{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:00:30Z","timestamp":1790715630640,"version":"4.1.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,2,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Background. \u2003The 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.<\/jats:p>\n               <jats:p>Methods. \u2003We 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.<\/jats:p>\n               <jats:p>Results. \u2003One 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 \u00d7 106 (6 \u00d7 1010) copies\/mL. Viral loads (positive detection frequencies) in 84 URT samples were 1.9 \u00d7 104 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.<\/jats:p>\n               <jats:p>Conclusions. \u2003The 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.<\/jats:p>","DOI":"10.1093\/cid\/civ951","type":"journal-article","created":{"date-parts":[[2015,11,13]],"date-time":"2015-11-13T01:29:04Z","timestamp":1447378144000},"page":"477-483","source":"Crossref","is-referenced-by-count":233,"title":["Viral Shedding and Antibody Response in 37 Patients With Middle East Respiratory Syndrome Coronavirus Infection"],"prefix":"10.1093","volume":"62","author":[{"given":"Victor M.","family":"Corman","sequence":"first","affiliation":[{"name":"Institute of Virology, University of Bonn Medical Centre 1"},{"name":"German Centre for Infection Research, Partner Site Bonn-Cologne 2 , Bonn ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali M.","family":"Albarrak","sequence":"additional","affiliation":[{"name":"3 Division of Infectious Diseases"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Senosi","family":"Omrani","sequence":"additional","affiliation":[{"name":"3 Division of Infectious Diseases"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed M.","family":"Albarrak","sequence":"additional","affiliation":[{"name":"4 Department of Critical Care"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Elamin","family":"Farah","sequence":"additional","affiliation":[{"name":"Prince Sultan Military City 5 Central Military Laboratory and Blood Bank, Microbiology Division ,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malak","family":"Almasri","sequence":"additional","affiliation":[{"name":"Ministry of Health 6 , Riyadh ,","place":["Kingdom of Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doreen","family":"Muth","sequence":"additional","affiliation":[{"name":"Institute of Virology, University of Bonn Medical Centre 1"},{"name":"German Centre for Infection Research, Partner Site Bonn-Cologne 2 , Bonn ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Sieberg","sequence":"additional","affiliation":[{"name":"Institute of Virology, University of Bonn Medical Centre 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Meyer","sequence":"additional","affiliation":[{"name":"Institute of Virology, University of Bonn Medical Centre 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah M.","family":"Assiri","sequence":"additional","affiliation":[{"name":"Ministry of Health 6 , Riyadh ,","place":["Kingdom of Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tabea","family":"Binger","sequence":"additional","affiliation":[{"name":"Institute of Virology, University of Bonn Medical Centre 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katja","family":"Steinhagen","sequence":"additional","affiliation":[{"name":"Euroimmun AG 7 , L\u00fcbeck ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Lattwein","sequence":"additional","affiliation":[{"name":"Euroimmun AG 7 , L\u00fcbeck ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaffar","family":"Al-Tawfiq","sequence":"additional","affiliation":[{"name":"Johns Hopkins Aramco Healthcare 8 , Dhahran"},{"name":"Indiana University School of Medicine 9 , Indianapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel A.","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Institute of Virology, University of Bonn Medical Centre 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Drosten","sequence":"additional","affiliation":[{"name":"Institute of Virology, University of Bonn Medical Centre 1"},{"name":"German Centre for Infection Research, Partner Site Bonn-Cologne 2 , Bonn ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziad A.","family":"Memish","sequence":"additional","affiliation":[{"name":"Ministry of Health 6 , Riyadh ,","place":["Kingdom of Saudi Arabia"]},{"name":"College of Medicine, Alfaisal University 10 , Riyadh ,","place":["Kingdom of Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2015,11,12]]},"reference":[{"key":"2024111411401559000_CIV951C1","doi-asserted-by":"crossref","first-page":"1814","DOI":"10.1056\/NEJMoa1211721","article-title":"Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia","volume":"367","author":"Zaki","year":"2012","journal-title":"N Engl J Med"},{"key":"2024111411401559000_CIV951C2","article-title":"Disease outbreak news: Middle East respiratory syndrome 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