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Middle East Respiratory Syndrome Coronavirus Outbreak in the Republic of Korea, 2015.

- Osong Public Health Res Perspect (2015)

Bottom Line: Older age [odds ratio (OR) = 4.86, 95% confidence interval (CI) 1.90-12.45] and underlying respiratory disease (OR = 4.90, 95% CI 1.64-14.65) were significantly associated with mortality.Phylogenetic analysis showed that the MERS-CoV of the index case clustered closest with a recent virus from Riyadh, Saudi Arabia.The lessons learned from the current outbreak will contribute to more up-to-date guidelines and global health security.

View Article: PubMed Central - PubMed

ABSTRACT

Objectives: The outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the Republic of Korea started from the index case who developed fever after returning from the Middle East. He infected 26 cases in Hospital C, and consecutive nosocomial transmission proceeded throughout the nation. We provide an epidemiologic description of the outbreak, as of July 2015.

Methods: Epidemiological research was performed by direct interview of the confirmed patients and reviewing medical records. We also analyzed the incubation period, serial interval, the characteristics of superspreaders, and factors associated with mortality. Full genome sequence was obtained from sputum specimens of the index patient.

Results: A total of 186 confirmed patients with MERS-CoV infection across 16 hospitals were identified in the Republic of Korea. Some 44.1% of the cases were patients exposed in hospitals, 32.8% were caregivers, and 13.4% were healthcare personnel. The most common presenting symptom was fever and chills. The estimated incubation period was 6.83 days and the serial interval was 12.5 days. A total of 83.2% of the transmission events were epidemiologically linked to five superspreaders, all of whom had pneumonia at presentation and contacted hundreds of people. Older age [odds ratio (OR) = 4.86, 95% confidence interval (CI) 1.90-12.45] and underlying respiratory disease (OR = 4.90, 95% CI 1.64-14.65) were significantly associated with mortality. Phylogenetic analysis showed that the MERS-CoV of the index case clustered closest with a recent virus from Riyadh, Saudi Arabia.

Conclusion: A single imported MERS-CoV infection case imposed a huge threat to public health and safety. This highlights the importance of robust preparedness and optimal infection prevention control. The lessons learned from the current outbreak will contribute to more up-to-date guidelines and global health security.

No MeSH data available.


Related in: MedlinePlus

Epidemiologic curve of 178 confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the Republic of Korea, 2015. Panel A (integrated curve) depicts the overall epidemiologic curve by date of symptom onset. Red color indicates the index patient, and three main clusters (Hospital C, Hospital H, and Hospital M and N) are depicted with yellow, green, and purple, respectively. Eight cases whose date of symptom onset is uncertain or who are still under investigation are excluded. Panel B shows the epidemic curve of each of the three main clusters. Stages of transmission are expressed by different patterns. An additional case in Hospital H whose stage of transmission is uncertain is excluded.
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fig1: Epidemiologic curve of 178 confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the Republic of Korea, 2015. Panel A (integrated curve) depicts the overall epidemiologic curve by date of symptom onset. Red color indicates the index patient, and three main clusters (Hospital C, Hospital H, and Hospital M and N) are depicted with yellow, green, and purple, respectively. Eight cases whose date of symptom onset is uncertain or who are still under investigation are excluded. Panel B shows the epidemic curve of each of the three main clusters. Stages of transmission are expressed by different patterns. An additional case in Hospital H whose stage of transmission is uncertain is excluded.

Mentions: A total of 186 confirmed patients of MERS-CoV infection were identified in the Republic of Korea between May 20, 2015 and July 13, 2015. The outbreak proceeded with three phases of transmission and spread to 16 healthcare facilities (Figure 1). The median age of confirmed MERS-CoV patients was 55 years (Interquartile range 42–66), and 111 patients (59.7%) were male (Table 1). Twenty-five (13.4%) cases were healthcare personnel, 82 (44.1%) were patients who had been exposed during admission or at clinics, and 61(32.8%) were caregivers. Common symptoms at presentation were fever/chills (74.2%) and myalgia (25.3%). Diabetes mellitus was the most common comorbidity (28.0%), followed by malignancy (23.1%). The majority (98%) of patients were infected with MERS-CoV in healthcare facilities.


