+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

A review of asymptomatic and sub-clinical Middle East Respiratory Syndrome Coronavirus Infections



A review of asymptomatic and sub-clinical Middle East Respiratory Syndrome Coronavirus Infections



Epidemiologic Reviews 2019



The epidemiology of Middle East Respiratory syndrome coronavirus (MERS-CoV) since 2012 has been largely characterised by recurrent zoonotic spill-over from dromedary camels followed by limited human-to-human transmission, predominantly in health care settings. The full extent of infection of MERS-CoV is not clear, nor is the extent and/or role of asymptomatic infections in transmission. We conducted a review of molecular and serological investigations through PubMed and EMBASE from September 2012 to 15 November 2018 attempting to measure sub-clinical or asymptomatic MERS-CoV infection within and outside of health care settings. We performed retrospective analysis of laboratory-confirmed MERS-CoV infections reported to the World Health Organization to 27 November 2018 to summarize what is known about asymptomatic infections identified through national surveillance systems. We identified 23 studies reporting evidence of MERS-CoV infection outside health care settings, mainly of camel workers, showing ranges of seroprevalence of 0-67% depending on the study location. We identified 20 studies in health care settings, of health care worker (HCW) and family contacts, of which 11 documented molecular evidence of MERS-CoV infection among asymptomatic contacts. Since 2012, 298 laboratory confirmed cases were reported as asymptomatic to the World Health Organization, 164 of whom were HCW. Viral shedding studies of asymptomatic MERS infections have demonstrated the potential to transmit MERS-CoV to others. Our results highlight the possibility for onward transmission of MERS-CoV from asymptomatic individuals. Screening of HCW contacts of confirmed MERS-CoV patients is currently recommended, but systematic screening of non-HCW contacts outside of health care facilities should be encouraged.

Please choose payment method:






(PDF emailed within 1 workday: $29.90)

Accession: 069565827

Download citation: RISBibTeXText

PMID: 31781765


Related references

A family cluster of Middle East Respiratory Syndrome Coronavirus infections related to a likely unrecognized asymptomatic or mild case. International Journal of Infectious Diseases 17(9): E668-E672, 2013

Healthcare-associated infections: the hallmark of Middle East respiratory syndrome coronavirus with review of the literature. Journal of Hospital Infection 101(1): 20-29, 2019

Proficiency testing for the detection of Middle East respiratory syndrome coronavirus demonstrates global capacity to detect Middle East respiratory syndrome coronavirus. Journal of Medical Virology 90(12): 1827-1833, 2018

Assessing the Detection of Middle East Respiratory Syndrome Coronavirus IgG in Suspected and Proven Cases of Middle East Respiratory Syndrome Coronavirus Infection. Viral Immunology 30(9): 649-653, 2017

Asymptomatic Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: Extent and implications for infection control: A systematic review. Travel Medicine and Infectious Disease 27: 27-32, 2019

Asymptomatic Middle East respiratory syndrome coronavirus infection in rabbits. Journal of Virology 89(11): 6131-6135, 2015

Infectivity of an Asymptomatic Patient With Middle East Respiratory Syndrome Coronavirus Infection. Clinical Infectious Diseases 64(10): 1457-1458, 2017

Asymptomatic Middle East Respiratory Syndrome coronavirus infection using a serologic survey in Korea. Epidemiology and Health 40: E2018014, 2018

Hospital-associated Middle East respiratory syndrome coronavirus infections. New England Journal of Medicine 369(18): 1761-1761, 2013

Family cluster of Middle East respiratory syndrome coronavirus infections. New England Journal of Medicine 368(26): 2487-2494, 2013

Lack of detection of Middle East respiratory syndrome coronavirus in mild and severe respiratory infections in Catalonia, northeastern Spain. New Microbes and new Infections 2(1): 27-28, 2014

Middle East respiratory syndrome coronavirus infections in health care workers. New England Journal of Medicine 369(9): 884-886, 2013

Cluster of Middle East respiratory syndrome coronavirus infections in Iran, 2014. Emerging Infectious Diseases 21(2): 362-364, 2015

Seroprevalence of Middle East Respiratory Syndrome Coronavirus Among Healthcare Personnel Caring for Patients With Middle East Respiratory Syndrome in South Korea. Infection Control and Hospital Epidemiology 37(12): 1513-1514, 2016

Family cluster of Middle East respiratory syndrome coronavirus infections, Tunisia, 2013. Emerging Infectious Diseases 20(9): 1527-1530, 2014