title: Viral Shedding and Antibody Response in 37 Patients With Middle East Respiratory Syndrome Coronavirus Infection.
abstract: BACKGROUND
  The Middle East respiratory syndrome (MERS) coronavirus causes isolated cases and outbreaks of severe respiratory disease. Essential features of the natural history of disease are poorly understood.
  
  
  METHODS
  We studied 37 adult patients infected with MERS coronavirus for viral load in the lower and upper respiratory tracts (LRT and URT, respectively), blood, stool, and urine. Antibodies and serum neutralizing activities were determined over the course of disease.
  
  
  RESULTS
  One hundred ninety-nine LRT samples collected during the 3 weeks following diagnosis yielded virus RNA in 93% of tests. Average (maximum) viral loads were 5 × 10(6) (6 × 10(10)) copies/mL. Viral loads (positive detection frequencies) in 84 URT samples were 1.9 × 10(4) copies/mL (47.6%). Thirty-three percent of all 108 serum samples tested yielded viral RNA. Only 14.6% of stool and 2.4% of urine samples yielded viral RNA. All seroconversions occurred during the first 2 weeks after diagnosis, which corresponds to the second and third week after symptom onset. Immunoglobulin M detection provided no advantage in sensitivity over immunoglobulin G (IgG) detection. All surviving patients, but only slightly more than half of all fatal cases, produced IgG and neutralizing antibodies. The levels of IgG and neutralizing antibodies were weakly and inversely correlated with LRT viral loads. Presence of antibodies did not lead to the elimination of virus from LRT.
  
  
  CONCLUSIONS
  The timing and intensity of respiratory viral shedding in patients with MERS closely matches that of those with severe acute respiratory syndrome. Blood viral RNA does not seem to be infectious. Extrapulmonary loci of virus replication seem possible. Neutralizing antibodies do not suffice to clear the infection.
authors.affiliation: Institute of Virology, University of Bonn Medical Centre.|German Centre for Infection Research, Partner Site Bonn-Cologne, Bonn, Germany.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Corman
authors.affiliation: Division of Infectious Diseases.
authors.forename: Ali M
authors.initials: AM
authors.lastname: Albarrak
authors.affiliation: Division of Infectious Diseases.
authors.forename: Ali Senosi
authors.initials: AS
authors.lastname: Omrani
authors.affiliation: Department of Critical Care.
authors.forename: Mohammed M
authors.initials: MM
authors.lastname: Albarrak
authors.affiliation: Central Military Laboratory and Blood Bank, Microbiology Division, Prince Sultan Military City.
authors.forename: Mohamed Elamin
authors.initials: ME
authors.lastname: Farah
authors.affiliation: Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Malak
authors.initials: M
authors.lastname: Almasri
authors.affiliation: Institute of Virology, University of Bonn Medical Centre.|German Centre for Infection Research, Partner Site Bonn-Cologne, Bonn, Germany.
authors.forename: Doreen
authors.initials: D
authors.lastname: Muth
authors.affiliation: Institute of Virology, University of Bonn Medical Centre.
authors.forename: Andrea
authors.initials: A
authors.lastname: Sieberg
authors.affiliation: Institute of Virology, University of Bonn Medical Centre.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Meyer
authors.affiliation: Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Abdullah M
authors.initials: AM
authors.lastname: Assiri
authors.affiliation: Institute of Virology, University of Bonn Medical Centre.
authors.forename: Tabea
authors.initials: T
authors.lastname: Binger
authors.affiliation: Euroimmun AG, Lübeck, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Steinhagen
authors.affiliation: Euroimmun AG, Lübeck, Germany.
authors.forename: Erik
authors.initials: E
authors.lastname: Lattwein
authors.affiliation: Johns Hopkins Aramco Healthcare, Dhahran.|Indiana University School of Medicine, Indianapolis.
authors.forename: Jaffar
authors.initials: J
authors.lastname: Al-Tawfiq
authors.affiliation: Institute of Virology, University of Bonn Medical Centre.
authors.forename: Marcel A
authors.initials: MA
authors.lastname: Müller
authors.affiliation: Institute of Virology, University of Bonn Medical Centre.|German Centre for Infection Research, Partner Site Bonn-Cologne, Bonn, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Drosten
authors.affiliation: Ministry of Health, Riyadh, Kingdom of Saudi Arabia.|College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Memish
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057134:Antibodies, Neutralizing / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D000917:Antibody Formation; D001769:Blood / Q000821:virology; D018352:Coronavirus Infections / Q000276:immunology* / Q000821:virology*; D005243:Feces / Q000821:virology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D065207:Middle East Respiratory Syndrome Coronavirus / Q000302:isolation & purification; D012137:Respiratory System / Q000821:virology; D014556:Urine / Q000821:virology; D017201:Virus Shedding; D055815:Young Adult
chemical_list: D057134:Antibodies, Neutralizing; D000914:Antibodies, Viral
keywords: MERS; antibodies; clearance; shedding; viral load