities such as diabetes, hypertension, chronic renal or lung disease, cancer, and heart disease are at increased risk of developing severe disease and death (<xref rid="bib13" ref-type="bibr">Badawi and Ryoo, 2016</xref>). Although the vast majority of confirmed cases have been in male adults, children are also susceptible to infection, albeit at lower rate and with milder disease (<xref rid="bib6" ref-type="bibr">Al-Tawfiq et al., 2016</xref>). Based on limited data, MERS-CoV infection in pregnancy can also lead to maternal and perinatal disease and death (<xref rid="bib6" ref-type="bibr">Al-Tawfiq et al., 2016</xref>, <xref rid="bib11" ref-type="bibr">Assiri et al., 2016</xref>). Not surprisingly, the severity of infection and the risk of transmission of MERS-CoV are significantly increased in environments such as hospitals (<xref rid="bib18" ref-type="bibr">Cho et al., 2016</xref>, <xref rid="bib28" ref-type="bibr">Hastings et al., 2016</xref>).</p><p id="p0170">The clinical symptoms of MERS-CoV infection, especially in early stages of the infection, are typically nonspecific and can resemble a number of acute respiratory tract infections. However, acute febrile respiratory illness in a patient with a recent travel history to the Middle East or direct/indirect contract with a confirmed case of MERS-CoV should be enough suspicion to request laboratory testing for MERS-CoV. Studies indicate that viral replication and shedding is higher in lower compared to upper respiratory tract (<xref rid="bib19" ref-type="bibr">de Wit et al., 2016</xref>, <xref rid="bib38" ref-type="bibr">Memish et al., 2014a</xref>, <xref rid="bib39" ref-type="bibr">Memish et al., 2014b</xref>, <xref rid="bib40" ref-type="bibr">Memish et al., 2014c</xref>). Hence, for laboratory diagnosis, lower respiratory tract specimens such as tracheal aspirate, bronchoalveolar lavage, or pleural fluid are preferred over upper respiratory tract specimens such as nasopharyngeal swab (<xref rid="bib37" ref-type="bibr">Mackay and Arden, 2015</xref>, <xref rid="bib38" ref-type="bibr">Memish et al., 2014a</xref>, <xref rid="bib39" ref-type="bibr">Memish et al., 2014b</xref>, <xref rid="bib40" ref-type="bibr">Memish et al., 2014c</xref>). It is essential that appropriate personal protective equipment (PPE) and infection control measures are implemented when dealing with suspected cases.</p><p id="p0175">The assay of choice for the laboratory diagnosis of MERS-CoV is reverse transcriptase real-time polymerase chain reaction (RT-PCR) on respiratory samples. This assay was established soon after the identification of MERS-CoV back in 2012 (<xref rid="bib60" ref-type="bibr">Zaki et al., 2012</xref>). RT-PCR is not only very sensitive but also importantly a fairly rapid technique, which is essential for early diagnosis and quarantine implementation. The virus can also be cultured. A number of different cell lines are susceptible for in vitro infection, including Vero and LLC-MK2 cells (<xref rid="bib60" ref-type="bibr">Zaki et al., 2012</xref>). However, cell culture approach is very slow and not easily adaptable to every diagnostic laboratory, hence the preference of RT-PCR. For determining past infection or for surveillance studies, the detection of antibodies to MERS-CoV using serological assay, such as enzyme linked immunosorbent assay (ELISA), can be performed (<xref rid="bib37" ref-type="bibr">Mackay and Arden, 2015</xref>).</p></sec><sec id="s0040"><title>Treatment and Prevention</title><p id="p0180">Currently, no specific antiviral therapy or vaccine is available for the treatment and prevention of MERS-CoV infection. Supportive care and prevention of complications are the main management options that are available. However, efforts are underway for the development of therapeutic and vaccine candidates. In a marmoset model of MERS-CoV infection, several compounds, including ribavirin, lopinavir/ritonavir, interferon-β1b, and interferon-α2B, alone or in combinations, have shown varying degree of success (<xref rid="bib16" ref-type="bibr">Chan et al., 2015a</xref>, <xref rid="bib17" ref-type="bibr">Chan et al., 2015b</xref>, <xref rid="bib22" ref-type="bibr">Falzarano et al., 2013</xref>). Similarly, passive immunotherapy with neutralizing antibodies against MERS-CoV has also shown some therapeutic value in inhibiting viral replication (<xref rid="bib36" ref-type="bibr">Luke et al., 2016</xref>). In terms of vaccines, several potential candidates have been developed and are in different stages of clinical testing (<xref rid="bib21" ref-type="bibr">Du et al., 2016</xref>). The possibility of developing an effective vaccine based on MERS-CoV spike protein is promising (<xref rid="bib27" ref-type="bibr">Haagmans et al., 2015</xref>). In the absence of licensed antiviral or vaccine, current strategies of combating MERS-CoV infection are aimed at reducing the risk of animal-to-human and human-to-human transmissions. Strategies recommended include avoidance of drinking unpasteurized camel milk, limiting direct contact with a sick animal, avoidance of close contact, and sharing of utensils with an infected individual, using PPE when in direct contact with an infected person and proper hand hygiene. In addition, early recognition and laboratory confirmation of infected cases, segregation/isolation of infected cases, and contact tracing and strict implementation of infection control measures in healthcare settings are all essential for controlling and preventing of MERS-CoV infection and spread.</p></sec></sec></body><back><ref-list id="bibliog0010"><title>References</title><ref id="bib1"><element-citation publication-type="journal" id="sbref1"><person-group person-group-type="author"><name><surname>Adney</surname><given-names>D.R.</given-names></name><name><surname>van Doremalen</surname><given-names>N.</given-names></name><name><surname>Brown</surname><given-names>V.R.</given-names></name><name><surname>Bushmaker</surname><given-names>T.</given-names></name><name><surname>Scott</surname><given-names>D.</given-names></name><name><surname>de Wit</surname><given-names>E.</given-names></name></person-group><article-title>Replication and shedding of MERS-CoV in upper respiratory tract of inoculated dromedary camels</article-title><source>Emerg. Infect. Dis.</source><volume>20</volume><issue>12</issue><year>2014</year><fpage>1999</fpage><lpage>2005</lpage><pub-id pub-id-type="doi">10.3201/eid2012.141280</pub-id><pub-id pub-id-type="pmid">25418529</pub-id></element-citation></ref><ref id="bib3"><element-citation publication-type="journal" id="sbref2"><person-group person-group-type="author"><name><surname>Alhamlan</surname><given-names>F.S.</given-names></name><name><surname>Majumder</surname><given-names>M.S.</given-names></name><name><surname>Brownstein</surname><given-names>J.S.</given-names></name><name><surname>Hawkins</surname><given-names>J.</given-names></name><name><surname>Al-Abdely</surname><given-names>H.M.