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Asymptomatic Middle East Respiratory Syndrome coronavirus infection using a serologic survey in Korea
Yeong-jun Song, Jeong-Sun Yang, Hee Jung Yoon, Hae-Sung Nam, Soon Young Lee, Hae-Kwan Cheong, Woo-Jung Park, Sung Han Park, Bo Youl Choi, Sung Soon Kim, Moran Ki
Epidemiol Health. 2018;40:e2018014.   Published online April 15, 2018
DOI: https://doi.org/10.4178/epih.e2018014
  • 18,695 View
  • 302 Download
  • 15 Web of Science
  • 16 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The rates of asymptomatic infection with Middle East Respiratory Syndrome (MERS) coronavirus vary. A serologic study was conducted to determine the asymptomatic MERS infection rate in healthcare workers and non-healthcare workers by exposure status.
METHODS
Study participants were selected from contacts of MERS patients based on a priority system in 4 regions strongly affected by the 2015 MERS outbreak. A sero-epidemiological survey was performed in 1,610 contacts (average duration from exposure to test, 4.8 months), and the collected sera were tested using an enzyme-linked immunespecific assay (ELISA), immunofluorescence assay (IFA), and plaque reduction neutralization antibody test (PRNT). Among the 1,610 contacts, there were 7 ELISA-positive cases, of which 1 exhibited positive IFA and PRNT results.
RESULTS
The asymptomatic infection rate was 0.060% (95% confidence interval, 0.002 to 0.346). The asymptomatic MERS case was a patient who had been hospitalized with patient zero on the same floor of the hospital at the same time. The case was quarantined at home for 2 weeks after discharge, and had underlying diseases, including hypertension, angina, and degenerative arthritis.
CONCLUSIONS
The asymptomatic infection was acquired via healthcare-associated transmission. Thus, it is necessary to extend serologic studies to include inpatient contacts who have no symptoms.
Summary
Korean summary
2015년 국내 MERS 유행시에 자가격리를 시행하였던 접촉자 약 15,000명 (의료인과 비의료인 포함) 중에서 주요 유행지역, 노출 강도 등을 고려하여 선별된 3,291명을 대상으로 무증상 감염여부를 확인하기 위한 혈청 역학조사를 수행하였다. 최종 검사에 참여한 1,610명 중에서 7명이 ELISA 양성 반응을 보였고, 그 중 1명이 IFA와 PRNT에서도 양성 반응을 보여 무증상 감염률은 0.060%(95% CI: 0.002-0.346)로 기존 연구에 비하여 낮았다. 최종 양성을 보인 1명은 노출 당시 1번환자와 가까운 병실에 입원하였던 환자였다.

