A Narrative Review on the Recent Insights Into the Pathogenicity and Potential Role of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in the Emergence of "Disease X".
Zubaier Ahmed, Kazi Milenur Rahman Prattay, Sabrina Sharmin, Fatema-Tuz-Zohora, Asef Raj, Forhad Bin Faruk, Bagdad Ahmed, Humair Bin Md Omer, Anika Awal Omi, Fazle Rabbi, Nasiba Binte Bahar, Sumiya Sharmin Mou, Mehedi Islam, Eshaba Karim, Md Elias Al-Mamun
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Abstract
Background and aims: Following the end of the COVID-19 global emergency, concern has shifted to "Disease X," a hypothetical, highly transmissible, and deadly pathogen, and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a prime candidate for this. This review explores its epidemiology, mutations, transmission, and potential to become a pandemic-capable pathogen, aiming to support future research and public health preparedness against the disease.
Methods: A comprehensive search of major databases was conducted for peer-reviewed English articles (2000-2025) focusing on virology, outbreaks, treatments, and public health using relevant but definite keywords. Studies met strict inclusion criteria and standardized methods to ensure quality, reproducibility, and transparency.
Results: Since it was identified in 2012, MERS-CoV has spread across 27 countries, presenting a high case fatality rate (~34.5%) and zoonotic origin. It is primarily linked to dromedary camels, but shows limited human-to-human transmission (R₀ < 1). Unlike SARS-CoV-2, MERS-CoV's spread is confined to close contact and healthcare settings, largely in the Middle East and parts of Africa. Its pathogenesis involves severe respiratory illness, driven by immune evasion and systemic inflammation, especially in individuals with comorbidities. While MERS-CoV lacks pandemic-level transmissibility, its genetic plasticity poses a risk for future evolution. Vaccine and therapeutic development remain limited due to sporadic outbreaks and low global urgency.
Conclusion: Despite not currently fitting the Disease X archetype, MERS-CoV's high mortality, zoonotic spillover potential, and possibility for increased transmissibility warrant continued surveillance, targeted research, and strengthened public health infrastructure to prevent localized outbreaks from escalating into broader crises.
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