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Lately shocked the world with the spread of MERS (Middle East Respiratory Syndrome) which occurred in several countries. Until May 5, 2014, MERS found in middle eastern countries include, Jordan, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates and Yemen, France , Germany, Greece, Italy, the UK, Tunisia, Egypt, Malaysia and the Philippines and United States last report. Overall the case has close links with the Middle East. In France, Italy, Tunisia and the United Kingdom (UK), limited local transmission has occurred in people with no history of visiting the Middle East but has a history of close contact with patients with suspected MERS – CoV.

And Saudi Arabia is the greatest country that experienced epidemic disease caused by this virus. Number of patients per May 1, 2014 reached 449 patients, while 121 people died reached.

MERS is a respiratory disease caused by a virus. MERS first case reported in Saudi Arabia in 2012. Virus that causes this disease is a type of corona virus (coronavirus) so that the virus is named MERS – CoV. Corona virus is a large family of viruses that cause pain with varying degrees of severity. Most people with MERS experienced severe acute respiratory illness.

Human corona virus was first discovered in the mid 1960s. This virus is found from the results of the patient ‘s nostrils swabs common cold (flu). The scientists named the corona virus as there are protrusions shaped crown (crown) on its surface .


The corona virus causes respiratory tract infections in humans and animals (especially mammals and birds). However, in addition to respiratory infections, the virus can also infect the gastrointestinal tract. Approximately 30 % of flu symptoms caused by two types of corona virus that HCoV – 229E and HCoV – OC43. Until now identified seven types of corona virus that can infect humans that HCoV – 229E, HCoV – OC43, SARS – CoV, NL63 – CoV, HKU1 – CoV, HCoV – EMC, and MERS – CoV.

More or less MERS epidemic remind us again with the SARS epidemic (Severe Acute Respiratory Syndrome) which have occurred in 2003 after it was first discovered in Guandong, China in November 2002. Maybe we wondered then what is the difference between MERS with SARS ?

MERS can be said to be similar but not identical to SARS. Both are caused by a corona virus, but by a different type. Corona virus that causes MERS (MERS – CoV) is a corona virus with strains of C. Lineage incubation period MERS – CoV virus is 2-14 days. The incubation period is the time from the first infected with the virus until the onset of symptoms. The most fundamental difference of the two is the spread of SARS – CoV more quickly and easily than with MERS – CoV. However, the data showed that the progression of the disease to manifest respiratory failure occurred in MERS faster than SARS.

Corona virus transmitted or spread from patient to person through the air (coughing / sneezing) and close contact with patients, for example by touching or shaking hands. The virus can also be spread by touching contaminated objects or surfaces and then with the same hand holding the mouth, nose, or eyes.

Transmission from animals is also unclear, although obtained evidence that MERS -CoV virus are similar to those obtained from humans in some populations camel in Egypt, Qatar and Saudi Arabia, based on it is still possible to obtain MERS – CoV virus to other animals such as goats, sheep, cows, pigs and other. This still requires further research. Research in Egypt in slaughterhouses found 3.6 % of camel infected MERS – CoV but virus isn’t found in humans who contact with around. Based in this problem camels as a source of transmission of MERS – CoV still require further research, however caution should still be do.

Symptoms after a person is infected with corona virus symptoms of upper respiratory tract infections in general such as fever, cough, runny nose, sore throat and difficulty in breathing or chest tightness and can be accompanied by gastrointestinal symptoms, including diarrhea. Moreover, it can happen also symptoms of lower respiratory tract infections that manifest into pneumonia (lung inflammation) to respiratory failure that can be encountered on MERS – CoV infection and SARS –CoV.

Deaths from MERS – CoV cases were reported in 1 of 3 patients (27 %) and the disease becomes severe in people with diabetes, chronic lung disease, asthma and immune disorders. In contrast to some of the people who contact with patients MERS – CoV infection showed positive but not sick.

The resilience of the corona virus infection diagnosis can be do with some laboratory tests. The examination includes virus isolation in cell culture, PCR (Polymerase Chain Reaction) to examine the viral DNA, serological tests to check for antibodies to the corona virus. However, in general, if that happens only mild symptoms, various checks are not necessary.

There is no specific treatment for the disease caused by the human corona virus and the vaccine for this virus has not yet been found. Influenza vaccine is not to prevent this virus, but the virus to prevent infection of other risk factors that facilitate contracting MERS – CoV. Most people with the disease caused by a corona virus infections will heal on its own like most other viral diseases. However, there are factors that can worsen the condition of old age and the infection of a person with impaired immune system.

Therefore, better prevention of corona virus infection in general and MERS – CoV in particular. Prevention is the most important thing to do is to implement healthy behavior and healthy life as diligent hand washing with soap and water, not carelessly touching the mouth, nose, or eyes with dirty hands, and avoid contact with the patient. If you are already infected and showing symptoms, then the thing to do is rest, plenty of drink, and use drugs to relieve the symptoms that accompany such as fever and sore throat. If symptoms persist, you should immediately meet with medical personnel. Special vaccination to prevent the MERS – CoV have not been determined .

And for those who will travel or go out to the Middle East to the Hajj or Umrah trip purpose and the Indonesian workers (TKI) there are few prevention of MERS to do, namely :

• For patients with chronic diseases such as diabetes mellitus, chronic disease and immune impairment is recommended to delay the departure , but if not then expected to prepare a health condition in a stable condition .

• Understanding of health information in the course of such vigilance to understand the symptoms of influenza, respiratory infections and diarrhea, and immediately report the condition to the officer in place of arrival and departure. Give emphasis to improve hygiene by washing hands with soap and clean water, healthy foods and clean (food covered), avoid any foods or beverages that are not cooked, washing fruits and vegetables before eating and other hygiene.

• If symptoms are acute respiratory illness such as fever, cough or shortness of more severe to interfere with daily activities should minimize contact with many people, applying ethics cough properly, that is covering your nose and mouth when coughing and sneezing, dispose of the tissue when using tissue and wash your hands immediately afterward, or close it with his sleeve.

• If a return from the Middle East and experiencing symptoms of acute respiratory illness immediately went to the health center, doctor or other health care facilities, especially in the 2 weeks since coming home.

• If the same symptoms found in people or family members who contact with people who have symptoms of MERS – CoV it must also immediately report to the health workers such as health centers, hospitals and other health services.

• Convey the health professionals that the patient has a history of travel to the Middle East countries especially Hajj and Umrah or as workers.

• During the Hajj or Umrah avoid contact with farm animals, especially camels, went to the farm , livestock market or livestock slaughterhouse

• Avoid eating raw animal products like raw camel milk, or other raw animal products

• Eat healthy foods and clean, when buying food that is cooked and covered choose to avoid contamination of any debris including animal feces .

• Consumption of fruits and vegetables after washed

If there are symptoms and also have risk factors for MERS-CoV infection, for example, there is a history of direct contact with patients or there is a history of traveling to places MERS sources (the Middle Eastern country), you should immediately consult the medical staff to do further screening. To address this MERS epidemic, governments of various countries have already put items in the international airport screening each and for positive people who are infected will be quarantined MERS-CoV closely at health centers to improve the patient’s condition.

# from various sources

Written by dr. Yelsi Khairani & dr Yahmin Setiawan, MARS

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