Citations

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  • MERS-CoV seroconversion amongst Malaysian Hajj pilgrims returning from the Middle East, 2016–2018: results from the MERCURIAL multiyear prospective cohort study
    Jefree Johari, Robert D. Hontz, Brian L. Pike, Tupur Husain, Norhayati Rusli, Rozainanee Mohd-Zain, Vunjia Tiong, Hai-Yen Lee, Boon-Teong Teoh, Sing-Sin Sam, Chee-Sieng Khor, Shih-Keng Loong, Juraina Abd-Jamil, Siti-Sarah Nor'e, Hasmawati Yahaya, Naim Che
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    Hanjie Jonathan Gan, Amaravadhi Harikishore, Jihye Lee, Sangeun Jeon, Sreekanth Rajan, Ming Wei Chen, Jun Long Neo, Seungtaek Kim, Ho Sup Yoon
    Antiviral Research.2021; 185: 104996.     CrossRef
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    Afnan A. Degnah, Sawsan S. Al-amri, Ahmed M. Hassan, Abdulrahman S. Almasoud, Manar Mousa, Sarah A. Almahboub, Rowa Y. Alhabbab, Ahmed A. Mirza, Salwa I. Hindawi, Naif Khalaf Alharbi, Esam I. Azhar, Anwar M. Hashem
    Journal of Infection and Public Health.2020; 13(5): 697.     CrossRef
  • Characterization of a human monoclonal antibody generated from a B-cell specific for a prefusion-stabilized spike protein of Middle East respiratory syndrome coronavirus
    Jang-Hoon Choi, Hye-Min Woo, Tae-young Lee, So-young Lee, Sang-Mu Shim, Woo-Jung Park, Jeong-Sun Yang, Joo Ae Kim, Mi-Ran Yun, Dae-Won Kim, Sung Soon Kim, Yi Zhang, Wei Shi, Lingshu Wang, Barney S. Graham, John R. Mascola, Nanshuang Wang, Jason S. McLella
    PLOS ONE.2020; 15(5): e0232757.     CrossRef
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    Dong Zhao, Mengmei Wang, Ming Wang, Yang Zhao, Zhishui Zheng, Xiaochen Li, Yunting Zhang, Tao Wang, Shaolin Zeng, Weihua Hu, Wenzhen Yu, Ke Hu
    International Journal of Infectious Diseases.2020; 99: 219.     CrossRef
  • Asymptomatic Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: Extent and implications for infection control: A systematic review
    Jaffar A. Al-Tawfiq, Philippe Gautret
    Travel Medicine and Infectious Disease.2019; 27: 27.     CrossRef
  • Airflow analysis of Pyeongtaek St Mary's Hospital during hospitalization of the first Middle East respiratory syndrome patient in Korea
    Seongmin Jo, Jinkwan Hong, Sang-Eun Lee, Moran Ki, Bo Youl Choi, Minki Sung
    Royal Society Open Science.2019; 6(3): 181164.     CrossRef
  • Comparative Analysis of Eleven Healthcare-Associated Outbreaks of Middle East Respiratory Syndrome Coronavirus (Mers-Cov) from 2015 to 2017
    Sibylle Bernard-Stoecklin, Birgit Nikolay, Abdullah Assiri, Abdul Aziz Bin Saeed, Peter Karim Ben Embarek, Hassan El Bushra, Moran Ki, Mamunur Rahman Malik, Arnaud Fontanet, Simon Cauchemez, Maria D. Van Kerkhove
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  • Airflow as a Possible Transmission Route of Middle East Respiratory Syndrome at an Initial Outbreak Hospital in Korea
    Minki Sung, Seongmin Jo, Sang-Eun Lee, Moran Ki, Bo Youl Choi, JinKwan Hong
    International Journal of Environmental Research and Public Health.2018; 15(12): 2757.     CrossRef
  • CD8+ T Cells Responding to the Middle East Respiratory Syndrome Coronavirus Nucleocapsid Protein Delivered by Vaccinia Virus MVA in Mice
    Svenja Veit, Sylvia Jany, Robert Fux, Gerd Sutter, Asisa Volz
    Viruses.2018; 10(12): 718.     CrossRef
  • Considering Revision the Criteria for Patients under Investigations for MERS-CoV Infections: Diarrhea or Not
    Mi-Na Kim, Eui-Chong Kim
    Journal of Korean Medical Science.2018;[Epub]     CrossRef
Experience of 16 years and its associated challenges in the Field Epidemiology Training Program in Korea
Moo-Sik Lee, Eun-Young Kim, Sang-Won Lee
Epidemiol Health. 2017;39:e2017058.   Published online December 25, 2017
DOI: https://doi.org/10.4178/epih.e2017058
  • 15,332 View
  • 267 Download
  • 6 Web of Science
  • 11 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The field epidemiologist system of South Korea, which employs public health doctors who are relatively more readily available, was created in 1999 to ensure a ready supply of experts for epidemiological investigations and enable an effective response for new and reemerging infectious diseases. However, the 2015 outbreak of Middle East Respiratory Syndrome revealed limitations in the existing systems of management of field epidemiologists and communicable diseases.
METHODS
The present study aims to evaluate data on current states, administrative reports, and other literature on the field epidemiologist system that has been in place in South Korea for 16 years since 1999 and to suggest appropriate future improvements in this system.
RESULTS
By suggesting methods to evaluate the field epidemiologist system and training programs and by suggesting ways for the Korea Centers for Disease Control and Prevention to conduct evaluations on its own, the present study provides supporting evidence for improvement of systems for training of experts in epidemiological investigations. Moreover, based on the findings, this study also suggests methods to systematically train experts in communicable diseases management and a sustainable system to establish the basis of and develop strategies for a systematic and phased management of field epidemiologist training programs.
CONCLUSIONS
The present study suggests the possibility of establishing dedicated training facilities, revising the guidelines on training and improvement of the competency of public health experts, while not limiting the scope of application to communicable diseases.
Summary
Korean summary
목적 : 이 연구는 한국의 역학조사관제도의 바람직한 개선방향을 제시하고자 하였다. 방법 : 1999년 이후 16년간 한국에서 진행되어왔던 역학조사관 제도의 운영 현황자료, 각종 문헌, 행정보고서 등을 리뷰하고, 분석 및 평가하였다. 결과 : 연구 분석결과를 활용하여 보다 체계적인 감염병 관리 전문가 양성을 위한 방안과 역학조사관 교육 프로그램의 체계적인, 단계적인 운영 기반을 구축하고 전략 개발을 위한 지속가능한 수행체계를 제안하였으며, 역학조사관 제도 및 교육프로그램의 평가 방법을 제시하고, 향후 질병관리본부에서 자체적인 평가방향을 제안하였다. 또한 감염병에만 국한되지 않는 공중보건 전문인력 양성 및 역량 강화의 가이드라인 개정 및 전문 교육기관 설립에 대한 가능성을 제안함으로써 한국의 역학조사 전문인력 양성을 위한 제도개선을 위한 근거 자료를 마련하였다. 결론 : 이 연구에서 제안된 안을 바탕으로 향후 한국의 역학조사관제도의 적극적인 개선이 요구된다.

