Zespół oddechowy bliskiego wschodu (mers) – Rokowania, prognozy i postęp choroby

Zespół oddechowy bliskiego wschodu (mers)
Rokowania, prognozy i postęp choroby

Zespół oddechowy Bliskiego Wschodu (MERS), wywoływany przez koronawirusa MERS-CoV, charakteryzuje się wysoką śmiertelnością sięgającą około 35-36%, z surowym współczynnikiem śmiertelności wynoszącym 32,1% (95% CI: 29,9%-34,3%). Wskaźnik ten jest znacznie wyższy niż w przypadku SARS (~10%), co wiąże się z częstszym występowaniem zespołu ostrej niewydolności oddechowej (ARDS) u pacjentów z MERS. Czynniki ryzyka złego rokowania obejmują wiek >60 lat, płeć męską, choroby współistniejące takie jak cukrzyca, przewlekła choroba nerek, choroby płuc, nadciśnienie tętnicze, choroby układu sercowo-naczyniowego, nowotwory oraz obniżoną odporność. Pacjenci z chorobami współistniejącymi mają około 4-krotnie wyższe ryzyko zgonu (skorygowany HR 3,74; 95% CI: 2,57-5,67). Mediana czasu od wystąpienia objawów do przyjęcia na OIT wynosi około 5 dni, a do zgonu około 12 dni, z gwałtownym wzrostem ryzyka śmierci w pierwszym tygodniu (średni dzienny przyrost 13%).

Prognostyka Zespołu Oddechowego Bliskiego Wschodu (MERS)

Wskaźniki śmiertelności
Czynniki ryzyka niekorzystnego rokowania
Progresja choroby i śmiertelność w czasie
Prognostyka w grupach szczególnego ryzyka
Czynniki wpływające na rozprzestrzenianie i śmiertelność
Możliwości terapeutyczne i ich wpływ na prognozę
Podsumowanie czynników prognostycznych
Kolejne rozdziały

Prognostyka Zespołu Oddechowego Bliskiego Wschodu (MERS)

Zespół oddechowy Bliskiego Wschodu (MERS) jest poważną chorobą układu oddechowego wywoływaną przez koronawirusa MERS-CoV. Od czasu pierwszego zidentyfikowania w Arabii Saudyjskiej w 2012 roku, choroba ta stała się istotnym patogenem oddechowym o zasięgu globalnym, charakteryzującym się wysoką śmiertelnością i poważnymi powikłaniami, zwłaszcza u osób z chorobami współistniejącymi.¹²

Wskaźniki śmiertelności

Według danych Światowej Organizacji Zdrowia (WHO), współczynnik śmiertelności wśród potwierdzonych przypadków MERS wynosi około 35-36%. Należy jednak zaznaczyć, że może to być zawyżona wartość, ponieważ łagodne przypadki zakażeń MERS-CoV często pozostają niewykryte przez istniejące systemy nadzoru.³⁴ W analizie danych do końca października 2016 roku surowy współczynnik śmiertelności wynosił 32,1% (95% przedział ufności: 29,9%, 34,3%).⁵

Porównując z innymi koronawirusami wywołującymi ciężkie zakażenia, wskaźnik śmiertelności MERS jest znacznie wyższy niż w przypadku SARS (zespołu ciężkiej ostrej niewydolności oddechowej), który wynosi około 10%, co odzwierciedla większą częstość występowania zespołu ostrej niewydolności oddechowej (ARDS) u pacjentów z MERS.⁶

Czynniki ryzyka niekorzystnego rokowania

Zidentyfikowano szereg czynników, które są związane z gorszym rokowaniem i zwiększonym ryzykiem zgonu u pacjentów z MERS:⁷⁸

Wiek powyżej 60 lat⁹
Płeć męska¹⁰¹¹
Choroby współistniejące, szczególnie:¹²¹³
Niski poziom albumin¹⁴
Postępująca limfocytopenia¹⁵

Analiza danych wykazała, że pacjenci z chorobami współistniejącymi mają około 4-krotnie wyższe ryzyko zgonu w porównaniu do osób bez takich chorób (skorygowany współczynnik ryzyka 3,74; 95% CI: 2,57, 5,67).¹⁶

