Key features of these viruses are the dominance of nosocomial transmission, and pathogenesis that is driven by a combination of viral replication in the lower respiratory tract and an aberrant host immune response. This Review highlights the pandemic and epidemic potential of emerging coronaviruses and discusses our current knowledge of the biology of SARS-CoV and MERS-CoV, including their transmission, their pathogenesis and the development of medical countermeasures. As of 26 April 2016, there have been 1,728 confirmed cases of MERS, including 624 deaths in 27 countries 15. In May 2015, a single person returning from the Middle East started a nosocomial outbreak of MERS in South Korea that involved 16 hospitals and 186 patients 14.
MERS-CoV continued to emerge and spread to countries outside of the Arabian Peninsula as a result of travel of infected persons often, these imported MERS cases resulted in nosocomial transmission. A cluster of cases of severe respiratory disease had occurred in April 2012 in a hospital in Jordan and was retrospectively diagnosed as MERS 12, and a cluster of three cases of MERS in the UK was identified in September 2012 (Ref. A novel coronavirus, Middle East respiratory syndrome coronavirus (MERS-CoV), was isolated from his sputum 11. In June 2012, 10 years after the first emergence of SARS-CoV, a man in Saudi Arabia died of acute pneumonia and renal failure. However, certain SARS-CoV-like viruses found in bats have recently been shown to be able to infect human cells without prior adaptation 9, 10, which indicates that SARS could re-emerge. Measures of infection control, rather than medical interventions, ended the SARS pandemic. 8), but no human SARS cases have been detected since. Five additional SARS cases, resulting from zoonotic transmission, occurred in December 2003–January 2004 (Ref. By July 2003 and after a total of 8,096 reported cases, including 774 deaths in 27 countries 7, no more infections were detected, and the SARS pandemic was declared to be over. A remarkable global effort led to the identification of SARS coronavirus (SARS-CoV) in early April of that year 4, 5, 6. In March 2003, the WHO established a network of laboratories to determine the causative agent of SARS. Individuals who were infected and subsequently travelled spread the outbreak to Hong Kong 2 and from there to Vietnam, Canada and several other countries 3. New cases emerged in mainland China, and by February 2003, more than 300 cases had been reported, around one-third of which were in health care workers 1. In November 2002, the first known case of severe acute respiratory syndrome (SARS) occurred in Foshan, China 1. This century has seen the global spread of two previously unknown coronaviruses.
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