Extended Viral Shedding of MERS-CoV Clade B Virus in Llamas Compared with African Clade C Strain
Jordi RodonAnna Z. MykytynNigeer TeNisreen M.A. OkbaMart M. LamersLola Pailler‐GarcíaGuillermo CanteroIrina C. AlbulescuBerend‐Jan BoschMalik PeirisAlbert BensaïdJúlia Vergara‐AlertBart L. HaagmansJoaquím Segalés
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Abstract:
Middle East respiratory syndrome coronavirus (MERS-CoV) clade B viruses are found in camelids and humans in the Middle East, but clade C viruses are not. We provide experimental evidence for extended shedding of MERS-CoV clade B viruses in llamas, which might explain why they outcompete clade C strains in the Arabian Peninsula.Keywords:
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Viral Shedding
Objective: To provide a conceptual and clinical review of Middle East respiratory syndrome. Data Sources: Peer-reviewed articles were identified through searches of PubMed using the terms "Middle East respiratory syndrome," "coronavirus respiratory illness in Saudi Arabia," and "novel (beta) coronavirus and human coronavirus Erasmus Medical Center". In addition, articles were searched on the websites of the World Health Organization and the U.S. Centers for Disease Control and Prevention using the terms "Middle East respiratory syndrome" and "novel coronavirus in Middle East." The reference lists of these articles and relevant review articles were also reviewed. Study Selection and Data Extraction: Final references were selected for inclusion in the review on the basis of their relevance. Data Synthesis: The emerging Middle East respiratory syndrome coronavirus causes severe pulmonary disease with multiorgan involvement and a high fatality rate. Within months after its emergence, Middle East respiratory syndrome coronavirus was reported in several countries worldwide in people who had traveled from the Middle East. Middle East respiratory syndrome coronavirus is considered a zoonotic virus that has crossed the species barrier to humans, but the pathogenesis and the routes of transmission are not completely understood. There is currently no recommended treatment for Middle East respiratory syndrome coronavirus, although supportive treatment has played an important role. Conclusions: This syndrome has raised global public health concerns about the dissemination of an emerging infectious disease and highlights the need for a coordinated global response to contain such a disease threat.
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Middle East Respiratory Syndrome (MERS) is a viral respiratory illness that is new to humans. It is caused by a coronavirus specifically called Middle East Respiratory Syndrome Corona virus (MERS-CoV).1,2 The public health impact of this disease in India is considerable if one considers the frequency of travel of the considerable Indian expatriate population in the Middle East countries between their place of work and their native cities.
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Middle East respiratory syndrome coronavirus was first described in 2012. More than 1800 cases have been reported so far, the majority from countries in the Middle East region. This article outlines current understanding of the epidemiological and clinical features of Middle East respiratory syndrome coronavirus infection.
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Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic infection that emerged in the Middle East in 2012. Symptoms range from mild to severe and include both respiratory and gastrointestinal illnesses. The virus is mainly present in camel populations with occasional zoonotic spill over into humans. The severity of infection in humans is influenced by numerous factors, and similar to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), underlying health complications can play a major role. Currently, MERS-CoV and SARS-CoV-2 are coincident in the Middle East and thus a rapid way of sequencing MERS-CoV to derive genotype information for molecular epidemiology is needed. Additionally, complicating factors in MERS-CoV infections are coinfections that require clinical management. The ability to rapidly characterize these infections would be advantageous. To rapidly sequence MERS-CoV, an amplicon-based approach was developed and coupled to Oxford Nanopore long read length sequencing. This and a metagenomic approach were evaluated with clinical samples from patients with MERS. The data illustrated that whole-genome or near-whole-genome information on MERS-CoV could be rapidly obtained. This approach provided data on both consensus genomes and the presence of minor variants, including deletion mutants. The metagenomic analysis provided information of the background microbiome. The advantage of this approach is that insertions and deletions can be identified, which are the major drivers of genotype change in coronaviruses. IMPORTANCE Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in late 2012 in Saudi Arabia. The virus is a serious threat to people not only in the Middle East but also in the world and has been detected in over 27 countries. MERS-CoV is spreading in the Middle East and neighboring countries, and approximately 35% of reported patients with this virus have died. This is the most severe coronavirus infection so far described. Saudi Arabia is a destination for many millions of people in the world who visit for religious purposes (Umrah and Hajj), and so it is a very vulnerable area, which imposes unique challenges for effective control of this epidemic. The significance of our study is that clinical samples from patients with MERS were used for rapid in-depth sequencing and metagenomic analysis using long read length sequencing.
