Background (Updated October 2014)

Since April 2012, more than 850 laboratory-confirmed cases of human infection with novel coronavirus (MERS-CoV) have been reported to WHO, all with direct or indirect links to the Middle East.  Camels play a role in transmission, but how humans are infected from camels is largely unknown.  Human-to-human transmission has been documented in households, health care settings and one workplace.  Large nosocomial outbreaks have been reported, most notably, in Saudi Arabia in March - May 2014.

It is difficult to ascertain whether other primary zoonotic or secondary human-to-human transmission cases have been missed.

More information on MERS-CoV can be found at the WHO coronavirus website here.


CONSISE has developed epidemiologic protocols for MERS-CoV investigations.  These are described below.  For more information or support in the use of these protocols, please contact CONSISE.

Protocol 1: Seroepidemiological Assessment of Health Care Personnel for Patients with Middle Eastern Respiratory Syndrome (MERS-CoV)  (link to WHO adapted protocol [posted 27 January 2014])

Comprehensive epidemiological, virological and serological investigations health care personnel (HCP) caring for MERS-CoV patients is essential to understand the potential for human-to-human transmission of the MERS-CoV virus and to assess modes of transmission in order to inform guidance and policy in directing national and international public health response.

Primary Objectives:

  •  Determine the risk factors for MERS-CoV transmission and infection in health care settings
  • Assess the extent of MERS-CoV secondary transmission to HCP caring for probable and confirmed patients


Protocol 2: Seroepidemiological Investigation of Close Contacts of Novel Coronavirus (MERS-CoV) Patients

UPDATE:  Based on updated epiedmiologic information about MERS-CoV, WHO has adapted and modifed this protocol.  The updated, and CONSISE recommended, protocol is available here: Seroepidemiological Investigation of Contacts of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Patients

A comprehensive assessment of contacts – including household, familial, social occupational and health care associated contacts – of confirmed and probable MERS-CoV cases is warranted to determine the extent of (asymptomatic) infections, routes and risk of transmission, and guide efforts for prevention of (human to human) transmission of the MERS-CoV virus.  

This protocol outlines 1) how to find and test all contacts of laboratory-confirmed and probable MERS-CoV patients, and 2) methods to assess risk factors for MERS-CoV infection.

Primary Objectives:

  • Estimate frequency of MERS-CoV infections (as measured by virologic and serologic tests) in relation to human and other exposures (i.e. evaluate determinants/risk factors [including sources] for infection) among contacts of confirmed MERS-CoV cases
  • Evaluate (modifiable) risk factors (e.g. exposures, behaviours, practices) for human MERS-CoV infection
  • Evaluate the extent of MERS-CoV transmission among contacts of confirmed and probable MERS-CoV patients
  • Describe the presentation and clinical course of disease with MERS-CoV infection
  • Quantify the proportion of asymptomatic/sub-clinical MERS-CoV infections


Protocol 3:  Cross-sectional seroprevalence study of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in presumed high risk populations [Posted by WHO in September 2014]

Representative serologic studies are designed to collect data to estimate prevalence of antibodies to a new pathogen in a population. This information is critical to better understand the extent of infection in a population and the severity of the new virus. This study protocol outlines methods to collect data to measure the seroprevalence of cross-reactive antibodies to MERS-CoV in specific populations that are believed to be at an elevated risk of infection and to evaluate risk factors for infection among those with evidence of infection (seropositive subjects) compared to those without infection (seronegative subjects).

Primary Objectives:

  • Estimate the frequency of MERS-CoV infections among groups of individuals at different presumed levels of risk
  • Identify modifiable risk factors (e.g., exposures, behaviors, practices) for human MERS-CoV infection


Adaption of protocols:

Recently, WHO adapted the Seroepidemiological Investigation of Close Contacts of Novel Coronavirus (nCoV) Patients as a Case-control study to assess potential risk factors related to human illness caused by novel  Coronavirus (nCoV). This protocol (final version after consultation with affected countries) can be found on the WHO novel Coronavirus website here. 



CONSISE protocols have been created by members of CONSISE (Consortium for the Standardization for Influenza Seroepidemiology) and are distributed under the “Creative Commons Attribution-NonCommercial-ShareAlike 3.0” You can freely copy, adapt, distribute and transmit under the conditions that: the original source is attributed; the work is not used for commercial purposes, and any altered forms of this document are distributed freely under the same conditions.   

We encourage you to provide feedback on the use of this protocol on our website


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