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Epidemiologic Investigation
Healthcare worker infected with Middle East Respiratory Syndrome during cardiopulmonary resuscitation in Korea, 2015
Hae-Sung Nam, Mi-Yeon Yeon, Jung Wan Park, Jee-Young Hong, Ji Woong Son
Epidemiol Health. 2017;39:e2017052.   Published online November 12, 2017
DOI: https://doi.org/10.4178/epih.e2017052
  • 19,731 View
  • 284 Download
  • 26 Web of Science
  • 39 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
During the outbreak of the Middle East Respiratory Syndrome (MERS) in Korea in 2015, the Korea Centers for Disease Control and Prevention (KCDC) confirmed a case of MERS in a healthcare worker in Daejeon, South Korea. To verify the precise route of infection for the case, we conducted an in-depth epidemiological investigation in cooperation with the KCDC.
METHODS
We reviewed the MERS outbreak investigation report of the KCDC, and interviewed the healthcare worker who had recovered from MERS. Using the media interview data, we reaffirmed and supplemented the nature of the exposure.
RESULTS
The healthcare worker, a nurse, was infected while performing cardiopulmonary resuscitation (CPR) for a MERS patient in an isolation room. During the CPR which lasted for an hour, a large amount of body fluid was splashed. The nurse was presumed to have touched the mask to adjust its position during the CPR. She suggested that she was contaminated with the MERS patient’s body fluids by wiping away the sweat from her face during the CPR.
CONCLUSIONS
The possible routes of infection may include the following: respiratory invasion of aerosols contaminated with MERS-coronavirus (MERS-CoV) through a gap between the face and mask; mucosal exposure to sweat contaminated with MERS-CoV; and contamination during doffing of personal protective equipment. The MERS guidelines should reflect this case to decrease the risk of infection during CPR.
Summary
Korean summary
2015년 한국의 Middle East respiratory syndrome (MERS) 유행 기간 중 질병관리본부는 MERS 환자 심폐소생술(cardio–pulmonary resuscitation, CPR)에 참여한 간호사에서 MERS를 확진하였다. 이 사례에 대해 대전광역시 메르스 대응 민간역학조사지원단에서 심층역학조사를 실시한 결과 (1) CPR 수행 중 MERS-CoV에 오염된 에어로졸의 호흡기 침투, (2) MERS-CoV에 오염된 땀의 점막 침투, (3) 보호구 탈의 과정에서 MERS-Cov에 오염 등이 가능한 감염 경로로 파악되었다. 본 사례는 MERS 환자에 대한 CPR 수행 및 수행자의 보호구 착용과 관련하여 MERS 관리 지침의 개정이 필요함을 시사한다.

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Original Article
Infectious disease-related laws: prevention and control measures
Mijeong Park
Epidemiol Health. 2017;39:e2017033.   Published online July 25, 2017
DOI: https://doi.org/10.4178/epih.e2017033
  • 21,276 View
  • 291 Download
  • 18 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study examines recently revised Korean government legislation addressing global infectious disease control for public health emergency situations, with the aim of proposing more rational, effective and realistic interpretations and applications for improvement of law.
METHODS
The Korea reported its first laboratory-confirmed case of Middle East Respiratory Syndrome (MERS) coronavirus on May 20, 2015. Since the first indexed case, Korean public health authorities enforced many public health measures that were not authorized in the law; the scope of the current law was too limited to cover MERS. Korea has three levels of government: the central government, special self-governing provinces, and si/gun/gu. Unfortunately, the Infectious Disease Control and Prevention Act does not designate the specific roles of each level of government, and does not state how these governmental branches should be vertically integrated in a state of emergency.
RESULTS
When thinking about these policy questions, we should be especially concerned about introducing a new act that deals with all matters relevant to emerging infectious diseases. The aim would be to develop a structure that specifies the roles of each level of government, and facilitates the close collaboration among them, then enacting this in law for the prevention and response of infectious disease.
CONCLUSIONS
To address this problem, after analyzing the national healthcare infrastructure along with the characteristics of emerging infectious diseases, we propose the revision of the relevant law(s) in terms of governance aspects, emergency medical countermeasure aspects, and the human rights aspect.
Summary
Korean summary
본 연구의 목적은 2015년 메르스 발생 후, 감염병의 예방 및 관리에 관한 법률의 입법경과를 검토하여 감염병으로 인한 공중보건위기 대응과 관련된 법률의 보다 구체적인 개선방안을 제시하는 것이다. 중앙정부와 지자체의 협력을 위한 거버넌스, 응급상황에서의 긴급의약품 제공을 위한 절차, 격리 대상자의 인권보장과 관련된 부분의 충분한 법적 상당성을 갖추기 위해 국가 보건의료체계 하부구조 측면에서 문제점을 분석한 후 법률 개정방안을 제언하였다.