</given-names></name><name><surname>Alzahrani</surname><given-names>A.</given-names></name></person-group><article-title>Case characteristics among Middle East respiratory syndrome coronavirus outbreak and non-outbreak cases in Saudi Arabia from 2012 to 2015</article-title><source>BMJ Open</source><volume>7</volume><issue>1</issue><year>2017</year><fpage>e011865</fpage><pub-id pub-id-type="doi">10.1136/bmjopen-2016-011865</pub-id></element-citation></ref><ref id="bib2"><element-citation publication-type="journal" id="sbref3"><person-group person-group-type="author"><name><surname>Al Hammadi</surname><given-names>Z.M.</given-names></name><name><surname>Chu</surname><given-names>D.K.W.</given-names></name><name><surname>Eltahir</surname><given-names>Y.M.</given-names></name><name><surname>Al Hosani</surname><given-names>F.</given-names></name><name><surname>Al Mulla</surname><given-names>M.</given-names></name><name><surname>Tarnini</surname><given-names>W.</given-names></name></person-group><article-title>Asymptomatic MERS-CoV infection in humans possibly linked to infected dromedaries imported from Oman to United Arab Emirates, May 2015</article-title><source>Emerg. Infect. Dis.</source><volume>21</volume><issue>12</issue><year>2015</year><fpage>2197</fpage><lpage>2200</lpage><pub-id pub-id-type="doi">10.3201/eid2112.151132</pub-id><pub-id pub-id-type="pmid">26584223</pub-id></element-citation></ref><ref id="bib4"><element-citation publication-type="journal" id="sbref4"><person-group person-group-type="author"><name><surname>Ali</surname><given-names>M.</given-names></name><name><surname>El-Shesheny</surname><given-names>R.</given-names></name><name><surname>Kandeil</surname><given-names>A.</given-names></name><name><surname>Shehata</surname><given-names>M.</given-names></name><name><surname>Elsokary</surname><given-names>B.</given-names></name><name><surname>Gomaa</surname><given-names>M.</given-names></name></person-group><article-title>Cross-sectional surveillance of Middle East respiratory syndrome coronavirus (MERS-CoV) in dromedary camels and other mammals in Egypt, August 2015 to January 2016</article-title><source>Euro Surveill.</source><volume>22</volume><issue>11</issue><year>2017</year><pub-id pub-id-type="doi">10.2807/1560-7917.ES.2017.22.11.30487</pub-id></element-citation></ref><ref id="bib5"><element-citation publication-type="journal" id="sbref5"><person-group person-group-type="author"><name><surname>Alraddadi</surname><given-names>B.M.</given-names></name><name><surname>Watson</surname><given-names>J.T.</given-names></name><name><surname>Almarashi</surname><given-names>A.</given-names></name><name><surname>Abedi</surname><given-names>G.R.</given-names></name><name><surname>Turkistani</surname><given-names>A.</given-names></name><name><surname>Sadran</surname><given-names>M.</given-names></name></person-group><article-title>Risk factors for primary Middle East respiratory syndrome coronavirus illness in humans, Saudi Arabia, 2014</article-title><source>Emerg. Infect. Dis.</source><volume>22</volume><issue>1</issue><year>2016</year><fpage>49</fpage><lpage>55</lpage><pub-id pub-id-type="doi">10.3201/eid2201.151340</pub-id><pub-id pub-id-type="pmid">26692185</pub-id></element-citation></ref><ref id="bib6"><element-citation publication-type="journal" id="sbref6"><person-group person-group-type="author"><name><surname>Al-Tawfiq</surname><given-names>J.A.</given-names></name><name><surname>Kattan</surname><given-names>R.F.</given-names></name><name><surname>Memish</surname><given-names>Z.A.</given-names></name></person-group><article-title>Middle East respiratory syndrome coronavirus disease is rare in children: an update from Saudi Arabia</article-title><source>World J. Clin. Pediatr.</source><volume>5</volume><issue>4</issue><year>2016</year><fpage>391</fpage><lpage>396</lpage><pub-id pub-id-type="doi">10.5409/wjcp.v5.i4.391</pub-id><pub-id pub-id-type="pmid">27872828</pub-id></element-citation></ref><ref id="bib7"><element-citation publication-type="journal" id="sbref7"><person-group person-group-type="author"><name><surname>Aly</surname><given-names>M.</given-names></name><name><surname>Elrobh</surname><given-names>M.</given-names></name><name><surname>Alzayer</surname><given-names>M.</given-names></name><name><surname>Aljuhani</surname><given-names>S.</given-names></name><name><surname>Balkhy</surname><given-names>H.</given-names></name></person-group><article-title>Occurrence of the Middle East respiratory syndrome coronavirus (MERS-CoV) across the gulf corporation council countries: four years update</article-title><source>PLoS One</source><volume>12</volume><issue>10</issue><year>2017</year><pub-id pub-id-type="doi">10.1371/journal.pone.0183850</pub-id></element-citation></ref><ref id="bib8"><element-citation publication-type="journal" id="sbref8"><person-group person-group-type="author"><name><surname>Anthony</surname><given-names>S.J.</given-names></name><name><surname>Gilardi</surname><given-names>K.</given-names></name><name><surname>Menachery</surname><given-names>V.D.</given-names></name><name><surname>Goldstein</surname><given-names>T.</given-names></name><name><surname>Ssebide</surname><given-names>B.</given-names></name><name><surname>Mbabazi</surname><given-names>R.</given-names></name></person-group><article-title>Further evidence for bats as the evolutionary source of Middle East respiratory syndrome coronavirus</article-title><source>mBio</source><volume>8</volume><issue>2</issue><year>2017</year><pub-id pub-id-type="doi">10.1128/mBio.00373-17</pub-id></element-citation></ref><ref id="bib9"><element-citation publication-type="journal" id="sbref9"><person-group person-group-type="author"><name><surname>Arabi</surname><given-names>Y.M.</given-names></name><name><surname>Balkhy</surname><given-names>H.H.</given-names></name><name><surname>Hayden</surname><given-names>F.G.</given-names></name><name><surname>Bouchama</surname><given-names>A.</given-names></name><name><surname>Luke</surname><given-names>T.</given-names></name><name><surname>Baillie</surname><given-names>J.K.</given-names></name></person-group><article-title>Middle East respiratory syndrome</article-title><source>N. Engl. J. Med.</source><volume>376</volume><issue>6</issue><year>2017</year><fpage>584</fpage><lpage>594</lpage><pub-id pub-id-type="doi">10.1056/NEJMsr1408795</pub-id><pub-id pub-id-type="pmid">28177862</pub-id></element-citation></ref><ref id="bib10"><element-citation publication-type="journal" id="sbref10"><person-group person-group-type="author"><name><surname>Assiri</surname><given-names>A.</given-names></name><name><surname>Al-Tawfiq</surname><given-names>J.A.</given-names></name><name><surname>Al-Rabeeah</surname><given-names>A.A.</given-names></name><name><surname>Al-Rabiah</surname><given-names>F.A.</given-names></name><name><surname>Al-Hajjar</surname><given-names>S.</given-names></name><name><surname>Al-Barrak</surname><given-names>A.