Progresja choroby i śmiertelność w czasie

Obserwacje dotyczące przebiegu czasowego MERS wskazują na szybką progresję choroby w ciężkich przypadkach:¹⁷

Mediana czasu od wystąpienia objawów do przyjęcia na oddział intensywnej terapii wynosi około 5 dni
Mediana czasu od wystąpienia objawów do zgonu wynosi około 12 dni

Ryzyko zgonu z powodu MERS gwałtownie wzrasta w pierwszym tygodniu od początku choroby, ze średnim dziennym przyrostem wynoszącym 13%.¹⁸

Prognostyka w grupach szczególnego ryzyka

Pacjenci hematologiczni i onkologiczni

Szczególnie niekorzystne rokowanie obserwuje się u pacjentów z chorobami hematologicznymi lub nowotworowymi. W małej kohorcie pacjentów hematologicznych i onkologicznych z zakażeniem MERS-CoV odnotowano 100% śmiertelność, niezależnie od wieku i statusu choroby podstawowej.¹⁹ W tej grupie mediana czasu do zgonu wynosiła 26 dni (zakres 15-77 dni).²⁰

Pacjenci hospitalizowani

Większość hospitalizowanych pacjentów z MERS miała wcześniej istniejące schorzenia, które prawdopodobnie zwiększały ryzyko ciężkiego przebiegu choroby.²¹ U pacjentów krytycznie chorych obserwuje się dłuższe utrzymywanie się wirusa MERS-CoV w drogach oddechowych niż u pacjentów z łagodnym przebiegiem choroby.²²

Wykrywalność materiału genetycznego wirusa (RNA MERS-CoV) u osób, które przeżyły zakażenie, może utrzymywać się przez miesiąc lub dłużej od początku choroby, a wirusa zdolnego do namnażania można wykryć do 25 dni po wystąpieniu objawów.²³

Czynniki wpływające na rozprzestrzenianie i śmiertelność

Głównym czynnikiem prowadzącym do utrzymywania się zakażeń MERS-CoV w krajach wysokiego ryzyka jest transmisja w placówkach opieki zdrowotnej, która wynika głównie z luk w środkach kontroli zakażeń oraz późnej izolacji podejrzanych przypadków.²⁴ Późna identyfikacja przypadków i opóźnienie w izolacji pacjentów są zdecydowanie najważniejszymi czynnikami wpływającymi na rozprzestrzenianie się choroby.²⁵

Możliwości terapeutyczne i ich wpływ na prognozę

Obecnie nie jest dostępna szczepionka ani specyficzne leczenie przeciwko MERS-CoV, chociaż kilka szczepionek i leków przeciwwirusowych specyficznych dla MERS-CoV jest w fazie rozwoju.²⁶²⁷ Leczenie pozostaje głównie objawowe, koncentrując się na zarządzaniu objawami w zależności od ciężkości choroby.²⁸

Biorąc pod uwagę udział odpowiedzi immunologicznej gospodarza w patogenezie MERS, prawdopodobnie leki hamujące replikację wirusa będą musiały być połączone z terapiami kontrolującymi niekorzystne odpowiedzi immunologiczne, aby osiągnąć optymalny efekt terapeutyczny.²⁹

Podsumowanie czynników prognostycznych

Podsumowując, MERS charakteryzuje się wysokim wskaźnikiem śmiertelności, szczególnie u osób z chorobami współistniejącymi. Wczesna identyfikacja czynników ryzyka niekorzystnego rokowania, szybka diagnostyka, izolacja przypadków oraz wdrożenie odpowiedniego leczenia objawowego są kluczowe dla poprawy wyników leczenia.³⁰³¹ Pacjenci z chorobami hematologicznymi, onkologicznymi oraz osoby z obniżoną odpornością wymagają szczególnej uwagi ze względu na wyjątkowo niekorzystne rokowanie w tych grupach.³²

