Abstract
MERS-CoV infection emerged in the Kingdom of Saudi Arabia (KSA) in 2012 and has spread to 26 countries. However, 80% of all cases have occurred in KSA. The largest outbreak outside KSA occurred in South Korea (SK) in 2015. In this report, we describe an epidemiological comparison of the two outbreaks. Data from 1299 cases in KSA (2012–2015) and 186 cases in SK (2015) were collected from publicly available resources, including FluTrackers, the World Health Organization (WHO) outbreak news and the Saudi MOH (MOH). Descriptive analysis, t-tests, Chi-square tests and binary logistic regression were conducted to compare demographic and other characteristics (comorbidity, contact history) of cases by nationality. Epidemic curves of the outbreaks were generated. The mean age of cases was 51 years in KSA and 54 years in SK. Older males (⩾70 years) were more likely to be infected or to die from MERS-CoV infection, and males exhibited increased rates of comorbidity in both countries. The epidemic pattern in KSA was more complex, with animal-to-human, human-to-human, nosocomial and unknown exposure, whereas the outbreak in SK was more clearly nosocomial. Of the 1186 MERS cases in KSA with reported risk factors, 158 (13.3%) cases were hospital associated compared with 175 (94.1%) in SK, and an increased proportion of cases with unknown exposure risk was found in KSA (710, 59.9%). In a globally connected world, travel is a risk factor for emerging infections, and health systems in all countries should implement better triage systems for potential imported cases of MERS-CoV to prevent large epidemics.Emerging Microbes & Infections (2017) 6, e51; doi:10.1038/emi.2017.40; published online 7 June 2017
Highlights
MERS-CoV first emerged in the Kingdom of Saudi Arabia (KSA) in 20121 and has since spread to 26 countries.[2]
There was a higher frequency of males among cases in KSA (741 of 1137, 65.2%) than in South Korea (SK) (110 of 186, 59.1%); no significant differences in sex distribution were found between the two countries
The age-specific case fatality rate (CFR) increased by age in both counties, and the highest values were reported in the age group ⩾ 70 years (Figures 1B and 1C)
Summary
MERS-CoV first emerged in the Kingdom of Saudi Arabia (KSA) in 20121 and has since spread to 26 countries.[2]. Human-to-human transmission occurs in healthcare facilities and communities.[7,8,9] Globally, as of 16 January, 2017, a total of 1879 laboratory-confirmed cases of MERSCoV and at least 659 deaths have been reported to the WHO.[10,11] The case fatality rate (CFR) in patients (35%) is higher than that of Severe Acute Respiratory Syndrome (SARS) (9.6%).[12,13] In contrast to MERS-CoV, the SARS epidemic, which exhibited an increased estimated reproductive number R0 of ~ 2, peaked, waned and ended within 8 months. MERS has paradoxically persisted with a largely sporadic pattern for over four years.[14,15] Among the global MERS cases, males (63%)[16] are more affected than females, with a male to female ratio of 1.7:1.17 The mean age of all cases reported worldwide is years, and most cases are between and 59 years of age.[17]
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