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16 March 2016
Middle East Respiratory Syndrome  

Causative agent

Middle East respiratory syndrome (MERS) is a viral respiratory disease caused by a novel coronavirus that was first identified in Saudi Arabia in 2012. Coronaviruses are a large family of viruses which include viruses that may cause mild illness like common cold as well as severe illness like severe acute respiratory syndrome (SARS) in humans. There are 3 main subgroups of coronaviruses: alpha (α), beta (β) and gamma (γ). Middle East Respiratory Syndrome Coronavirus (MERS-CoV), is a beta coronavirus which has not been identified in humans before and is different from any coronaviruses (including SARS-coronavirus) that have been found in humans or animals.

Clinical features

Infected persons may present with acute serious respiratory illness with symptoms including fever, cough, shortness of breath and breathing difficulties. Most patients with MERS developed severe complications such as pneumonia and kidney failure. Many also had gastrointestinal symptoms including diarrhoea and nausea/vomiting. In people with immune deficiencies, the disease may have atypical presentation.

Mode of transmission

There is still uncertainty at the moment. People may be infected upon exposure to animals (especially camel), environment or other confirmed patients (such as in a hospital setting).

Coronaviruses are typically spread like other respiratory infections such as influenza. Based on the current information, MERS-CoV could be spread from person-to-person through close contact. Since April 2014, many cases appeared to be secondary cases which might have been infected from a confirmed patient. These secondary cases were mainly healthcare workers who had taken care of patients suffering from MERS and were infected within healthcare settings. Some of them presented with no or mild symptoms.

Besides, scientific studies support that camels serve as the primary source of MERS-CoV.

Incubation period

2 – 14 days


There is currently no specific treatment for the disease. Treatment is supportive.


Wear surgical mask and seek medical advice promptly if respiratory symptoms develop.

Personal hygiene

  • Keep hands clean
    • Wash hands frequently with liquid soap and water especially after sneezing, coughing or cleaning the nose.
    • When hands are not visibly soiled, clean them with 70 - 80% alcohol-based handrub as an effective alternative.
    • Avoid touching your eyes, nose and mouth before washing hands.
  • Cover nose and mouth with tissue paper while sneezing or coughing and dispose of soiled tissue paper in a lidded rubbish bin.
  • Build up good body immunity by having a balanced diet, regular exercise and adequate rest, do not smoke and avoid alcohol consumption.

Environmental hygiene

Though coronaviruses may survive for some time in the environment, they are easily destroyed by most detergents and cleaning agents. It is important to:

  • Maintain good ventilation.
  • Avoid visiting crowded places with poor ventilation.
  • Keep our home clean – clean and disinfect frequently touched surfaces, furniture, commonly shared items and floor at least once daily by using appropriate disinfectant. For non-metallic surface, clean with diluted household bleach (e.g. mixing 10ml of bleach containing 5.25% sodium hypochlorite with 990ml of water), wait until dry and then rinse with water. For metallic surface, disinfect with 70% alcohol.

Travel health advice

Consult a health care provider at least 6 weeks before travelling to review the risk, as pre-existing major medical conditions including diabetes, chronic lung disease, pre-existing renal failure, or immunocompromised conditions can increase the likelihood of medical problems, including MERS, during travel.

  • Avoid going to farms, barns and markets with camels.
  • Avoid contact with animals, especially camels (including riding camels or participating in any activity involving contact with camels), birds, poultry or sick people during travel.
  • Wash hands regularly before and after touching animals in case of visits to farms, barns or markets with camels.
  • Avoid close contact with sick people, especially with those suffering from acute respiratory infections, and avoid visit to healthcare settings with MERS patients.
  • Adhere to food safety and hygiene rules such as avoiding consuming raw or undercooked animal products, including milk and meat, or foods which may be contaminated by animal secretions, excretions (such as urine) or products, unless they have been properly cooked, washed or peeled.
  • If feeling unwell, put on a surgical mask and seek medical attention immediately.
    • Before departure: postpone your trip until recovery.
    • While overseas: inform hotel staff or tour leader.
    • After returning home: during medical consultation, inform doctor of recent travel history.

Special note for people planning to travel for pilgrimage

Pilgrims with pre-existing major medical conditions (e.g. diabetes, chronic lung disease, chronic renal disease, immunodeficiency, etc.) are more likely to develop severe infection for MERS if they are exposed to the virus. Thus, pilgrims should consult a health care provider before travelling to review the risk and assess whether making the pilgrimage is advisable. They are advised to delay travel if suffering from a significant acute respiratory illness with fever and cough.

Pilgrims should cover their mouth and nose when coughing or sneezing, and wash hands after contact with respiratory secretions. If suffering from acute febrile respiratory symptoms, keep a distance of one metre with other persons.

If pilgrims develop a significant acute respiratory illness with fever and cough (severe enough to interfere with usual daily activities) during Umra or Hajj, they should:

  • report to the medical staff accompanying the group or to the local health services;
  • cover their mouth and nose when coughing or sneezing, wash hands afterwards, or if this is not possible, cough or sneeze into upper sleeves of their clothing;
  • avoid attending crowded places and preferably isolate themselves until the end of the respiratory symptoms and, if isolation is not possible, use a surgical mask or a tissue for covering nose and mouth when in crowded places.

If pilgrims feel unwell during the two weeks after returning to Hong Kong, seek medical attention immediately and inform doctor of recent travel history.

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