Probable transmission chains of Middle East respiratory syndrome coronavirus and the multiple generations of secondary infection in South Korea - PubMed (original) (raw)

Probable transmission chains of Middle East respiratory syndrome coronavirus and the multiple generations of secondary infection in South Korea

Shui Shan Lee et al. Int J Infect Dis. 2015 Sep.

Abstract

Background: In May 2015, South Korea reported its first case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in a 68-year-old man with a history of travel in the Middle East. In the presence of secondary infections, an understanding of the transmission dynamics of the virus is crucial. The aim of this study was to characterize the transmission chains of MERS-CoV infection in the current South Korean outbreak.

Methods: Individual-level data from multiple sources were collected and used for epidemiological analyses.

Results: As of July 14, 2015, 185 confirmed cases of MERS have been reported in the Korean outbreak. Three generations of secondary infection, with over half belonging to the second generation, could be delineated. Hospital infection was found to be the most important cause of virus transmission, affecting largely non-healthcare workers (154/184). Healthcare switching has probably accounted for the emergence of multiple generations of secondary infection. Fomite transmission may explain a significant proportion of the infections occurring in the absence of direct contact with infected cases.

Conclusions: Publicly available data from multiple sources, including the media, are useful to describe the epidemic history of an outbreak. The effective control of MERS-CoV hinges on the upholding of infection control standards and an understanding of health-seeking behaviours in the community.

Keywords: Coronavirus; Epidemiology; Infectious diseases outbreaks; MERS.

Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

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Figures

Figure 1

Figure 1

Chain transmission of reported MERS-CoV cases in South Korea as differentiated by the respective generations of secondary infection (as of July 14, 2015) and location, i.e. the healthcare institutions, with solid circles (● in different colours) representing incident cases who contracted the virus from source patients (■ solid squares in different colours) who were infected before transfer to the implicated institution. Letters A to I denote hospitals, while the numbers (1–177) are codes given to each case, after excluding 9 unclassified ones. The National Designated Medical Centre ‘N’ was set up by the Government to take in confirmed MERS cases.

Figure 2

Figure 2

Epidemic curve showing the reported numbers of cases by generation (n = 177, excluding unclassified cases) against time, as of July 14, 2015.

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