Kolejne rozdziały

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Materiały źródłowe

#1 MERS-CoV as an emerging respiratory illness: A review of prevention methods
https://pmc.ncbi.nlm.nih.gov/articles/PMC7110694/
Middle East Respiratory Coronavirus Virus (MERS-CoV) first emerged from Saudi Arabia in 2012 and has since been recognized as a significant human respiratory pathogen on a global level. […] As of Nov 2019, a total of 2468 laboratory-confirmed cases of MERS-CoV were diagnosed mostly from Middle Eastern regions with a mortality rate of at least 35%. […] The main factors leading to sustainability of MERS-CoV infection in high risk courtiers is healthcare facility transmission. MERS-CoV transmission in healthcare facility mainly results from laps in infection control measures and late isolation of suspected cases. […] Predictors of poor outcome includes age above 60 years, male gender, diabetes mellitus, chronic lung disease and chronic renal disease, low albumin level and progressive lymphocytopenia.
#2 SARS and MERS: recent insights into emerging coronaviruses | Nature Reviews Microbiology
https://www.nature.com/articles/nrmicro.2016.81
Severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) are zoonotic pathogens that can cause severe respiratory disease in humans. Although disease progression is fairly similar for SARS and MERS, the case fatality rate of MERS is much higher than that of SARS. […] Comorbidities have an important role in SARS and MERS. Several risk factors are associated with progression to acute respiratory distress syndrome (ARDS) in SARS and MERS cases, especially advanced age and male sex. For MERS, additional risk factors that are associated with severe disease include chronic conditions such as diabetes mellitus, hypertension, cancer, renal and lung disease, and co-infections. […] The severity of the diseases that are caused by emerging coronaviruses highlights the need to develop effective therapeutic measures against these viruses.
#3
https://www.who.int/news-room/fact-sheets/detail/middle-east-respiratory-syndrome-coronavirus-(mers-cov)
Approximately 35% of MERS cases reported to WHO have died. […] Approximately 35% of cases reported to WHO have died, but this may be an overestimate of the true mortality rate, as mild cases of MERS may be missed by existing surveillance systems. […] Severe illness can cause respiratory failure that requires mechanical ventilation or support in an intensive care unit. Older people, people with weakened immune systems, and those with chronic diseases such as renal disease, cancer, chronic lung disease, hypertension, cardiovascular disease and diabetes appear to be at greater risk of developing severe disease.
#4
https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON560
Between 6 September 2024 and 28 February 2025, the Ministry of Health (MoH) of the Kingdom of Saudi Arabia (KSA) reported four cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including two deaths, with the last case being reported on 4 February 2025. […] The fatality rate among confirmed cases is around 36%, though this may be an overestimate since milder cases often go undetected. […] MERS-CoV infection appears to cause more severe disease in people with underlying chronic medical conditions such as diabetes, renal failure, chronic lung disease, and in immunocompromised persons. Therefore, people with these underlying medical conditions should avoid close contact with animals, particularly dromedaries, when visiting farms, markets, or barn areas where the virus may be circulating. […] No vaccine or specific treatment is currently available, although several MERS-CoV-specific vaccines and therapeutics are in development. Treatment remains supportive, focusing on managing symptoms based on the severity of the illness.
#5 Impact of Comorbidity on Fatality Rate of Patients with Middle East Respiratory Syndrome | Scientific Reports
https://www.nature.com/articles/s41598-017-10402-1
To date, 1841 cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported worldwide, with 652 deaths. […] The crude fatality rate of MERS cases was 32.1% (95% credibility interval (CI): 29.9%, 34.3%). […] After adjusting for age, epidemic period, MERS patients with comorbidity had around 4 times the risk for fatal infection than those without (adjusted hazard ratio of 3.74 (95% CI: 2.57, 5.67)). […] The fatality rate of MERS cases based on the data till the end of October, 2016 was 32.1%. […] Those with comorbid conditions and/or who were older had a significantly higher fatality rate, but the difference in fatality rate among countries of disease onset was not significant. […] The risk of MERS death soared during the first week since disease onset with an average of 13% daily increment. […] Possession of comorbidities increased the mortality rate of MERS patients in this study. […] In conclusion, the existence of comorbid condition in MERS cases predicts a fourfold risk of fatal outcome compared with those without, alongside a generally elevated increase in fatality rate with age.