</given-names></name></person-group><article-title>Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study</article-title><source>Lancet Infect. Dis.</source><volume>13</volume><issue>9</issue><year>2013</year><fpage>752</fpage><lpage>761</lpage><pub-id pub-id-type="doi">10.1016/S1473-3099(13)70204-4</pub-id><pub-id pub-id-type="pmid">23891402</pub-id></element-citation></ref><ref id="bib11"><element-citation publication-type="journal" id="sbref11"><person-group person-group-type="author"><name><surname>Assiri</surname><given-names>A.</given-names></name><name><surname>Abedi</surname><given-names>G.R.</given-names></name><name><surname>Al Masri</surname><given-names>M.</given-names></name><name><surname>Bin Saeed</surname><given-names>A.</given-names></name><name><surname>Gerber</surname><given-names>S.I.</given-names></name><name><surname>Watson</surname><given-names>J.T.</given-names></name></person-group><article-title>Middle East respiratory syndrome coronavirus infection during pregnancy: a report of 5 cases from Saudi Arabia</article-title><source>Clin. Infect. Dis.</source><volume>63</volume><issue>7</issue><year>2016</year><fpage>951</fpage><lpage>953</lpage><pub-id pub-id-type="doi">10.1093/cid/ciw412</pub-id><pub-id pub-id-type="pmid">27358348</pub-id></element-citation></ref><ref id="bib12"><element-citation publication-type="journal" id="sbref12"><person-group person-group-type="author"><name><surname>Azhar</surname><given-names>E.I.</given-names></name><name><surname>El-Kafrawy</surname><given-names>S.A.</given-names></name><name><surname>Farraj</surname><given-names>S.A.</given-names></name><name><surname>Hassan</surname><given-names>A.M.</given-names></name><name><surname>Al-Saeed</surname><given-names>M.S.</given-names></name><name><surname>Hashem</surname><given-names>A.M.</given-names></name></person-group><article-title>Evidence for camel-to-human transmission of MERS coronavirus</article-title><source>N. Engl. J. Med.</source><volume>370</volume><issue>26</issue><year>2014</year><fpage>2499</fpage><lpage>2505</lpage><pub-id pub-id-type="doi">10.1056/NEJMoa1401505</pub-id><pub-id pub-id-type="pmid">24896817</pub-id></element-citation></ref><ref id="bib13"><element-citation publication-type="journal" id="sbref13"><person-group person-group-type="author"><name><surname>Badawi</surname><given-names>A.</given-names></name><name><surname>Ryoo</surname><given-names>S.G.</given-names></name></person-group><article-title>Prevalence of comorbidities in the Middle East respiratory syndrome coronavirus (MERS-CoV): a systematic review and meta-analysis</article-title><source>Int. J. Infect. Dis.: IJID</source><volume>49</volume><year>2016</year><fpage>129</fpage><lpage>133</lpage><pub-id pub-id-type="doi">10.1016/j.ijid.2016.06.015</pub-id><pub-id pub-id-type="pmid">27352628</pub-id></element-citation></ref><ref id="bib14"><element-citation publication-type="journal" id="sbref14"><person-group person-group-type="author"><name><surname>Buliva</surname><given-names>E.</given-names></name><name><surname>Elhakim</surname><given-names>M.</given-names></name><name><surname>Minh</surname><given-names>T.</given-names></name><name><surname>Nguyen</surname><given-names>N.</given-names></name><name><surname>Elkholy</surname><given-names>A.</given-names></name><name><surname>Mala</surname><given-names>P.</given-names></name></person-group><article-title>Emerging and reemerging diseases in the World Health Organization (WHO) Eastern Mediterranean Region—progress, challenges, and WHO initiatives</article-title><source>Front. Public Health</source><volume>5</volume><year>2017</year><pub-id pub-id-type="doi">10.3389/fpubh.2017.00276</pub-id></element-citation></ref><ref id="bib15"><element-citation publication-type="journal" id="sbref15"><person-group person-group-type="author"><name><surname>Chafekar</surname><given-names>A.</given-names></name><name><surname>Fielding</surname><given-names>B.C.</given-names></name></person-group><article-title>MERS-CoV: understanding the latest human coronavirus threat</article-title><source>Viruses</source><volume>10</volume><issue>2</issue><year>2018</year><fpage>93</fpage><pub-id pub-id-type="doi">10.3390/v10020093</pub-id></element-citation></ref><ref id="bib16"><element-citation publication-type="journal" id="sbref16"><person-group person-group-type="author"><name><surname>Chan</surname><given-names>J.F.</given-names></name><name><surname>Lau</surname><given-names>S.K.P.</given-names></name><name><surname>To</surname><given-names>K.K.W.</given-names></name><name><surname>Cheng</surname><given-names>V.C.C.</given-names></name><name><surname>Woo</surname><given-names>P.C.Y.</given-names></name><name><surname>Yuen</surname><given-names>K.-Y.</given-names></name></person-group><article-title>Middle East respiratory syndrome coronavirus: another zoonotic betacoronavirus causing SARS-like disease</article-title><source>Clin. Microbiol. Rev.</source><volume>28</volume><issue>2</issue><year>2015</year><fpage>465</fpage><lpage>522</lpage><pub-id pub-id-type="doi">10.1128/CMR.00102-14</pub-id><pub-id pub-id-type="pmid">25810418</pub-id></element-citation></ref><ref id="bib17"><element-citation publication-type="journal" id="sbref17"><person-group person-group-type="author"><name><surname>Chan</surname><given-names>J.F.-W.</given-names></name><name><surname>Yao</surname><given-names>Y.</given-names></name><name><surname>Yeung</surname><given-names>M.-L.</given-names></name><name><surname>Deng</surname><given-names>W.</given-names></name><name><surname>Bao</surname><given-names>L.</given-names></name><name><surname>Jia</surname><given-names>L.</given-names></name></person-group><article-title>Treatment with lopinavir/ritonavir or interferon-β1b improves outcome of MERS-CoV infection in a nonhuman primate model of common marmoset</article-title><source>J. Infect. Dis.</source><volume>212</volume><issue>12</issue><year>2015</year><fpage>1904</fpage><lpage>1913</lpage><pub-id pub-id-type="doi">10.1093/infdis/jiv392</pub-id><pub-id pub-id-type="pmid">26198719</pub-id></element-citation></ref><ref id="bib18"><element-citation publication-type="journal" id="sbref18"><person-group person-group-type="author"><name><surname>Cho</surname><given-names>S.Y.</given-names></name><name><surname>Kang</surname><given-names>J.-M.</given-names></name><name><surname>Ha</surname><given-names>Y.E.</given-names></name><name><surname>Park</surname><given-names>G.E.</given-names></name><name><surname>Lee</surname><given-names>J.Y.</given-names></name><name><surname>Ko</surname><given-names>J.-H.</given-names></name></person-group><article-title>MERS-CoV outbreak following a single patient exposure in an emergency room in South Korea: an epidemiological outbreak study</article-title><source>Lancet (London, England)</source><volume>388</volume><issue>10048</issue><year>2016</year><fpage>994</fpage><lpage>1001</lpage><pub-id pub-id-type="doi">10.1016/S0140-6736(16)30623-7</pub-id></element-citation></ref><ref id="bib19"><element-citation publication-type="journal" id="sbref19"><person-group person-group-type="author"><name><surname>de Wit</surname><given-names>E.