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Two coronaviruses causing severe respiratory disease and high mortality rates emerging within the past dozen years reinforces the need for clinically efficacious antivirals targeting coronaviruses. Alternative screening approaches for antivirals against the recently emergent Middle East respiratory syndrome coronavirus (MERS-CoV) may provide lead compounds to address this need. Two Antimicrobial Agents and Chemotherapy (AAC) papers screened libraries of approved compounds that may potentially be repurposed as MERS-CoV antivirals. A third AAC paper showed that a previously described severe acute respiratory syndrome coronavirus (SARS-CoV) helicase inhibitor also has activity against MERS-CoV.
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The Middle East Respiratory Syndrome coronavirus (MERS-CoV) has been detected in a number of countries in the Middle East and Europe with an apparently high mortality rate. It is phylogenetically related to the SARS coronavirus and has also been associated with severe respiratory illness as well as nosocomial transmission in healthcare settings. Current international recommendations do not support any specific therapies; however, there are a number of agents, which were used during the SARS epidemic of 2003. It is possible that these might be active against the related MERS coronavirus. We have reviewed the literature on the safety and efficacy of therapies used in patients with SARS with a view to their potential use in patients with MERS-CoV infections.
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The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is an important emerging respiratory pathogen. MERS-CoV resulted in multiple hospital outbreaks within and outside the Arabian Peninsula. The disease has a high case fatality rate, with the need for a therapeutic option. Areas covered: In this review, we provide an overview of the progress in the development of therapeutic strategies for MERS. We searched PubMed, Embase, Cochrane, Scopus, and Google Scholar, using the following terms: 'MERS', 'MERS-CoV', 'Middle East respiratory syndrome' in combination with 'treatment' or 'therapy'. Expert commentary: There are multiple agents tried in vitro and in vivo. None of these agents were used in large clinical studies. Available clinical studies are limited to the use of the combination of interferon and other agents. These clinical studies are based solely on case reports and case series. There are no prospective or randomized trials. There is a need to have prospective and randomized clinical trials for the therapy of MERS-CoV. However, this strategy might be hampered by the sporadic cases outside the large hospital outbreaks.
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Middle East Respiratory Syndrome Coronavirus during Pregnancy, Abu Dhabi, United Arab Emirates, 2013
As of June 19, 2015, the World Health Organization had received 1,338 notifications of laboratory-confirmed infection with Middle East respiratory syndrome coronavirus (MERS-CoV). Little is known about the course of or treatment for MERS-CoV in pregnant women. We report a fatal case of MERS-CoV in a pregnant woman administered combination ribavirin-peginterferon-α therapy.
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Abstract The severe acute respiratory syndrome Coronavirus ( SARS‐CoV ) and the Middle East respiratory syndrome Coronavirus ( MERS‐CoV ) are two highly pathogenic viruses that recently emerged from zoonotic sources. In 2002, SARS‐CoV was identified as the agent that causes severe acute respiratory syndrome, or SARS , in the Guangdong province of China (Drosten et al ., 2003; Marra et al ., 2003; Rota et al ., 2003). Almost 10 years later in 2012, MERS‐CoV was identified as the cause of Middle East respiratory syndrome, or MERS , in the Kingdom of Saudi Arabia ( KSA ) (Coleman and Frieman, 2014). There have been no new infections of SARS‐CoV reported since 2004, but it is possible that this virus could re‐emerge, as it is capable of spreading to humans again from its zoonotic source (Yang et al ., 2013). In 2015, MERS‐CoV continues to spread throughout the Middle East and to other neighboring countries. Here, we review the epidemiology, clinical disease and virology of these disease‐causing viruses. Key Concepts Emerging Coronaviruses are serious threat to global public health. Infection control in outbreak setting is crucial for containing Coronavirus spread. Coronavirus genome structures are conserved between known and newly identified family members. Therapeutic development is crucial for front line healthcare worker protection. Animal model development is essential to understand the underlying pathology of each virus. Comparisons between SARS‐CoV, MERS‐CoV and other human coronaviruses will give us insights into disease progression and therapeutic direction.
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