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MERS-Original Articles
Preventive behaviors by the level of perceived infection sensitivity during the Korea outbreak of Middle East Respiratory Syndrome in 2015
Soon Young Lee, Hee Jeong Yang, Gawon Kim, Hae-Kwan Cheong, Bo Youl Choi
Epidemiol Health. 2016;38:e2016051.   Published online November 16, 2016
DOI: https://doi.org/10.4178/epih.e2016051
  • 17,289 View
  • 248 Download
  • 17 Web of Science
  • 17 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study was performed to investigate the relationship between community residents’ infection sensitivity and their levels of preventive behaviors during the 2015 Middle East Respiratory Syndrome (MERS) outbreak in Korea.
METHODS
Seven thousands two hundreds eighty one participants from nine areas in Gyeonggi-do including Pyeongtaek, the origin of the outbreak in 2015 agreed to participate in the survey and the data from 6,739 participants were included in the final analysis. The data on the perceived infection sensitivity were subjected to cluster analysis. The levels of stress, reliability/practice of preventive behaviors, hand washing practice and policy credibility during the outbreak period were analyzed for each cluster.
RESULTS
Cluster analysis of infection sensitivity due to the MERS outbreak resulted in classification of participants into four groups: the non-sensitive group (14.5%), social concern group (17.4%), neutral group (29.1%), and overall sensitive group (39.0%). A logistic regression analysis found that the overall sensitive group with high sensitivity had higher stress levels (17.80; 95% confidence interval [CI], 13.77 to 23.00), higher reliability on preventive behaviors (5.81; 95% CI, 4.84 to 6.98), higher practice of preventive behaviors (4.53; 95% CI, 3.83 to 5.37) and higher practice of hand washing (2.71; 95% CI, 2.13 to 3.43) during the outbreak period, compared to the non-sensitive group.
CONCLUSIONS
Infection sensitivity of community residents during the MERS outbreak correlated with gender, age, occupation, and health behaviors. When there is an outbreak in the community, there is need to maintain a certain level of sensitivity while reducing excessive stress, as well as promote the practice of preventive behaviors among local residents. In particular, target groups need to be notified and policies need to be established with a consideration of the socio-demographic characteristics of the community.
Summary
Korean summary
2015년 한국에서 발생한 메르스 유행 시 지역 주민이 인식하는 민감도와 예방행위 수준을 파악하고 연관성을 밝히고자 2015년 경기도 9개 시의 지역사회건강조사 대상자 6,739명을 대상으로 감염 민감도와 예방행위 등을 조사 분석하였다. 감염 민감도는 성별, 연령, 직업, 건강행위와 연관성이 있었으며, 감염에 대한 민감도가 높을수록 스트레스를 많이 받는 한편, 예방행위 실천에 긍정적인 영향을 미침을 알 수 있었다. 따라서 감염병 유행 시 지나친 스트레스는 줄이되 공중보건 위기에 대한 적정 수준의 민감도를 유지하고, 인구사회학적 특성을 고려한 관리정책이 요구된다.

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Mental health status of people isolated due to Middle East Respiratory Syndrome
Hyunsuk Jeong, Hyeon Woo Yim, Yeong-Jun Song, Moran Ki, Jung-Ah Min, Juhee Cho, Jeong-Ho Chae
Epidemiol Health. 2016;38:e2016048.   Published online November 5, 2016
DOI: https://doi.org/10.4178/epih.e2016048
  • 47,470 View
  • 1,175 Download
  • 672 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Isolation due to the management of infectious diseases is thought to affect mental health, but the effects are still unknown. We examined the prevalence of anxiety symptoms and anger in persons isolated during the Middle East Respiratory Syndrome (MERS) epidemic both at isolation period and at four to six months after release from isolation. We also determined risk factors associated with these symptoms at four to six months.
METHODS
Of 14,992 individuals isolated for 2-week due to having contact with MERS patients in 2015, when MERS was introduced to Korea, 1,692 individuals were included in this study. Anxiety symptoms were evaluated with the Generalized Anxiety Disorder 7-item scale and anger was assessed with the State-Trait Anger Expression Inventory at four to six months after release from isolation for MERS.
RESULTS
Of 1,692 who came in contact with MERS patients, 1,656 were not diagnosed with MERS. Among 1,656, anxiety symptoms showed 7.6% (95% confidence interval [CI], 6.3 to 8.9%) and feelings of anger were present in 16.6% (95% CI, 14.8 to 18.4%) during the isolation period. At four to six months after release from isolation, anxiety symptoms were observed in 3.0% (95%CI, 2.2 to 3.9%). Feelings of anger were present in 6.4% (95% CI, 5.2 to 7.6%). Risk factors for experiencing anxiety symptoms and anger at four to six months after release included symptoms related to MERS during isolation, inadequate supplies (food, clothes, accommodation), social networking activities (email, text, Internet), history of psychiatric illnesses, and financial loss.
CONCLUSIONS
Mental health problems at four to six month after release from isolation might be prevented by providing mental health support to individuals with vulnerable mental health, and providing accurate information as well as appropriate supplies, including food, clothes, and accommodation.
Summary
Korean summary
메르스 환자와의 밀착접촉으로 격리되었던 1,692명을 대상으로 격리 당시와 격리해제 후 4-6개월 시점의 불안증상과 분노감 유병율을 파악하고 격리 해제 후 4-6개월 시점에 불안증상과 분노감 유병과 연관된 격리기간 동안의 위험요인을 알아보고자 하였다. 메르스 격리자에서 격리시점의 불안증상 유병율은 7.6% (95%CI: 6.3-8.9%), 분노감 유병율은 16.6% (95%CI: 14.8-18.4%) 였고, 4-6개월 시점이 불안증상 유병율은 3.0% (95%CI: 2.2-3.9%), 분노감 유병율은 6.4% (95%CI: 5.2-7.6%) 이였다. 성별과 연령을 보정한 후 격리해제 4-6개월 지난 시점에서 불안증상 및 분노감 유병의 위험요인은 격리 당시 메르스 증상이 있었거나 구호품 보급이 충분하지 않았거나, 정신과 질환의 과거력이 있었던 경우, 재정 손실이 있었던 사람이었다.