</given-names></name><name><surname>van Doremalen</surname><given-names>N.</given-names></name><name><surname>Falzarano</surname><given-names>D.</given-names></name><name><surname>Munster</surname><given-names>V.J.</given-names></name></person-group><article-title>SARS and MERS: recent insights into emerging coronaviruses</article-title><source>Nat. Rev. Microbiol.</source><volume>14</volume><issue>8</issue><year>2016</year><fpage>523</fpage><lpage>534</lpage><pub-id pub-id-type="doi">10.1038/nrmicro.2016.81</pub-id><pub-id pub-id-type="pmid">27344959</pub-id></element-citation></ref><ref id="bib20"><element-citation publication-type="journal" id="sbref20"><person-group person-group-type="author"><name><surname>Drosten</surname><given-names>C.</given-names></name><name><surname>Meyer</surname><given-names>B.</given-names></name><name><surname>Müller</surname><given-names>M.A.</given-names></name><name><surname>Corman</surname><given-names>V.M.</given-names></name><name><surname>Al-Masri</surname><given-names>M.</given-names></name><name><surname>Hossain</surname><given-names>R.</given-names></name></person-group><article-title>Transmission of MERS-coronavirus in household contacts</article-title><source>N. Engl. J. Med.</source><volume>371</volume><issue>9</issue><year>2014</year><fpage>828</fpage><lpage>835</lpage><pub-id pub-id-type="doi">10.1056/NEJMoa1405858</pub-id><pub-id pub-id-type="pmid">25162889</pub-id></element-citation></ref><ref id="bib21"><element-citation publication-type="journal" id="sbref21"><person-group person-group-type="author"><name><surname>Du</surname><given-names>L.</given-names></name><name><surname>Tai</surname><given-names>W.</given-names></name><name><surname>Zhou</surname><given-names>Y.</given-names></name><name><surname>Jiang</surname><given-names>S.</given-names></name></person-group><article-title>Vaccines for the prevention against the threat of MERS-CoV</article-title><source>Expert Rev. Vaccines</source><volume>15</volume><issue>9</issue><year>2016</year><fpage>1123</fpage><lpage>1134</lpage><pub-id pub-id-type="doi">10.1586/14760584.2016.1167603</pub-id><pub-id pub-id-type="pmid">26985862</pub-id></element-citation></ref><ref id="bib22"><element-citation publication-type="journal" id="sbref22"><person-group person-group-type="author"><name><surname>Falzarano</surname><given-names>D.</given-names></name><name><surname>de Wit</surname><given-names>E.</given-names></name><name><surname>Rasmussen</surname><given-names>A.L.</given-names></name><name><surname>Feldmann</surname><given-names>F.</given-names></name><name><surname>Okumura</surname><given-names>A.</given-names></name><name><surname>Scott</surname><given-names>D.P.</given-names></name></person-group><article-title>Treatment with interferon-α2b and ribavirin improves outcome in MERS-CoV-infected rhesus macaques</article-title><source>Nat. Med.</source><volume>19</volume><issue>10</issue><year>2013</year><fpage>1313</fpage><lpage>1317</lpage><pub-id pub-id-type="doi">10.1038/nm.3362</pub-id><pub-id pub-id-type="pmid">24013700</pub-id></element-citation></ref><ref id="bib23"><element-citation publication-type="journal" id="sbref23"><person-group person-group-type="author"><name><surname>Forni</surname><given-names>D.</given-names></name><name><surname>Cagliani</surname><given-names>R.</given-names></name><name><surname>Clerici</surname><given-names>M.</given-names></name><name><surname>Sironi</surname><given-names>M.</given-names></name></person-group><article-title>Molecular evolution of human coronavirus genomes</article-title><source>Trends Microbiol.</source><volume>25</volume><issue>1</issue><year>2017</year><fpage>35</fpage><lpage>48</lpage><pub-id pub-id-type="doi">10.1016/j.tim.2016.09.001</pub-id><pub-id pub-id-type="pmid">27743750</pub-id></element-citation></ref><ref id="bib24"><element-citation publication-type="journal" id="sbref24"><person-group person-group-type="author"><name><surname>Gierer</surname><given-names>S.</given-names></name><name><surname>Bertram</surname><given-names>S.</given-names></name><name><surname>Kaup</surname><given-names>F.</given-names></name><name><surname>Wrensch</surname><given-names>F.</given-names></name><name><surname>Heurich</surname><given-names>A.</given-names></name><name><surname>Krämer-Kühl</surname><given-names>A.</given-names></name></person-group><article-title>The spike-protein of the emerging betacoronavirus EMC uses a novel coronavirus receptor for entry, can be activated by TMPRSS2 and is targeted by neutralizing antibodies</article-title><source>J. Virol.</source><year>2013</year><pub-id pub-id-type="doi">10.1128/JVI.00128-13</pub-id></element-citation></ref><ref id="bib25"><element-citation publication-type="journal" id="sbref25"><person-group person-group-type="author"><name><surname>Guery</surname><given-names>B.</given-names></name><name><surname>Poissy</surname><given-names>J.</given-names></name><name><surname>el Mansouf</surname><given-names>L.</given-names></name><name><surname>Séjourné</surname><given-names>C.</given-names></name><name><surname>Ettahar</surname><given-names>N.</given-names></name><name><surname>Lemaire</surname><given-names>X.</given-names></name></person-group><article-title>Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission</article-title><source>Lancet</source><volume>381</volume><issue>9885</issue><year>2013</year><fpage>2265</fpage><lpage>2272</lpage><pub-id pub-id-type="doi">10.1016/S0140-6736(13)60982-4</pub-id><pub-id pub-id-type="pmid">23727167</pub-id></element-citation></ref><ref id="bib26"><element-citation publication-type="journal" id="sbref26"><person-group person-group-type="author"><name><surname>Haagmans</surname><given-names>B.L.</given-names></name><name><surname>Al Dhahiry</surname><given-names>S.H.S.</given-names></name><name><surname>Reusken</surname><given-names>C.B.E.M.</given-names></name><name><surname>Raj</surname><given-names>V.S.</given-names></name><name><surname>Galiano</surname><given-names>M.</given-names></name><name><surname>Myers</surname><given-names>R.</given-names></name></person-group><article-title>Middle East respiratory syndrome coronavirus in dromedary camels: an outbreak investigation</article-title><source>Lancet Infect. Dis.</source><year>2013</year><pub-id pub-id-type="doi">10.1016/S1473-3099(13)70690-X</pub-id></element-citation></ref><ref id="bib27"><element-citation publication-type="journal" id="sbref27"><person-group person-group-type="author"><name><surname>Haagmans</surname><given-names>B.L.</given-names></name><name><surname>van den Brand</surname><given-names>J.M.A.</given-names></name><name><surname>Raj</surname><given-names>V.S.</given-names></name><name><surname>Volz</surname><given-names>A.