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      Middle East respiratory syndrome

      review-article
      , Prof, FRCP a , b , c , , Prof, PhD d , , PhD e , , Prof, FRCP f , g , *
      Lancet (London, England)
      Elsevier Ltd.

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          Summary

          The Middle East respiratory syndrome coronavirus (MERS-CoV) is a lethal zoonotic pathogen that was first identified in humans in Saudi Arabia and Jordan in 2012. Intermittent sporadic cases, community clusters, and nosocomial outbreaks of MERS-CoV continue to occur. Between April 2012 and December 2019, 2499 laboratory-confirmed cases of MERS-CoV infection, including 858 deaths (34·3% mortality) were reported from 27 countries to WHO, the majority of which were reported by Saudi Arabia (2106 cases, 780 deaths). Large outbreaks of human-to-human transmission have occurred, the largest in Riyadh and Jeddah in 2014 and in South Korea in 2015. MERS-CoV remains a high-threat pathogen identified by WHO as a priority pathogen because it causes severe disease that has a high mortality rate, epidemic potential, and no medical countermeasures. This Seminar provides an update on the current knowledge and perspectives on MERS epidemiology, virology, mode of transmission, pathogenesis, diagnosis, clinical features, management, infection control, development of new therapeutics and vaccines, and highlights unanswered questions and priorities for research, improved management, and prevention.

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          Most cited references134

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          A Novel Coronavirus from Patients with Pneumonia in China, 2019

          Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)
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            Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia.

            A previously unknown coronavirus was isolated from the sputum of a 60-year-old man who presented with acute pneumonia and subsequent renal failure with a fatal outcome in Saudi Arabia. The virus (called HCoV-EMC) replicated readily in cell culture, producing cytopathic effects of rounding, detachment, and syncytium formation. The virus represents a novel betacoronavirus species. The closest known relatives are bat coronaviruses HKU4 and HKU5. Here, the clinical data, virus isolation, and molecular identification are presented. The clinical picture was remarkably similar to that of the severe acute respiratory syndrome (SARS) outbreak in 2003 and reminds us that animal coronaviruses can cause severe disease in humans.
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              Coronaviruses: An Overview of Their Replication and Pathogenesis

              Coronaviruses (CoVs), enveloped positive-sense RNA viruses, are characterized by club-like spikes that project from their surface, an unusually large RNA genome, and a unique replication strategy. Coronaviruses cause a variety of diseases in mammals and birds ranging from enteritis in cows and pigs and upper respiratory disease in chickens to potentially lethal human respiratory infections. Here we provide a brief introduction to coronaviruses discussing their replication and pathogenicity, and current prevention and treatment strategies. We also discuss the outbreaks of the highly pathogenic Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and the recently identified Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV).
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                Author and article information

                Contributors
                Journal
                Lancet
                Lancet
                Lancet (London, England)
                Elsevier Ltd.
                0140-6736
                1474-547X
                4 March 2020
                28 March-3 April 2020
                4 March 2020
                : 395
                : 10229
                : 1063-1077
                Affiliations
                [a ]College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
                [b ]Research Center, King Saud Medical City Ministry of Health, Riyadh, Saudi Arabia
                [c ]Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
                [d ]Department of Microbiology and Immunology, and Department of Pediatrics, University of Iowa, Iowa City, IA, USA
                [e ]Infectious Hazards Management, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
                [f ]Department of Infection, Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, UK
                [g ]National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, UK
                Author notes
                [* ]Correspondence to: Prof Sir Alimuddin Zumla, Department of Infection, Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, NW3 OPE, UK a.zumla@ 123456ucl.ac.uk
                Article
                S0140-6736(19)33221-0
                10.1016/S0140-6736(19)33221-0
                7155742
                32145185
                b036e943-edc3-4ea6-888c-8a642b5d091b
                © 2020 Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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