#6 SARS and MERS: recent insights into emerging coronaviruses | Nature Reviews Microbiology
https://www.nature.com/articles/nrmicro.2016.81
The higher incidence of acute respiratory distress syndrome (ARDS) in individuals with MERS is reflected in the case fatality rate: this is 36% for MERS compared with 10% for SARS. […] Several risk factors are associated with poor disease outcome, especially advanced age and male sex. For MERS, additional risk factors for a poor outcome include diabetes mellitus, hypertension, cancer, renal and lung disease, and co-infections. […] The involvement of the host immune response in the pathogenesis of SARS, and most likely also that of MERS, suggests that drugs which inhibit viral replication will need to be combined with treatments that control detrimental immune responses.
#7 MERS-CoV as an emerging respiratory illness: A review of prevention methods
https://pmc.ncbi.nlm.nih.gov/articles/PMC7110694/
Middle East Respiratory Coronavirus Virus (MERS-CoV) first emerged from Saudi Arabia in 2012 and has since been recognized as a significant human respiratory pathogen on a global level. […] As of Nov 2019, a total of 2468 laboratory-confirmed cases of MERS-CoV were diagnosed mostly from Middle Eastern regions with a mortality rate of at least 35%. […] The main factors leading to sustainability of MERS-CoV infection in high risk courtiers is healthcare facility transmission. MERS-CoV transmission in healthcare facility mainly results from laps in infection control measures and late isolation of suspected cases. […] Predictors of poor outcome includes age above 60 years, male gender, diabetes mellitus, chronic lung disease and chronic renal disease, low albumin level and progressive lymphocytopenia.
#8 SARS and MERS: recent insights into emerging coronaviruses | Nature Reviews Microbiology
https://www.nature.com/articles/nrmicro.2016.81
The higher incidence of acute respiratory distress syndrome (ARDS) in individuals with MERS is reflected in the case fatality rate: this is 36% for MERS compared with 10% for SARS. […] Several risk factors are associated with poor disease outcome, especially advanced age and male sex. For MERS, additional risk factors for a poor outcome include diabetes mellitus, hypertension, cancer, renal and lung disease, and co-infections. […] The involvement of the host immune response in the pathogenesis of SARS, and most likely also that of MERS, suggests that drugs which inhibit viral replication will need to be combined with treatments that control detrimental immune responses.
#9 MERS-CoV as an emerging respiratory illness: A review of prevention methods
https://pmc.ncbi.nlm.nih.gov/articles/PMC7110694/
Middle East Respiratory Coronavirus Virus (MERS-CoV) first emerged from Saudi Arabia in 2012 and has since been recognized as a significant human respiratory pathogen on a global level. […] As of Nov 2019, a total of 2468 laboratory-confirmed cases of MERS-CoV were diagnosed mostly from Middle Eastern regions with a mortality rate of at least 35%. […] The main factors leading to sustainability of MERS-CoV infection in high risk courtiers is healthcare facility transmission. MERS-CoV transmission in healthcare facility mainly results from laps in infection control measures and late isolation of suspected cases. […] Predictors of poor outcome includes age above 60 years, male gender, diabetes mellitus, chronic lung disease and chronic renal disease, low albumin level and progressive lymphocytopenia.
#10 MERS-CoV as an emerging respiratory illness: A review of prevention methods
https://pmc.ncbi.nlm.nih.gov/articles/PMC7110694/
Middle East Respiratory Coronavirus Virus (MERS-CoV) first emerged from Saudi Arabia in 2012 and has since been recognized as a significant human respiratory pathogen on a global level. […] As of Nov 2019, a total of 2468 laboratory-confirmed cases of MERS-CoV were diagnosed mostly from Middle Eastern regions with a mortality rate of at least 35%. […] The main factors leading to sustainability of MERS-CoV infection in high risk courtiers is healthcare facility transmission. MERS-CoV transmission in healthcare facility mainly results from laps in infection control measures and late isolation of suspected cases. […] Predictors of poor outcome includes age above 60 years, male gender, diabetes mellitus, chronic lung disease and chronic renal disease, low albumin level and progressive lymphocytopenia.
#11 SARS and MERS: recent insights into emerging coronaviruses | Nature Reviews Microbiology
https://www.nature.com/articles/nrmicro.2016.81