</given-names></name><name><surname>Wohlsein</surname><given-names>P.</given-names></name><name><surname>Smits</surname><given-names>S.L.</given-names></name></person-group><article-title>An orthopoxvirus-based vaccine reduces virus excretion after MERS-CoV infection in dromedary camels</article-title><source>Science (New York, NY)</source><year>2015</year><pub-id pub-id-type="doi">10.1126/science.aad1283</pub-id></element-citation></ref><ref id="bib28"><element-citation publication-type="journal" id="sbref28"><person-group person-group-type="author"><name><surname>Hastings</surname><given-names>D.L.</given-names></name><name><surname>Tokars</surname><given-names>J.I.</given-names></name><name><surname>Abdel Aziz</surname><given-names>I.Z.A.M.</given-names></name><name><surname>Alkhaldi</surname><given-names>K.Z.</given-names></name><name><surname>Bensadek</surname><given-names>A.T.</given-names></name><name><surname>Alraddadi</surname><given-names>B.M.</given-names></name></person-group><article-title>Outbreak of Middle East respiratory syndrome at Tertiary Care Hospital, Jeddah, Saudi Arabia, 2014</article-title><source>Emerg. Infect. Dis.</source><volume>22</volume><issue>5</issue><year>2016</year><fpage>794</fpage><lpage>801</lpage><pub-id pub-id-type="doi">10.3201/eid2205.151797</pub-id><pub-id pub-id-type="pmid">27089550</pub-id></element-citation></ref><ref id="bib29"><element-citation publication-type="journal" id="sbref29"><person-group person-group-type="author"><name><surname>Hunter</surname><given-names>J.C.</given-names></name><name><surname>Nguyen</surname><given-names>D.</given-names></name><name><surname>Aden</surname><given-names>B.</given-names></name><name><surname>Al Bandar</surname><given-names>Z.</given-names></name><name><surname>Al Dhaheri</surname><given-names>W.</given-names></name><name><surname>Abu Elkheir</surname><given-names>K.</given-names></name></person-group><article-title>Transmission of Middle East Respiratory syndrome coronavirus infections in healthcare settings, Abu Dhabi</article-title><source>Emerg. Infect. Dis.</source><volume>22</volume><issue>4</issue><year>2016</year><fpage>647</fpage><lpage>656</lpage><pub-id pub-id-type="doi">10.3201/eid2204.151615</pub-id><pub-id pub-id-type="pmid">26981708</pub-id></element-citation></ref><ref id="bib30"><element-citation publication-type="journal" id="sbref30"><person-group person-group-type="author"><name><surname>Khan</surname><given-names>G.</given-names></name></person-group><article-title>A novel coronavirus capable of lethal human infections: an emerging picture</article-title><source>Virol. J.</source><volume>10</volume><year>2013</year><fpage>66</fpage><pub-id pub-id-type="doi">10.1186/1743-422X-10-66</pub-id><pub-id pub-id-type="pmid">23445530</pub-id></element-citation></ref><ref id="bib31"><element-citation publication-type="journal" id="sbref31"><person-group person-group-type="author"><name><surname>Kim</surname><given-names>J.Y.</given-names></name><name><surname>Song</surname><given-names>J.Y.</given-names></name><name><surname>Yoon</surname><given-names>Y.K.</given-names></name><name><surname>Choi</surname><given-names>S.-H.</given-names></name><name><surname>Song</surname><given-names>Y.G.</given-names></name><name><surname>Kim</surname><given-names>S.-R.</given-names></name></person-group><article-title>Middle East respiratory syndrome infection control and prevention guideline for healthcare facilities</article-title><source>Infect. Chemother.</source><volume>47</volume><issue>4</issue><year>2015</year><fpage>278</fpage><lpage>302</lpage><pub-id pub-id-type="doi">10.3947/ic.2015.47.4.278</pub-id><pub-id pub-id-type="pmid">26788414</pub-id></element-citation></ref><ref id="bib32"><element-citation publication-type="journal" id="sbref32"><person-group person-group-type="author"><name><surname>Kim</surname><given-names>K.H.</given-names></name><name><surname>Tandi</surname><given-names>T.E.</given-names></name><name><surname>Choi</surname><given-names>J.W.</given-names></name><name><surname>Moon</surname><given-names>J.M.</given-names></name><name><surname>Kim</surname><given-names>M.S.</given-names></name></person-group><article-title>Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in South Korea, 2015: epidemiology, characteristics and public health implications</article-title><source>J. Hosp. Infect.</source><volume>95</volume><issue>2</issue><year>2017</year><fpage>207</fpage><lpage>213</lpage><pub-id pub-id-type="doi">10.1016/j.jhin.2016.10.008</pub-id><pub-id pub-id-type="pmid">28153558</pub-id></element-citation></ref><ref id="bib33"><element-citation publication-type="journal" id="sbref33"><person-group person-group-type="author"><name><surname>Kutter</surname><given-names>J.S.</given-names></name><name><surname>Spronken</surname><given-names>M.I.</given-names></name><name><surname>Fraaij</surname><given-names>P.L.</given-names></name><name><surname>Fouchier</surname><given-names>R.A.</given-names></name><name><surname>Herfst</surname><given-names>S.</given-names></name></person-group><article-title>Transmission routes of respiratory viruses among humans</article-title><source>Curr. Opin. Virol.</source><volume>28</volume><year>2018</year><fpage>142</fpage><lpage>151</lpage><pub-id pub-id-type="doi">10.1016/j.coviro.2018.01.001</pub-id><pub-id pub-id-type="pmid">29452994</pub-id></element-citation></ref><ref id="bib34"><element-citation publication-type="journal" id="sbref34"><person-group person-group-type="author"><name><surname>Lee</surname><given-names>S.S.</given-names></name><name><surname>Wong</surname><given-names>N.S.</given-names></name></person-group><article-title>Probable transmission chains of Middle East respiratory syndrome coronavirus and the multiple generations of secondary infection in South Korea</article-title><source>Int. J. Infect. Dis.</source><volume>38</volume><year>2015</year><fpage>65</fpage><lpage>67</lpage><pub-id pub-id-type="doi">10.1016/j.ijid.2015.07.014</pub-id><pub-id pub-id-type="pmid">26216766</pub-id></element-citation></ref><ref id="bib35"><element-citation publication-type="journal" id="sbref35"><person-group person-group-type="author"><name><surname>Lu</surname><given-names>G.</given-names></name><name><surname>Hu</surname><given-names>Y.</given-names></name><name><surname>Wang</surname><given-names>Q.</given-names></name><name><surname>Qi</surname><given-names>J.</given-names></name><name><surname>Gao</surname><given-names>F.</given-names></name><name><surname>Li</surname><given-names>Y.</given-names></name></person-group><article-title>Molecular basis of binding between novel human coronavirus MERS-CoV and its receptor CD26</article-title><source>Nature</source><volume>500</volume><issue>7461</issue><year>2013</year><fpage>227</fpage><lpage>231</lpage><pub-id pub-id-type="doi">10.1038/nature12328</pub-id><pub-id pub-id-type="pmid">23831647</pub-id></element-citation></ref><ref id="bib36"><element-citation publication-type="journal" id="sbref36"><person-group person-group-type="author"><name><surname>Luke</surname><given-names>T.