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MERS-Epidemiologic Investigation
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
  • 17,667 View
  • 186 Download
  • 22 Web of Science
  • 28 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
  • 22,302 View
  • 277 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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