The higher incidence of acute respiratory distress syndrome (ARDS) in individuals with MERS is reflected in the case fatality rate: this is 36% for MERS compared with 10% for SARS. […] Several risk factors are associated with poor disease outcome, especially advanced age and male sex. For MERS, additional risk factors for a poor outcome include diabetes mellitus, hypertension, cancer, renal and lung disease, and co-infections. […] The involvement of the host immune response in the pathogenesis of SARS, and most likely also that of MERS, suggests that drugs which inhibit viral replication will need to be combined with treatments that control detrimental immune responses.
#12
https://www.who.int/news-room/fact-sheets/detail/middle-east-respiratory-syndrome-coronavirus-(mers-cov)
Approximately 35% of MERS cases reported to WHO have died. […] Approximately 35% of cases reported to WHO have died, but this may be an overestimate of the true mortality rate, as mild cases of MERS may be missed by existing surveillance systems. […] Severe illness can cause respiratory failure that requires mechanical ventilation or support in an intensive care unit. Older people, people with weakened immune systems, and those with chronic diseases such as renal disease, cancer, chronic lung disease, hypertension, cardiovascular disease and diabetes appear to be at greater risk of developing severe disease.
#13 SARS and MERS: recent insights into emerging coronaviruses | Nature Reviews Microbiology
https://www.nature.com/articles/nrmicro.2016.81
The higher incidence of acute respiratory distress syndrome (ARDS) in individuals with MERS is reflected in the case fatality rate: this is 36% for MERS compared with 10% for SARS. […] Several risk factors are associated with poor disease outcome, especially advanced age and male sex. For MERS, additional risk factors for a poor outcome include diabetes mellitus, hypertension, cancer, renal and lung disease, and co-infections. […] The involvement of the host immune response in the pathogenesis of SARS, and most likely also that of MERS, suggests that drugs which inhibit viral replication will need to be combined with treatments that control detrimental immune responses.
#14 MERS-CoV as an emerging respiratory illness: A review of prevention methods
https://pmc.ncbi.nlm.nih.gov/articles/PMC7110694/
Middle East Respiratory Coronavirus Virus (MERS-CoV) first emerged from Saudi Arabia in 2012 and has since been recognized as a significant human respiratory pathogen on a global level. […] As of Nov 2019, a total of 2468 laboratory-confirmed cases of MERS-CoV were diagnosed mostly from Middle Eastern regions with a mortality rate of at least 35%. […] The main factors leading to sustainability of MERS-CoV infection in high risk courtiers is healthcare facility transmission. MERS-CoV transmission in healthcare facility mainly results from laps in infection control measures and late isolation of suspected cases. […] Predictors of poor outcome includes age above 60 years, male gender, diabetes mellitus, chronic lung disease and chronic renal disease, low albumin level and progressive lymphocytopenia.
#15 MERS-CoV as an emerging respiratory illness: A review of prevention methods
https://pmc.ncbi.nlm.nih.gov/articles/PMC7110694/
Middle East Respiratory Coronavirus Virus (MERS-CoV) first emerged from Saudi Arabia in 2012 and has since been recognized as a significant human respiratory pathogen on a global level. […] As of Nov 2019, a total of 2468 laboratory-confirmed cases of MERS-CoV were diagnosed mostly from Middle Eastern regions with a mortality rate of at least 35%. […] The main factors leading to sustainability of MERS-CoV infection in high risk courtiers is healthcare facility transmission. MERS-CoV transmission in healthcare facility mainly results from laps in infection control measures and late isolation of suspected cases. […] Predictors of poor outcome includes age above 60 years, male gender, diabetes mellitus, chronic lung disease and chronic renal disease, low albumin level and progressive lymphocytopenia.
#16 Impact of Comorbidity on Fatality Rate of Patients with Middle East Respiratory Syndrome | Scientific Reports
https://www.nature.com/articles/s41598-017-10402-1
To date, 1841 cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported worldwide, with 652 deaths. […] The crude fatality rate of MERS cases was 32.1% (95% credibility interval (CI): 29.9%, 34.3%). […] After adjusting for age, epidemic period, MERS patients with comorbidity had around 4 times the risk for fatal infection than those without (adjusted hazard ratio of 3.74 (95% CI: 2.57, 5.67)). […] The fatality rate of MERS cases based on the data till the end of October, 2016 was 32.1%. […] Those with comorbid conditions and/or who were older had a significantly higher fatality rate, but the difference in fatality rate among countries of disease onset was not significant. […] The risk of MERS death soared during the first week since disease onset with an average of 13% daily increment. […] Possession of comorbidities increased the mortality rate of MERS patients in this study. […] In conclusion, the existence of comorbid condition in MERS cases predicts a fourfold risk of fatal outcome compared with those without, alongside a generally elevated increase in fatality rate with age.