</given-names></name><name><surname>Wu</surname><given-names>H.</given-names></name><name><surname>Zhao</surname><given-names>J.</given-names></name><name><surname>Channappanavar</surname><given-names>R.</given-names></name><name><surname>Coleman</surname><given-names>C.M.</given-names></name><name><surname>Jiao</surname><given-names>J.-A.</given-names></name></person-group><article-title>Human polyclonal immunoglobulin G from transchromosomic bovines inhibits MERS-CoV in vivo</article-title><source>Sci. Transl. Med.</source><volume>8</volume><issue>326</issue><year>2016</year><fpage>326ra21</fpage><pub-id pub-id-type="doi">10.1126/scitranslmed.aaf1061</pub-id></element-citation></ref><ref id="bib37"><element-citation publication-type="journal" id="sbref37"><person-group person-group-type="author"><name><surname>Mackay</surname><given-names>I.M.</given-names></name><name><surname>Arden</surname><given-names>K.E.</given-names></name></person-group><article-title>MERS coronavirus: diagnostics, epidemiology and transmission</article-title><source>Virol. J.</source><volume>12</volume><year>2015</year><fpage>222</fpage><pub-id pub-id-type="doi">10.1186/s12985-015-0439-5</pub-id><pub-id pub-id-type="pmid">26695637</pub-id></element-citation></ref><ref id="bib38"><element-citation publication-type="journal" id="sbref38"><person-group person-group-type="author"><name><surname>Memish</surname><given-names>Z.A.</given-names></name><name><surname>Al-Tawfiq</surname><given-names>J.A.</given-names></name><name><surname>Makhdoom</surname><given-names>H.Q.</given-names></name><name><surname>Al-Rabeeah</surname><given-names>A.A.</given-names></name><name><surname>Assiri</surname><given-names>A.</given-names></name><name><surname>Alhakeem</surname><given-names>R.F.</given-names></name></person-group><article-title>Screening for Middle East respiratory syndrome coronavirus infection in hospital patients and their healthcare worker and family contacts: a prospective descriptive study</article-title><source>Clin. Microbiol. Infect.</source><volume>20</volume><issue>5</issue><year>2014</year><fpage>469</fpage><lpage>474</lpage><pub-id pub-id-type="doi">10.1111/1469-0691.12562</pub-id><pub-id pub-id-type="pmid">24460984</pub-id></element-citation></ref><ref id="bib39"><element-citation publication-type="journal" id="sbref39"><person-group person-group-type="author"><name><surname>Memish</surname><given-names>Z.A.</given-names></name><name><surname>Al-Tawfiq</surname><given-names>J.A.</given-names></name><name><surname>Makhdoom</surname><given-names>H.Q.</given-names></name><name><surname>Assiri</surname><given-names>A.</given-names></name><name><surname>Alhakeem</surname><given-names>R.F.</given-names></name><name><surname>Albarrak</surname><given-names>A.</given-names></name></person-group><article-title>Respiratory tract samples, viral load, and genome fraction yield in patients with Middle East respiratory syndrome</article-title><source>J. Infect. Dis.</source><volume>210</volume><issue>10</issue><year>2014</year><fpage>1590</fpage><lpage>1594</lpage><pub-id pub-id-type="doi">10.1093/infdis/jiu292</pub-id><pub-id pub-id-type="pmid">24837403</pub-id></element-citation></ref><ref id="bib40"><element-citation publication-type="journal" id="sbref40"><person-group person-group-type="author"><name><surname>Memish</surname><given-names>Z.A.</given-names></name><name><surname>Cotten</surname><given-names>M.</given-names></name><name><surname>Meyer</surname><given-names>B.</given-names></name><name><surname>Watson</surname><given-names>S.J.</given-names></name><name><surname>Alsahafi</surname><given-names>A.J.</given-names></name><name><surname>Al Rabeeah</surname><given-names>A.A.</given-names></name></person-group><article-title>Human infection with MERS coronavirus after exposure to infected camels, Saudi Arabia, 2013</article-title><source>Emerg. Infect. Dis.</source><volume>20</volume><issue>6</issue><year>2014</year><pub-id pub-id-type="doi">10.3201/eid2006.140402</pub-id></element-citation></ref><ref id="bib41"><element-citation publication-type="journal" id="sbref41"><person-group person-group-type="author"><name><surname>Menachery</surname><given-names>V.D.</given-names></name><name><surname>Graham</surname><given-names>R.L.</given-names></name><name><surname>Baric</surname><given-names>R.S.</given-names></name></person-group><article-title>Jumping species—a mechanism for coronavirus persistence and survival</article-title><source>Curr. Opin. Virol.</source><volume>23</volume><year>2017</year><fpage>1</fpage><lpage>7</lpage><pub-id pub-id-type="doi">10.1016/j.coviro.2017.01.002</pub-id><pub-id pub-id-type="pmid">28214731</pub-id></element-citation></ref><ref id="bib42"><element-citation publication-type="journal" id="sbref42"><person-group person-group-type="author"><name><surname>Meyerholz</surname><given-names>D.K.</given-names></name><name><surname>Lambertz</surname><given-names>A.M.</given-names></name><name><surname>McCray</surname><given-names>P.B.</given-names></name></person-group><article-title>Dipeptidyl peptidase 4 distribution in the human respiratory tract</article-title><source>Am. J. Pathol.</source><volume>186</volume><issue>1</issue><year>2016</year><fpage>78</fpage><lpage>86</lpage><pub-id pub-id-type="doi">10.1016/j.ajpath.2015.09.014</pub-id><pub-id pub-id-type="pmid">26597880</pub-id></element-citation></ref><ref id="bib43"><element-citation publication-type="journal" id="sbref43"><person-group person-group-type="author"><name><surname>Milne-Price</surname><given-names>S.</given-names></name><name><surname>Miazgowicz</surname><given-names>K.L.</given-names></name><name><surname>Munster</surname><given-names>V.J.</given-names></name></person-group><article-title>The emergence of the Middle East respiratory syndrome coronavirus (MERS-CoV)</article-title><source>Pathog. Dis.</source><volume>71</volume><issue>2</issue><year>2014</year><fpage>119</fpage><lpage>134</lpage><pub-id pub-id-type="doi">10.1111/2049-632X.12166</pub-id></element-citation></ref><ref id="bib44"><element-citation publication-type="journal" id="sbref44"><person-group person-group-type="author"><name><surname>Mohd</surname><given-names>H.A.</given-names></name><name><surname>Al-Tawfiq</surname><given-names>J.A.</given-names></name><name><surname>Memish</surname><given-names>Z.A.</given-names></name></person-group><article-title>Middle East respiratory syndrome coronavirus (MERS-CoV) origin and animal reservoir</article-title><source>Virol. J.</source><year>2016</year><fpage>13</fpage><pub-id pub-id-type="doi">10.1186/s12985-016-0544-0</pub-id><pub-id pub-id-type="pmid">26811239</pub-id></element-citation></ref><ref id="bib45"><element-citation publication-type="journal" id="sbref45"><person-group person-group-type="author"><name><surname>Müller</surname><given-names>M.A.