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MERS-Epidemiologic Investigations
Epidemiological investigation of the 119th confirmed Middle East Respiratory Syndrome coronavirus case with an indefinite mode of transmission during the Pyeongtaek outbreak in Korea
Jong Hyuk Choi, Byoungin Yoo, Soon Young Lee, Eun Gyu Lee, Moran Ki, Woncheol Lee, Jong Rak Jung, Kyujin Chang
Epidemiol Health. 2015;37:e2015054.   Published online December 10, 2015
DOI: https://doi.org/10.4178/epih/e2015054
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
Since the first case was diagnosed on May 20, 2015, there were 186 confirmed cases of Middle East Respiratory Syndrome (MERS) until the end of outbreak in South Korea. Although medical institutions were the most identifiable sources of MERS transmission in South Korea, similar to other countries, in-depth epidemiological investigation was required for some confirmed cases with indefinite contact history or hospital visit records. The subject of epidemiological investigation in the present study was a 35 year-old male patient diagnosed with MERS (#119) who lived in Asan-city and worked in Pyeongtaek-city. Various potential sources of transmission were carefully investigated. While he could have been exposed to MERS through a friend from Saudi Arabia or confirmed MERS cases in his workplace, neighboring areas, and medical institutions, as well as contacts in his home, the chances of transmission were low; however, the potential for transmission through his local community could not be excluded. Practically, it was difficult to determine the modes of transmission for all outbreak cases in communicable disease that occurred in this short period of time. The investigation to identify the mode of transmission in this case was ultimately unsuccessful. However, the various data collected and analyzed to reveal modes of transmission provided detailed information that could not be collected using only interview surveys.
Summary
Korean summary
2015년 한국에서 유행한 메르스 환자들 중, 감염 경로가 불분명한 119번째 환자에 대한 심층 역학조사를 통해 다양한 감염경로의 가능성을 검토하였다. 감염경로를 명확하게 밝혀내지 못한 한계점이 있지만, 지역사회 전파에 대한 가능성을 제시하였다. 감염병 대유행시 효율적인 감염경로 파악을 위해서는 다방면의 자료에 대한 확보체계와 이를 신속히 분석하고 판단할 수 있는 전문 인력 확충이 필요하다.

