Global Burden and Pathogenesis of Middle East Respiratory Syndrome Coronavirus (MERS-CoV): Epidemiological and Preventive Perspectives

Abstract

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a zoonotic betacoronavirus first identified in Saudi Arabia in 2012, responsible for causing severe respiratory illness in humans with an estimated case fatality rate of about 35%. The virus originates from dromedary camels, which act as the primary reservoir and intermediate host, leading to sporadic spillover infections in humans through direct or indirect contact. Although human-to-human transmission remains limited, it has caused several healthcare-associated outbreaks and superspreading events. The clinical spectrum of MERS-CoV infection ranges from asymptomatic or mild illness to severe pneumonia, acute respiratory distress syndrome, and multi-organ failure. Laboratory diagnosis primarily relies on reverse transcription-polymerase chain reaction (RT-PCR) testing of respiratory specimens, while management remains supportive due to the absence of specific antiviral therapy or licensed vaccines. This review highlights the virology, epidemiology, pathogenesis, clinical features, global burden, and prevention strategies of MERS-CoV, emphasizing the urgent need for continuous surveillance, enhanced infection control, and multidisciplinary collaboration under the One Health approach to mitigate future outbreaks and global health threats.