Middle East Respiratory Syndrome Coronavirus Outbreak in the Republic of Korea, 2015.

- Osong Public Health Res Perspect (2015)

Epidemiologic curve of 178 confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the Republic of Korea, 2015. Panel A (integrated curve) depicts the overall epidemiologic curve by date of symptom onset. Red color indicates the index patient, and three main clusters (Hospital C, Hospital H, and Hospital M and N) are depicted with yellow, green, and purple, respectively. Eight cases whose date of symptom onset is uncertain or who are still under investigation are excluded. Panel B shows the epidemic curve of each of the three main clusters. Stages of transmission are expressed by different patterns. An additional case in Hospital H whose stage of transmission is uncertain is excluded.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4588443&req=5

fig1: Epidemiologic curve of 178 confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the Republic of Korea, 2015. Panel A (integrated curve) depicts the overall epidemiologic curve by date of symptom onset. Red color indicates the index patient, and three main clusters (Hospital C, Hospital H, and Hospital M and N) are depicted with yellow, green, and purple, respectively. Eight cases whose date of symptom onset is uncertain or who are still under investigation are excluded. Panel B shows the epidemic curve of each of the three main clusters. Stages of transmission are expressed by different patterns. An additional case in Hospital H whose stage of transmission is uncertain is excluded.
Mentions: A total of 186 confirmed patients of MERS-CoV infection were identified in the Republic of Korea between May 20, 2015 and July 13, 2015. The outbreak proceeded with three phases of transmission and spread to 16 healthcare facilities (Figure 1). The median age of confirmed MERS-CoV patients was 55 years (Interquartile range 42–66), and 111 patients (59.7%) were male (Table 1). Twenty-five (13.4%) cases were healthcare personnel, 82 (44.1%) were patients who had been exposed during admission or at clinics, and 61(32.8%) were caregivers. Common symptoms at presentation were fever/chills (74.2%) and myalgia (25.3%). Diabetes mellitus was the most common comorbidity (28.0%), followed by malignancy (23.1%). The majority (98%) of patients were infected with MERS-CoV in healthcare facilities.

Bottom Line: Older age [odds ratio (OR) = 4.86, 95% confidence interval (CI) 1.90-12.45] and underlying respiratory disease (OR = 4.90, 95% CI 1.64-14.65) were significantly associated with mortality.Phylogenetic analysis showed that the MERS-CoV of the index case clustered closest with a recent virus from Riyadh, Saudi Arabia.The lessons learned from the current outbreak will contribute to more up-to-date guidelines and global health security.

View Article: PubMed Central - PubMed

ABSTRACT

Objectives: The outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the Republic of Korea started from the index case who developed fever after returning from the Middle East. He infected 26 cases in Hospital C, and consecutive nosocomial transmission proceeded throughout the nation. We provide an epidemiologic description of the outbreak, as of July 2015.

Methods: Epidemiological research was performed by direct interview of the confirmed patients and reviewing medical records. We also analyzed the incubation period, serial interval, the characteristics of superspreaders, and factors associated with mortality. Full genome sequence was obtained from sputum specimens of the index patient.

Results: A total of 186 confirmed patients with MERS-CoV infection across 16 hospitals were identified in the Republic of Korea. Some 44.1% of the cases were patients exposed in hospitals, 32.8% were caregivers, and 13.4% were healthcare personnel. The most common presenting symptom was fever and chills. The estimated incubation period was 6.83 days and the serial interval was 12.5 days. A total of 83.2% of the transmission events were epidemiologically linked to five superspreaders, all of whom had pneumonia at presentation and contacted hundreds of people. Older age [odds ratio (OR) = 4.86, 95% confidence interval (CI) 1.90-12.45] and underlying respiratory disease (OR = 4.90, 95% CI 1.64-14.65) were significantly associated with mortality. Phylogenetic analysis showed that the MERS-CoV of the index case clustered closest with a recent virus from Riyadh, Saudi Arabia.

Conclusion: A single imported MERS-CoV infection case imposed a huge threat to public health and safety. This highlights the importance of robust preparedness and optimal infection prevention control. The lessons learned from the current outbreak will contribute to more up-to-date guidelines and global health security.

No MeSH data available.


Related in: MedlinePlus