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Epidemiology and Health 2018;e2018014.
DOI: https://doi.org/10.4178/epih.e2018014    [Accepted] Published online April 15, 2018.
Asymptomatic infection of Middle East respiratory syndrome coronavirus using serologic survey in Korea
Yeong-jun Song1  , Jeong-Sun Yang2  , Hae-Kwan Cheong3  , Hee Jung Yoon4, Hae-Sung Nam5  , Soon Young Lee6  , WooJung Park2  , SungHan Park2  , Bo Youl Choi7  , Sung Soon Kim2  , Moran Ki1 
1Department of Cancer Science and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
2Centers for Disease Control and Prevention, Cheongju, Republic of Korea
3Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
4The Korean Society of Infectious Diseases, Seoul, Republic of Korea
5Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
6Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
7Department of Preventive Medicine, Hanyang University Medical College, Seoul, Republic of Korea
Correspondence  Moran Ki ,Tel: +82-31-920-2736, Fax: +82-2-6008-6056, Email: moranki@ncc.re.kr
Submitted: March 26, 2018  Accepted after revision: April 15, 2018
Asymptomatic infection rates of Middle East respiratory syndrome (MERS) coronavirus vary. To identify rates of asymptomatic MERS infection in healthcare workers and non-healthcare workers, serologic survey was conducted.
Study individuals were selected from the contacts based on a priority system in four MERS prone-regions. Sero-epidemiological analysis 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 immunospecific assay (ELISA), immunofluorscence assay (IFA), and plaque reduction neutralization antibody test (PRNT). Of 1,610 contacts, there were seven ELISA-positive cases. Among these seven, one exhibited positive IFA and PRNT results.
Asymptomatic infection rate was 0.06% (95% confidence interval, 0.0016-0.3461%). The asymptomatic MERS case was a hospitalized patient with the patient zero on the same floor of the hospital at the same time. The case was quarantined at home for 2 weeks after discharge. The case had underlying diseases, including hypertension, angina, and degenerative arthritis.
The asymptomatic infection was acquired via healthcare-associated transmission. Thus, it is necessary to extend serological studies on inpatient contacts who have no symptoms.
Keywords: asymptomatic infection; epidemiology; Middle East respiratory syndrome coronavirus; nosocomial infections; outbreak; ELISA


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