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  • A database of geopositioned Middle East Respiratory Syndrome Coronavirus occurrences
    Rebecca E. Ramshaw, Ian D. Letourneau, Amy Y. Hong, Julia Hon, Julia D. Morgan, Joshua C. P. Osborne, Shreya Shirude, Maria D. Van Kerkhove, Simon I. Hay, David M. Pigott
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The first case of the 2015 Korean Middle East Respiratory Syndrome outbreak
Yong-Shik Park, Changhwan Lee, Kyung Min Kim, Seung Woo Kim, Keon-Joo Lee, Jungmo Ahn, Moran Ki
Epidemiol Health. 2015;37:e2015049.   Published online November 14, 2015
DOI: https://doi.org/10.4178/epih/e2015049
  • 19,461 View
  • 187 Download
  • 23 Web of Science
  • 29 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
This study reviewed problems in the prevention of outbreak and spread of Middle East Respiratory Syndrome (MERS) and aimed to provide assistance in establishing policies to prevent and manage future outbreaks of novel infectious diseases of foreign origin via in-depth epidemiological investigation of the patient who initiated the MERS outbreak in Korea, 2015. Personal and phone interviews were conducted with the patient and his guardians, and his activities in Saudi Arabia were investigated with the help of the Saudi Arabian Ministry of Health. Clinical courses and test results were confirmed from the medical records. The patient visited 4 medical facilities and contacted 742 people between May 11, 2015, at symptom onset, and May 20, at admission to the National Medical Center; 28 people were infected and diagnosed with MERS thereafter. Valuable lessons learned included: (1) epidemiological knowledge on the MERS transmission pattern and medical knowledge on its clinical course; (2) improvement of epidemiological investigative methods via closed-circuit television, global positioning system tracking, and review of Health Insurance Review and Assessment Service records; (3) problems revealed in the existing preventive techniques, including early determination of the various people contacted; (4) experiences with preventive methods used for the first time in Korea, including cohort quarantine; (5) reconsideration of the management systems for infectious disease outbreaks across the country, such as this case, at the levels of central government, local government, and the public; (6) reconsideration of hospital infectious disease management systems, culture involving patient visitation, and emergency room environments.
Summary
Korean summary
2015년 한국 메르스 유행의 발단이 된 첫 번째 환자의 역학조사를 통해 신종감염병의 국내 유입 경위 및 유행확산을 막기 위한 대응 과정의 문제점을 되짚어 보았다. 이를 통해 향후 신종감염병의 국내유입을 막기 위한 대비, 대응 정책 수립에 도움이 되길 바라며 이번 메르스 유행이 한국의 병원감염 관리 수준이 향상되는 계기가 되어야 할 것이다.

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MERS-Original Article
Epidemiologic features of the first MERS outbreak in Korea: focus on Pyeongtaek St. Mary’s Hospital
Kyung Min Kim, Moran Ki, Sung-il Cho, Minki Sung, Jin Kwan Hong, Hae-Kwan Cheong, Jong-Hun Kim, Sang-Eun Lee, Changhwan Lee, Keon-Joo Lee, Yong-Shik Park, Seung Woo Kim, Bo Youl Choi
Epidemiol Health. 2015;37:e2015041.   Published online September 17, 2015
DOI: https://doi.org/10.4178/epih/e2015041
  • 24,218 View
  • 278 Download
  • 30 Web of Science
  • 29 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study investigated the epidemiologic features of the confirmed cases of Middle East Respiratory Syndrome (MERS) in Pyeongtaek St. Mary’s Hospital, where the outbreak first began, in order to identify lessons relevant for the prevention and control of future outbreaks.
METHODS
The patients’ clinical symptoms and test results were collected from their medical records. The caregivers of patients were identified by phone calls.
RESULTS
After patient zero (case #1) was admitted to Pyeongtaek St. Mary’s Hospital (May 15-May 17), an outbreak occurred, with 36 cases between May 18 and June 4, 2015. Six patients died (fatality rate, 16.7%). Twenty-six cases occurred in the first-generation, and 10 in the second-generation. The median incubation period was five days, while the median period from symptom onset to death was 12.5 days. While the total attack rate was 3.9%, the attack rate among inpatients was 7.6%, and the inpatients on the eighth floor, where patient zero was hospitalized, had an 18.6% attack rate. In contrast, caregivers and medical staff showed attack rates of 3.3% and 1.1%, respectively.
CONCLUSIONS
The attack rates were higher than those of the previous outbreaks in other countries. The outbreak spread beyond Pyeongtaek St. Mary’s Hospital when four of the patients were moved to other hospitals without appropriate quarantine. The best method of preventing future outbreaks is to overcome the vulnerabilities observed in this outbreak, such as ward crowding, patient migration without appropriate data sharing, and the lack of an initial broad quarantine.
Summary
Korean summary
평택성모병원에서는 총 36명의 메르스 환자가 발생하여 이중 6명이 사망하였다. 또한 평택성모병원 유행의 발병률은 기존에 알려진 것보다 높았다. 한국의 메르스 유행이 시작된 평택성모병원에서 나타난 초기 방역 부족, 적절한 정보공유 없이 환자들이 병원간에 이동하는 것, 혼잡한 병동 문제 등의 감염병 전파 취약점을 극복하는 것이 향후 새로운 감염병 유행을 막을 수 있는 최선의 방법이 될 것이다.