</given-names></name><name><surname>Meyer</surname><given-names>B.</given-names></name><name><surname>Corman</surname><given-names>V.M.</given-names></name><name><surname>Al-Masri</surname><given-names>M.</given-names></name><name><surname>Turkestani</surname><given-names>A.</given-names></name><name><surname>Ritz</surname><given-names>D.</given-names></name></person-group><article-title>Presence of Middle East respiratory syndrome coronavirus antibodies in Saudi Arabia: a nationwide, cross-sectional, serological study</article-title><source>Lancet Infect. Dis.</source><volume>15</volume><issue>5</issue><year>2015</year><fpage>559</fpage><lpage>564</lpage><pub-id pub-id-type="doi">10.1016/S1473-3099(15)70090-3</pub-id><pub-id pub-id-type="pmid">25863564</pub-id></element-citation></ref><ref id="bib46"><element-citation publication-type="journal" id="sbref46"><person-group person-group-type="author"><name><surname>Oboho</surname><given-names>I.K.</given-names></name><name><surname>Tomczyk</surname><given-names>S.M.</given-names></name><name><surname>Al-Asmari</surname><given-names>A.M.</given-names></name><name><surname>Banjar</surname><given-names>A.A.</given-names></name><name><surname>Al-Mugti</surname><given-names>H.</given-names></name><name><surname>Aloraini</surname><given-names>M.S.</given-names></name></person-group><article-title>2014 MERS-CoV outbreak in Jeddah—a link to health care facilities</article-title><source>N. Engl. J. Med.</source><volume>372</volume><issue>9</issue><year>2015</year><fpage>846</fpage><lpage>854</lpage><pub-id pub-id-type="doi">10.1056/NEJMoa1408636</pub-id><pub-id pub-id-type="pmid">25714162</pub-id></element-citation></ref><ref id="bib47"><element-citation publication-type="journal" id="sbref47"><person-group person-group-type="author"><name><surname>Omrani</surname><given-names>A.S.</given-names></name><name><surname>Al-Tawfiq</surname><given-names>J.A.</given-names></name><name><surname>Memish</surname><given-names>Z.A.</given-names></name></person-group><article-title>Middle East respiratory syndrome coronavirus (MERS-CoV): animal to human interaction</article-title><source>Pathog. Global Health</source><volume>109</volume><issue>8</issue><year>2015</year><fpage>354</fpage><lpage>362</lpage><pub-id pub-id-type="doi">10.1080/20477724.2015.1122852</pub-id></element-citation></ref><ref id="bib48"><element-citation publication-type="journal" id="sbref48"><person-group person-group-type="author"><name><surname>Pebody</surname><given-names>R.G.</given-names></name></person-group><article-title>Evidence of person-to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013</article-title><source>Euro Surveill.: Bulletin Européen Sur Les Maladies Transmissibles=European Communicable Disease Bulletin</source><volume>18</volume><issue>11</issue><year>2013</year></element-citation></ref><ref id="bib49"><element-citation publication-type="journal" id="sbref49"><person-group person-group-type="author"><name><surname>Raj</surname><given-names>V.S.</given-names></name><name><surname>Mou</surname><given-names>H.</given-names></name><name><surname>Smits</surname><given-names>S.L.</given-names></name><name><surname>Dekkers</surname><given-names>D.H.W.</given-names></name><name><surname>Müller</surname><given-names>M.A.</given-names></name><name><surname>Dijkman</surname><given-names>R.</given-names></name></person-group><article-title>Dipeptidyl peptidase 4 is a functional receptor for the emerging human coronavirus-EMC</article-title><source>Nature</source><volume>495</volume><issue>7440</issue><year>2013</year><fpage>251</fpage><lpage>254</lpage><pub-id pub-id-type="doi">10.1038/nature12005</pub-id><pub-id pub-id-type="pmid">23486063</pub-id></element-citation></ref><ref id="bib50"><element-citation publication-type="journal" id="sbref50"><person-group person-group-type="author"><name><surname>Reusken</surname><given-names>C.B.E.M.</given-names></name><name><surname>Haagmans</surname><given-names>B.L.</given-names></name><name><surname>Müller</surname><given-names>M.A.</given-names></name><name><surname>Gutierrez</surname><given-names>C.</given-names></name><name><surname>Godeke</surname><given-names>G.-J.</given-names></name><name><surname>Meyer</surname><given-names>B.</given-names></name></person-group><article-title>Middle East respiratory syndrome coronavirus neutralising serum antibodies in dromedary camels: a comparative serological study</article-title><source>Lancet Infect. Dis.</source><volume>13</volume><issue>10</issue><year>2013</year><fpage>859</fpage><lpage>866</lpage><pub-id pub-id-type="doi">10.1016/S1473-3099(13)70164-6</pub-id><pub-id pub-id-type="pmid">23933067</pub-id></element-citation></ref><ref id="bib51"><element-citation publication-type="journal" id="sbref51"><person-group person-group-type="author"><name><surname>Reusken</surname><given-names>C.B.E.M.</given-names></name><name><surname>Farag</surname><given-names>E.A.B.A.</given-names></name><name><surname>Haagmans</surname><given-names>B.L.</given-names></name><name><surname>Mohran</surname><given-names>K.A.</given-names></name><name><surname>Godeke</surname><given-names>G.-J.</given-names></name><name><surname>Raj</surname><given-names>S.</given-names></name></person-group><article-title>Occupational exposure to dromedaries and risk for MERS-CoV infection, Qatar, 2013–2014</article-title><source>Emerg. Infect. Dis.</source><volume>21</volume><issue>8</issue><year>2015</year><fpage>1422</fpage><lpage>1425</lpage><pub-id pub-id-type="doi">10.3201/eid2108.150481</pub-id><pub-id pub-id-type="pmid">26196891</pub-id></element-citation></ref><ref id="bib52"><element-citation publication-type="journal" id="sbref52"><person-group person-group-type="author"><name><surname>Sabir</surname><given-names>J.S.M.</given-names></name><name><surname>Lam</surname><given-names>T.T.-Y.</given-names></name><name><surname>Ahmed</surname><given-names>M.M.M.</given-names></name><name><surname>Li</surname><given-names>L.</given-names></name><name><surname>Shen</surname><given-names>Y.</given-names></name><name><surname>Abo-Aba</surname><given-names>S.E.M.</given-names></name></person-group><article-title>Co-circulation of three camel coronavirus species and recombination of MERS-CoVs in Saudi Arabia</article-title><source>Science (New York, NY)</source><year>2015</year><pub-id pub-id-type="doi">10.1126/science.aac8608</pub-id></element-citation></ref><ref id="bib53"><element-citation publication-type="journal" id="sbref53"><person-group person-group-type="author"><name><surname>van Doremalen</surname><given-names>N.</given-names></name><name><surname>Bushmaker</surname><given-names>T.</given-names></name><name><surname>Munster</surname><given-names>V.J.