Middle East respiratory syndrome: what we learned from the 2015 outbreak in the Republic of Korea

Abstract

Middle East Respiratory Syndrome coronavirus (MERS-CoV) was first isolated from a patient with severe pneumonia in 2012. The 2015 Korea outbreak of MERSCoV involved 186 cases, including 38 fatalities. A total of 83% of transmission events were due to five superspreaders, and 44% of the 186 MERS cases were the patients who had been exposed in nosocomial transmission at 16 hospitals. The epidemic lasted for 2 months and the government quarantined 16,993 individuals for 14 days to control the outbreak. This outbreak provides a unique opportunity to fill the gap in our knowledge of MERS-CoV infection. Therefore, in this paper, we review the literature on epidemiology, virology, clinical features, and prevention of MERS-CoV, which were acquired from the 2015 Korea outbreak of MERSCoV.

Middle East respiratory syndrome

“…Several studies of MERS-CoV viral load measurements show that upper respiratory tract specimens have lower viral loads than lower respiratory specimens. 11,12,79,80 MERS-CoV RNA has been detected in blood, urine, and stool-but at much lower viral loads than in the respiratory tract. 81,82 Clinical specimens must be collected by trained staff using appropriate personal protective equipmenteg, when taking nasopharyngeal and oropharyngeal specimens, Dacron or rayon swabs specifically designed for collecting specimens for virology must be used.…”

“…Several studies have reported disease severity and mortality risk factor data from patients in the Middle East and South Korea. 11,12,21,[114][115][116][117] Ahmed and colleagues collected the daily information on MERS-CoV cases posted online by the Saudi Arabian Ministry of Health between Dec 2, 2014, and Nov 12, 2016, and reviewed 660 laboratory-confirmed cases of MERS. 114 They showed mortality at day 3 (13·8%), day 30 (28·3%), and overall (29·8%).…”

“…118 In the 2015 Korean outbreak, the case-fatality rate was 20·4% (39 of 186 patients died), the in-hospital mortality was 19·4% (36 of 186 patients), 7-day mortality (from symptom onset) was 3·8% (seven of 186), and 28-day mortality was 17·7% (33 of 186). 11,12 Host factors associated with mortality in this outbreak were older age (>60 years), smoking history, pre-existing pneumonia, abnormal renal function, and comorbidity. Low albumin, altered mentality, and high pneumonia severity index score at admission were risk factors for mortality.…”

“…2,10 Several outbreaks of human-to-human MERS-CoV trans mission have occurred, the largest outside the Middle East occurring in South Korea in 2015. 11,12 This outbreak was associated with substantial morbidity and mortality, as well as having substantial economic, social, and health security effects. 12 SARS-CoV-2 (initially named 2019-nCoV) was detected in December 2019 after sequencing of clinical samples from a cluster of patients in Wuhan, China who dev -eloped pneumonia of unknown cause.…”

“…11,12 This outbreak was associated with substantial morbidity and mortality, as well as having substantial economic, social, and health security effects. 12 SARS-CoV-2 (initially named 2019-nCoV) was detected in December 2019 after sequencing of clinical samples from a cluster of patients in Wuhan, China who dev -eloped pneumonia of unknown cause. 13 This outbreak is rapidly evolving and as of March 3, 2020 there have been 88 948 laboratory confirmed cases of COVID-19, with 3043 deaths (3·4% mortality).…”