#17 Clinical Overview of MERS | MERS | CDC
https://www.cdc.gov/mers/hcp/clinical-overview/index.html
Most hospitalized MERS patients have had pre-existing medical conditions that likely increased their risk for severe illness. […] Among global cases reported to date, the mortality rate of MERS cases reported to the World Health Organization (WHO) is approximately 35%. […] In critically ill patients, the median time from onset to ICU admission is approximately 5 days, and median time from onset to death is approximately 12 days. […] Duration of MERS-CoV shedding in the respiratory tract is typically longer in more severely ill patients than mildly ill patients. […] It has been reported that evidence of MERS-CoV RNA has been detected in survivors for a month or more after onset, and culturable virus has been detected up to 25 days after onset.
#18 Impact of Comorbidity on Fatality Rate of Patients with Middle East Respiratory Syndrome | Scientific Reports
https://www.nature.com/articles/s41598-017-10402-1
To date, 1841 cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported worldwide, with 652 deaths. […] The crude fatality rate of MERS cases was 32.1% (95% credibility interval (CI): 29.9%, 34.3%). […] After adjusting for age, epidemic period, MERS patients with comorbidity had around 4 times the risk for fatal infection than those without (adjusted hazard ratio of 3.74 (95% CI: 2.57, 5.67)). […] The fatality rate of MERS cases based on the data till the end of October, 2016 was 32.1%. […] Those with comorbid conditions and/or who were older had a significantly higher fatality rate, but the difference in fatality rate among countries of disease onset was not significant. […] The risk of MERS death soared during the first week since disease onset with an average of 13% daily increment. […] Possession of comorbidities increased the mortality rate of MERS patients in this study. […] In conclusion, the existence of comorbid condition in MERS cases predicts a fourfold risk of fatal outcome compared with those without, alongside a generally elevated increase in fatality rate with age.
#19 Outcome of Middle East Respiratory Syndrome (MERS) in hematology and oncology patients: A case series in Saudi Arabia
https://pmc.ncbi.nlm.nih.gov/articles/PMC7982909/
Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is associated with a high fatality rate (34%), which is higher in the presence of co-morbidities. […] The mortality rate was 100%, and the median time to death was 26 days (range 15-77 days). […] MERS-CoV infection in this small cohort of hematology or oncology patients has a 100% mortality rate, regardless of the status of the underlying disease. […] In conclusion, patients with MERS-CoV have high mortality rate in general. Patients with comorbidities are at a greater risk of mortality when developing MERS-CoV. In particular, we have observed a 100% mortality rate in hematology or oncology patients diagnosed with MERS-CoV, regardless of age and the underlying disease status.
#20 Outcome of Middle East Respiratory Syndrome (MERS) in hematology and oncology patients: A case series in Saudi Arabia
https://pmc.ncbi.nlm.nih.gov/articles/PMC7982909/
Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is associated with a high fatality rate (34%), which is higher in the presence of co-morbidities. […] The mortality rate was 100%, and the median time to death was 26 days (range 15-77 days). […] MERS-CoV infection in this small cohort of hematology or oncology patients has a 100% mortality rate, regardless of the status of the underlying disease. […] In conclusion, patients with MERS-CoV have high mortality rate in general. Patients with comorbidities are at a greater risk of mortality when developing MERS-CoV. In particular, we have observed a 100% mortality rate in hematology or oncology patients diagnosed with MERS-CoV, regardless of age and the underlying disease status.
#21 Clinical Overview of MERS | MERS | CDC
https://www.cdc.gov/mers/hcp/clinical-overview/index.html
Most hospitalized MERS patients have had pre-existing medical conditions that likely increased their risk for severe illness. […] Among global cases reported to date, the mortality rate of MERS cases reported to the World Health Organization (WHO) is approximately 35%. […] In critically ill patients, the median time from onset to ICU admission is approximately 5 days, and median time from onset to death is approximately 12 days. […] Duration of MERS-CoV shedding in the respiratory tract is typically longer in more severely ill patients than mildly ill patients. […] It has been reported that evidence of MERS-CoV RNA has been detected in survivors for a month or more after onset, and culturable virus has been detected up to 25 days after onset.
