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. 2016 Sep 3;388(10048):994-1001.
doi: 10.1016/S0140-6736(16)30623-7. Epub 2016 Jul 9.

MERS-CoV outbreak following a single patient exposure in an emergency room in South Korea: an epidemiological outbreak study

Sun Young Cho  1 , Ji-Man Kang  2 , Young Eun Ha  1 , Ga Eun Park  1 , Ji Yeon Lee  1 , Jae-Hoon Ko  1 , Ji Yong Lee  1 , Jong Min Kim  2 , Cheol-In Kang  1 , Ik Joon Jo  3 , Jae Geum Ryu  4 , Jong Rim Choi  4 , Seonwoo Kim  5 , Hee Jae Huh  6 , Chang-Seok Ki  6 , Eun-Suk Kang  6 , Kyong Ran Peck  1 , Hun-Jong Dhong  7 , Jae-Hoon Song  1 , Doo Ryeon Chung  8 , Yae-Jean Kim  9
Affiliations

MERS-CoV outbreak following a single patient exposure in an emergency room in South Korea: an epidemiological outbreak study

Sun Young Cho et al. Lancet. .

Abstract

Background: In 2015, a large outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection occurred following a single patient exposure in an emergency room at the Samsung Medical Center, a tertiary-care hospital in Seoul, South Korea. We aimed to investigate the epidemiology of MERS-CoV outbreak in our hospital.

Methods: We identified all patients and health-care workers who had been in the emergency room with the index case between May 27 and May 29, 2015. Patients were categorised on the basis of their exposure in the emergency room: in the same zone as the index case (group A), in different zones except for overlap at the registration area or the radiology suite (group B), and in different zones (group C). We documented cases of MERS-CoV infection, confirmed by real-time PCR testing of sputum samples. We analysed attack rates, incubation periods of the virus, and risk factors for transmission.

Findings: 675 patients and 218 health-care workers were identified as contacts. MERS-CoV infection was confirmed in 82 individuals (33 patients, eight health-care workers, and 41 visitors). The attack rate was highest in group A (20% [23/117] vs 5% [3/58] in group B vs 1% [4/500] in group C; p<0·0001), and was 2% (5/218) in health-care workers. After excluding nine cases (because of inability to determine the date of symptom onset in six cases and lack of data from three visitors), the median incubation period was 7 days (range 2-17, IQR 5-10). The median incubation period was significantly shorter in group A than in group C (5 days [IQR 4-8] vs 11 days [6-12]; p<0·0001). There were no confirmed cases in patients and visitors who visited the emergency room on May 29 and who were exposed only to potentially contaminated environment without direct contact with the index case. The main risk factor for transmission of MERS-CoV was the location of exposure.

Interpretation: Our results showed increased transmission potential of MERS-CoV from a single patient in an overcrowded emergency room and provide compelling evidence that health-care facilities worldwide need to be prepared for emerging infectious diseases.

Funding: None.

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Figures

Figure 1
Figure 1
(A) Floor plan of the emergency room and schematic views of (B) zone II, (C) zone III, and (D) zone IV Patient 14 was cared for in zones II–IV between May 27 and May 29, 2015.
Figure 2
Figure 2
(A) Confirmed cases of MERS-CoV infection by date of symptom onset after exposure to Patient 14 and (B) incubation periods (A) 73 confirmed cases are shown here; six patients were excluded because we could not determine the date of symptom onset, and data were not available from three visitors. (B) Incubation periods were calculated from data of 59 patients and visitors in groups A–C. MERS-CoV=Middle East respiratory syndrome coronavirus.
Figure 3
Figure 3
Attack rates (A) by groups of patient contacts and (B) by date of exposure Error bars represent 95% CI. MERS-CoV=Middle East respiratory syndrome coronavirus.
Figure 4
Figure 4
Location of Patient 14 during his stay in the emergency room HEPA=high-efficiency particulate arrestance.
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References

    1. Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med. 2012;367:1814–1820. - PubMed
    1. Middle East respiratory syndrome coronavirus (MERS-CoV)—Saudi Arabia. World Health Organization; Geneva: 2016. http://www.who.int/csr/don/23-march-2016-mers-saudi-arabia/en (accessed March 29, 2016).
    1. Cauchemez S, Fraser C, Van Kerkhove MD. Middle East respiratory syndrome coronavirus: quantification of the extent of the epidemic, surveillance biases, and transmissibility. Lancet Infect Dis. 2014;14:50–56. - PMC - PubMed
    1. Breban R, Riou J, Fontanet A. Interhuman transmissibility of Middle East respiratory syndrome coronavirus: estimation of pandemic risk. Lancet. 2013;382:694–699. - PMC - PubMed
    1. Chowell G, Blumberg S, Simonsen L, Miller MA, Viboud C. Synthesizing data and models for the spread of MERS-CoV, 2013: key role of index cases and hospital transmission. Epidemics. 2014;9:40–51. - PMC - PubMed

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