</given-names></name></person-group><article-title>Stability of Middle East respiratory syndrome coronavirus (MERS-CoV) under different environmental conditions</article-title><source>Euro Surveill.: Bulletin Europeen Sur Les Maladies Transmissibles=European Communicable Disease Bulletin</source><volume>18</volume><issue>38</issue><year>2013</year></element-citation></ref><ref id="bib54"><element-citation publication-type="journal" id="sbref54"><person-group person-group-type="author"><name><surname>Virlogeux</surname><given-names>V.</given-names></name><name><surname>Fang</surname><given-names>V.J.</given-names></name><name><surname>Park</surname><given-names>M.</given-names></name><name><surname>Wu</surname><given-names>J.T.</given-names></name><name><surname>Cowling</surname><given-names>B.J.</given-names></name></person-group><article-title>Comparison of incubation period distribution of human infections with MERS-CoV in South Korea and Saudi Arabia</article-title><source>Sci. Rep.</source><volume>6</volume><year>2016</year><pub-id pub-id-type="doi">10.1038/srep35839</pub-id></element-citation></ref><ref id="bib55"><mixed-citation publication-type="other" id="otherref0005">WHO, 2017. Confirmed global cases of MERS-CoV. <<ext-link ext-link-type="uri" xlink:href="http://www.who.int/emergencies/mers-cov/epi-17-november-2017.png?ua=1" id="interref55">http://www.who.int/emergencies/mers-cov/epi-17-november-2017.png?ua=1</ext-link>> (retrieved 07.03.18.).</mixed-citation></ref><ref id="bib56"><mixed-citation publication-type="other" id="otherref0010">WHO, n.d. MERS-CoV global summary and assessment of risk. <<ext-link ext-link-type="uri" xlink:href="http://www.who.int/emergencies/mers-cov/risk-assessment-july-2017.pdf" id="interref56">http://www.who.int/emergencies/mers-cov/risk-assessment-july-2017.pdf</ext-link>> (retrieved 21.07.17.).</mixed-citation></ref><ref id="bib57"><element-citation publication-type="journal" id="sbref55"><person-group person-group-type="author"><name><surname>Widagdo</surname><given-names>W.</given-names></name><name><surname>Begeman</surname><given-names>L.</given-names></name><name><surname>Schipper</surname><given-names>D.</given-names></name><name><surname>van Run</surname><given-names>P.R.</given-names></name><name><surname>Cunningham</surname><given-names>A.A.</given-names></name><name><surname>Kley</surname><given-names>N.</given-names></name></person-group><article-title>Tissue distribution of the MERS-coronavirus receptor in bats</article-title><source>Sci. Rep.</source><volume>7</volume><issue>1</issue><year>2017</year><fpage>1193</fpage><pub-id pub-id-type="doi">10.1038/s41598-017-01290-6</pub-id><pub-id pub-id-type="pmid">28446791</pub-id></element-citation></ref><ref id="bib58"><element-citation publication-type="journal" id="sbref56"><person-group person-group-type="author"><name><surname>Woo</surname><given-names>P.C.Y.</given-names></name><name><surname>Lau</surname><given-names>S.K.P.</given-names></name><name><surname>Li</surname><given-names>K.S.M.</given-names></name><name><surname>Poon</surname><given-names>R.W.S.</given-names></name><name><surname>Wong</surname><given-names>B.H.L.</given-names></name><name><surname>Tsoi</surname><given-names>H.</given-names></name></person-group><article-title>Molecular diversity of coronaviruses in bats</article-title><source>Virology</source><volume>351</volume><issue>1</issue><year>2006</year><fpage>180</fpage><lpage>187</lpage><pub-id pub-id-type="doi">10.1016/j.virol.2006.02.041</pub-id><pub-id pub-id-type="pmid">16647731</pub-id></element-citation></ref><ref id="bib59"><element-citation publication-type="journal" id="sbref57"><person-group person-group-type="author"><name><surname>Yu</surname><given-names>P.</given-names></name><name><surname>Xu</surname><given-names>Y.</given-names></name><name><surname>Deng</surname><given-names>W.</given-names></name><name><surname>Bao</surname><given-names>L.</given-names></name><name><surname>Huang</surname><given-names>L.</given-names></name><name><surname>Xu</surname><given-names>Y.</given-names></name></person-group><article-title>Comparative pathology of rhesus macaque and common marmoset animal models with Middle East respiratory syndrome coronavirus</article-title><source>PLoS One</source><volume>12</volume><issue>2</issue><year>2017</year><fpage>e0172093</fpage><pub-id pub-id-type="doi">10.1371/journal.pone.0172093</pub-id><pub-id pub-id-type="pmid">28234937</pub-id></element-citation></ref><ref id="bib60"><element-citation publication-type="journal" id="sbref58"><person-group person-group-type="author"><name><surname>Zaki</surname><given-names>A.M.</given-names></name><name><surname>van Boheemen</surname><given-names>S.</given-names></name><name><surname>Bestebroer</surname><given-names>T.M.</given-names></name><name><surname>Osterhaus</surname><given-names>A.D.M.E.</given-names></name><name><surname>Fouchier</surname><given-names>R.A.M.</given-names></name></person-group><article-title>Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia</article-title><source>N. Engl. J. Med.</source><volume>367</volume><year>2012</year><fpage>1814</fpage><lpage>1820</lpage><pub-id pub-id-type="doi">10.1056/NEJMoa1211721</pub-id><pub-id pub-id-type="pmid">23075143</pub-id></element-citation></ref><ref id="bib61"><element-citation publication-type="journal" id="sbref59"><person-group person-group-type="author"><name><surname>Zielecki</surname><given-names>F.</given-names></name><name><surname>Weber</surname><given-names>M.</given-names></name><name><surname>Eickmann</surname><given-names>M.</given-names></name><name><surname>Spiegelberg</surname><given-names>L.</given-names></name><name><surname>Zaki</surname><given-names>A.M.</given-names></name><name><surname>Matrosovich</surname><given-names>M.</given-names></name></person-group><article-title>Human cell tropism and innate immune system interactions of human respiratory coronavirus EMC compared to SARS-coronavirus</article-title><source>J. Virol.</source><volume>87</volume><issue>9</issue><year>2013</year><fpage>5300</fpage><lpage>5304</lpage><pub-id pub-id-type="doi">10.1128/JVI.03496-12</pub-id><pub-id pub-id-type="pmid">23449793</pub-id></element-citation></ref><ref id="bib62"><element-citation publication-type="journal" id="sbref60"><person-group person-group-type="author"><name><surname>Zumla</surname><given-names>A.</given-names></name><name><surname>Chan</surname><given-names>J.F.W.</given-names></name><name><surname>Azhar</surname><given-names>E.I.</given-names></name><name><surname>Hui</surname><given-names>D.S.C.</given-names></name><name><surname>Yuen</surname><given-names>K.-Y.</given-names></name></person-group><article-title>Coronaviruses—drug discovery and therapeutic options</article-title><source>Nat. Rev. Drug Discov.</source><volume>15</volume><issue>5</issue><year>2016</year><fpage>327</fpage><lpage>347</lpage><pub-id pub-id-type="doi">10.1038/nrd.2015.37</pub-id><pub-id pub-id-type="pmid">26868298</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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