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MERS-Perspective
Strengthening epidemiologic investigation of infectious diseases in Korea: lessons from the Middle East Respiratory Syndrome outbreak
Changhwan Lee, Moran Ki
Epidemiol Health. 2015;37:e2015040.   Published online September 16, 2015
DOI: https://doi.org/10.4178/epih/e2015040
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  • 219 Download
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The recent outbreak of Middle East Respiratory Syndrome (MERS) coronavirus infection in Korea resulted in large socioeconomic losses. This provoked the Korean government and the general public to recognize the importance of having a well-established system against infectious diseases. Although epidemiologic investigation is one of the most important aspects of prevention, it has been pointed out that much needs to be improved in Korea. We review here the current status of the Korean epidemiologic service and suggest possible supplementation measures. We examine the current national preventive infrastructure, including human resources such as Epidemic Intelligence Service officers, its governmental management, and related policies. In addition, we describe the practical application of these resources to the recent MERS outbreak and the progress in preventive measures. The spread of MERS demonstrated that the general readiness for emerging infectious diseases in Korea is considerably low. We believe that it is essential to increase society’s investment in disease prevention. Fostering public health personnel, legislating management policies, and establishing research centers for emerging infectious diseases are potential solutions. Evaluating international preventive systems, developing cooperative measures, and initiating improvements are necessary. We evaluated the Korean epidemiologic investigation system and the public preventive measures against infectious diseases in light of the recent MERS outbreak. We suggest that governmental authorities in Korea enforce preventive policies, foster the development of highly qualified personnel, and increase investment in the public health domain of infectious disease prevention.
Summary
Korean summary
2015년 한국의 메르스 유행시 실제 시행되었던 역학조사 내용을 기술하고, 단계별로 문제점을 검토하였다. 또한 향후 역학조사 강화방안으로 1)관련 법령 수정, 2)역학조사 전문인력 강화, 3) 신종 감염병 연구센터 필요성 등을 제시하였다. 이번 메르스 위기를 기회로 삼아 한국 감염병 대비대응체계를 굳건히 하여야 할 것이다.

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    Younsik Kim
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    Yeong-jun Song, Jeong-Sun Yang, Hee Jung Yoon, Hae-Sung Nam, Soon Young Lee, Hae-Kwan Cheong, Woo-Jung Park, Sung Han Park, Bo Youl Choi, Sung Soon Kim, Moran Ki
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    Hiroshi Nishiura, Akira Endo, Masaya Saitoh, Ryo Kinoshita, Ryo Ueno, Shinji Nakaoka, Yuichiro Miyamatsu, Yueping Dong, Gerardo Chowell, Kenji Mizumoto
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MERS-Epidemiologic Investigations
MERS epidemiological investigation to detect potential mode of transmission in the 178th MERS confirmed case in Pyeongtaek, Korea
Kyujin Chang, Moran Ki, Eun Gyu Lee, Soon Young Lee, Byoungin Yoo, Jong Hyuk Choi
Epidemiol Health. 2015;37:e2015036.   Published online August 15, 2015
DOI: https://doi.org/10.4178/epih/e2015036
  • 21,176 View
  • 166 Download
  • 10 Web of Science
  • 7 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
Most cases of Middle East Respiratory Syndrome (MERS) infection in Korea (outbreak: May 11-July 4, 2015) occurred in hospital settings, with uncertain transmission modes in some cases. We performed an in-depth investigation epidemiological survey on the 178th case to determine the precise mode of transmission. A 29- year-old man living in Pyeongtaek presented on June 16 with a febrile sensation, chills, and myalgia. Upon confirmatory diagnosis on June 23, he was treated in an isolation room and discharged on July 2 after cure. An epidemiological investigation of all possible infection routes indicated two likely modes of transmission: exposure to MERS in Pyeongtaek St. Mary’s Hospital during a visit to his hospitalized father (May 18-29), and infection through frequent contact with his father between the latter’s referral to Pyeongtaek Good Samaritan Bagae Hospital for treatment without confirmatory diagnosis until his death (May 29-June 6). Although lack of clear proof or evidence to the contrary does not allow a definitive conclusion, all other possibilities could be excluded by epidemiological inferences. While it is impossible to trace back the modes of transmission of all cases in a large-scale outbreak, case-by-case tracking and isolation of infected individuals and those in close contact with them is important in preventing the spread. Efforts should be made to establish a methodology for rapid tracking of all possible contacts and elimination-based identification of the precise modes of transmission.
Summary
Korean summary
이 논문은 2015년 한국에서 새롭게 발생한 감염병인 메르스 유행 중, 감염경로가 불분명하였던 178번째 환자에 대한 심층 역학조사 과정과 결과를 기술한 것이며, 조사를 통해 얻은 교훈을 학계 및 관계자들과 공유하고자 한다. 조사 결과, 다른 사례들과 마찬가지로 병원감염으로 볼 수 있음을 밝힌다.