#22 Clinical Overview of MERS | MERS | CDC
https://www.cdc.gov/mers/hcp/clinical-overview/index.html
Most hospitalized MERS patients have had pre-existing medical conditions that likely increased their risk for severe illness. […] Among global cases reported to date, the mortality rate of MERS cases reported to the World Health Organization (WHO) is approximately 35%. […] In critically ill patients, the median time from onset to ICU admission is approximately 5 days, and median time from onset to death is approximately 12 days. […] Duration of MERS-CoV shedding in the respiratory tract is typically longer in more severely ill patients than mildly ill patients. […] It has been reported that evidence of MERS-CoV RNA has been detected in survivors for a month or more after onset, and culturable virus has been detected up to 25 days after onset.
#23 Clinical Overview of MERS | MERS | CDC
https://www.cdc.gov/mers/hcp/clinical-overview/index.html
Most hospitalized MERS patients have had pre-existing medical conditions that likely increased their risk for severe illness. […] Among global cases reported to date, the mortality rate of MERS cases reported to the World Health Organization (WHO) is approximately 35%. […] In critically ill patients, the median time from onset to ICU admission is approximately 5 days, and median time from onset to death is approximately 12 days. […] Duration of MERS-CoV shedding in the respiratory tract is typically longer in more severely ill patients than mildly ill patients. […] It has been reported that evidence of MERS-CoV RNA has been detected in survivors for a month or more after onset, and culturable virus has been detected up to 25 days after onset.
#24 MERS-CoV as an emerging respiratory illness: A review of prevention methods
https://pmc.ncbi.nlm.nih.gov/articles/PMC7110694/
Middle East Respiratory Coronavirus Virus (MERS-CoV) first emerged from Saudi Arabia in 2012 and has since been recognized as a significant human respiratory pathogen on a global level. […] As of Nov 2019, a total of 2468 laboratory-confirmed cases of MERS-CoV were diagnosed mostly from Middle Eastern regions with a mortality rate of at least 35%. […] The main factors leading to sustainability of MERS-CoV infection in high risk courtiers is healthcare facility transmission. MERS-CoV transmission in healthcare facility mainly results from laps in infection control measures and late isolation of suspected cases. […] Predictors of poor outcome includes age above 60 years, male gender, diabetes mellitus, chronic lung disease and chronic renal disease, low albumin level and progressive lymphocytopenia.
#25 MERS-CoV as an emerging respiratory illness: A review of prevention methods
https://pmc.ncbi.nlm.nih.gov/articles/PMC7110694/
Although no current human vaccine is available, significant progress has been made. […] Prevention of healthcare facility transmission which is the main amplifier of persistent outbreaks and control community transmission. […] Late identification of cases and delay in isolation of patients is by far the most preventive strategy that can be adopted.
#26 MERS-CoV as an emerging respiratory illness: A review of prevention methods
https://pmc.ncbi.nlm.nih.gov/articles/PMC7110694/
Although no current human vaccine is available, significant progress has been made. […] Prevention of healthcare facility transmission which is the main amplifier of persistent outbreaks and control community transmission. […] Late identification of cases and delay in isolation of patients is by far the most preventive strategy that can be adopted.
#27
https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON560
Between 6 September 2024 and 28 February 2025, the Ministry of Health (MoH) of the Kingdom of Saudi Arabia (KSA) reported four cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including two deaths, with the last case being reported on 4 February 2025. […] The fatality rate among confirmed cases is around 36%, though this may be an overestimate since milder cases often go undetected. […] MERS-CoV infection appears to cause more severe disease in people with underlying chronic medical conditions such as diabetes, renal failure, chronic lung disease, and in immunocompromised persons. Therefore, people with these underlying medical conditions should avoid close contact with animals, particularly dromedaries, when visiting farms, markets, or barn areas where the virus may be circulating. […] No vaccine or specific treatment is currently available, although several MERS-CoV-specific vaccines and therapeutics are in development. Treatment remains supportive, focusing on managing symptoms based on the severity of the illness.