Citations

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    Huiquan Wang, Hong Ye, Lu Liu
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    Abdullah M Alnuqaydan, Abdulmajeed G Almutary, Arulmalar Sukamaran, Brian Tay Wei Yang, Xiao Ting Lee, Wei Xuan Lim, Yee Min Ng, Rania Ibrahim, Thiviya Darmarajan, Satheeshkumar Nanjappan, Jestin Chellian, Mayuren Candasamy, Thiagarajan Madheswaran, Ankur
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  • A database of geopositioned Middle East Respiratory Syndrome Coronavirus occurrences
    Rebecca E. Ramshaw, Ian D. Letourneau, Amy Y. Hong, Julia Hon, Julia D. Morgan, Joshua C. P. Osborne, Shreya Shirude, Maria D. Van Kerkhove, Simon I. Hay, David M. Pigott
    Scientific Data.2019;[Epub]     CrossRef
  • Identifying determinants of heterogeneous transmission dynamics of the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea, 2015: a retrospective epidemiological analysis
    Hiroshi Nishiura, Akira Endo, Masaya Saitoh, Ryo Kinoshita, Ryo Ueno, Shinji Nakaoka, Yuichiro Miyamatsu, Yueping Dong, Gerardo Chowell, Kenji Mizumoto
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Surveillance operation for the 141st confirmed case of Middle East Respiratory Syndrome coronavirus in response to the patient’s prior travel to Jeju Island
Jong-Myon Bae
Epidemiol Health. 2015;37:e2015035.   Published online August 7, 2015
DOI: https://doi.org/10.4178/epih/e2015035
  • 18,813 View
  • 172 Download
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The provincial government of Jeju, South Korea, was notified that a 42-year-old man infected with the Middle East Respiratory Syndrome (MERS) coronavirus had gone sightseeing in Jeju Island. Although the visiting period might be interpreted as the incubation period of MERS, the province decided to conduct active surveillance to prevent a worst-case scenario. Based on the channel of movement of the patient, healthy isolation and active monitoring were conducted for persons who came in contact with the patient. During the active surveillance, none of the 56 persons in self-isolation and 123 persons under active monitoring became infected. This fact supports that MERS is not contagious during the incubation period.
Summary
Korean summary
141번 MERS 양성확진자에 대한 역학조사를 통해 잠복기간에 제주도를 여행한 것이 확인되었다. 이에 제주도 MERS 방역본부는 최악의 경우를 염두에 두고, 밀접접촉자 56명과 일상접촉자 123명을 각각 자택격리와 능동모니터링 대상자로 조치하였다. 잠복기 14일을 기준으로 감시체계를 운영하였지만, 양성감염자는 전무하였다. 이는 MERS의 잠복기 동안에는 감염력이 없다는 근거가 된다.

Citations

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  • Sources of Infection Among Confirmed Cases of COVID-19 in Jeju Province, Korea
    Moonkyong Hwang, Jong-Myon Bae
    Journal of Preventive Medicine and Public Health.2021; 54(4): 245.     CrossRef
  • A database of geopositioned Middle East Respiratory Syndrome Coronavirus occurrences
    Rebecca E. Ramshaw, Ian D. Letourneau, Amy Y. Hong, Julia Hon, Julia D. Morgan, Joshua C. P. Osborne, Shreya Shirude, Maria D. Van Kerkhove, Simon I. Hay, David M. Pigott
    Scientific Data.2019;[Epub]     CrossRef
MERS-Editorial
2015 MERS outbreak in Korea: hospital-to-hospital transmission
Moran Ki
Epidemiol Health. 2015;37:e2015033.   Published online July 21, 2015
DOI: https://doi.org/10.4178/epih/e2015033
  • 42,774 View
  • 415 Download
  • 47 Web of Science
  • 160 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The distinct characteristic of the Middle East Respiratory Syndrome (MERS) outbreak in South Korea is that it not only involves intra-hospital transmission, but it also involves hospital-to-hospital transmission. It has been the largest MERS outbreak outside the Middle East, with 186 confirmed cases and, among them, 36 fatal cases as of July 26, 2015. All confirmed cases are suspected to be hospital-acquired infections except one case of household transmission and two cases still undergoing examination. The Korean health care system has been the major factor shaping the unique characteristics of the outbreak. Taking this as an opportunity, the Korean government should carefully assess the fundamental problems of the vulnerability to hospital infection and make short- as well as long-term plans for countermeasures. In addition, it is hoped that this journal, <i>Epidemiology and Health</i>, becomes a place where various topics regarding MERS can be discussed and shared.
Summary
Korean summary
한국의 메르스 유행은 병원내 감염뿐 아니라 병원에서 병원으로 전파되는 양상을 보인 것이 특징이다. 사우디아라비아 다음으로 가장 많은 환자가 발생하였는데 전체 확진자는 186명이고, 이중에 사망자는 36명이다. 확진자 대부분이 병원에서 감염된 것으로 추정된다. 가족간 감염이 의심되는 경우는 1명정도이며, 2명은 경로를 조사중인데 이중에 한명은 지역사회 감염이 의심된다. 한국의 의료체계 특성이 이번 유행에 중요한 요인이 되었다. 이 기회에 한국은 병원감염관리에 취약한 우리의 근본적인 문제점을 살펴서 장단기적인 대책을 마련하여야 할 것이다. 또한 역학회지가 메르스와 관련된 다양한 주제가 논의되는 장이 되기를 바란다.

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