#28
https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON560
Between 6 September 2024 and 28 February 2025, the Ministry of Health (MoH) of the Kingdom of Saudi Arabia (KSA) reported four cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including two deaths, with the last case being reported on 4 February 2025. […] The fatality rate among confirmed cases is around 36%, though this may be an overestimate since milder cases often go undetected. […] MERS-CoV infection appears to cause more severe disease in people with underlying chronic medical conditions such as diabetes, renal failure, chronic lung disease, and in immunocompromised persons. Therefore, people with these underlying medical conditions should avoid close contact with animals, particularly dromedaries, when visiting farms, markets, or barn areas where the virus may be circulating. […] No vaccine or specific treatment is currently available, although several MERS-CoV-specific vaccines and therapeutics are in development. Treatment remains supportive, focusing on managing symptoms based on the severity of the illness.
#29 SARS and MERS: recent insights into emerging coronaviruses | Nature Reviews Microbiology
https://www.nature.com/articles/nrmicro.2016.81
The higher incidence of acute respiratory distress syndrome (ARDS) in individuals with MERS is reflected in the case fatality rate: this is 36% for MERS compared with 10% for SARS. […] Several risk factors are associated with poor disease outcome, especially advanced age and male sex. For MERS, additional risk factors for a poor outcome include diabetes mellitus, hypertension, cancer, renal and lung disease, and co-infections. […] The involvement of the host immune response in the pathogenesis of SARS, and most likely also that of MERS, suggests that drugs which inhibit viral replication will need to be combined with treatments that control detrimental immune responses.
#30 Impact of Comorbidity on Fatality Rate of Patients with Middle East Respiratory Syndrome | Scientific Reports
https://www.nature.com/articles/s41598-017-10402-1
To date, 1841 cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported worldwide, with 652 deaths. […] The crude fatality rate of MERS cases was 32.1% (95% credibility interval (CI): 29.9%, 34.3%). […] After adjusting for age, epidemic period, MERS patients with comorbidity had around 4 times the risk for fatal infection than those without (adjusted hazard ratio of 3.74 (95% CI: 2.57, 5.67)). […] The fatality rate of MERS cases based on the data till the end of October, 2016 was 32.1%. […] Those with comorbid conditions and/or who were older had a significantly higher fatality rate, but the difference in fatality rate among countries of disease onset was not significant. […] The risk of MERS death soared during the first week since disease onset with an average of 13% daily increment. […] Possession of comorbidities increased the mortality rate of MERS patients in this study. […] In conclusion, the existence of comorbid condition in MERS cases predicts a fourfold risk of fatal outcome compared with those without, alongside a generally elevated increase in fatality rate with age.
#31
https://www.who.int/news-room/fact-sheets/detail/middle-east-respiratory-syndrome-coronavirus-(mers-cov)
Approximately 35% of MERS cases reported to WHO have died. […] Approximately 35% of cases reported to WHO have died, but this may be an overestimate of the true mortality rate, as mild cases of MERS may be missed by existing surveillance systems. […] Severe illness can cause respiratory failure that requires mechanical ventilation or support in an intensive care unit. Older people, people with weakened immune systems, and those with chronic diseases such as renal disease, cancer, chronic lung disease, hypertension, cardiovascular disease and diabetes appear to be at greater risk of developing severe disease.
#32 Outcome of Middle East Respiratory Syndrome (MERS) in hematology and oncology patients: A case series in Saudi Arabia
https://pmc.ncbi.nlm.nih.gov/articles/PMC7982909/
Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is associated with a high fatality rate (34%), which is higher in the presence of co-morbidities. […] The mortality rate was 100%, and the median time to death was 26 days (range 15-77 days). […] MERS-CoV infection in this small cohort of hematology or oncology patients has a 100% mortality rate, regardless of the status of the underlying disease. […] In conclusion, patients with MERS-CoV have high mortality rate in general. Patients with comorbidities are at a greater risk of mortality when developing MERS-CoV. In particular, we have observed a 100% mortality rate in hematology or oncology patients diagnosed with MERS-CoV, regardless of age and the underlying disease status.