Abstract
BackgroundEmerging respiratory infections represent a significant public health threat. Because of their novelty, there are limited measures available to control their early spread. Learning from past outbreaks is important for future preparation. The Middle Eastern Respiratory Syndrome CoronaVirus (MERS‐CoV ) 2015 outbreak in the Republic of Korea (ROK) provides one such opportunity.ObjectivesWe demonstrated through quantitative methodologies how to estimate MERS‐CoV's transmissibility and identified the effective countermeasures that stopped its spread.MethodsUsing the outbreak data, statistical methods were employed to estimate the basic reproductive number R 0, the average number of secondary cases produced by a typical primary case during its entire infectious period in a fully susceptible population. A transmission dynamics model was also proposed to estimate R 0 and to identify the most effective countermeasures. The consistency between results will provide cross‐validation of the approaches.Results R 0 ranged from 2.5 with 95% confidence interval (CI): [1.7, 3.1] (using the sequential Bayesian method) to 7.2 with 95% CI: [5.3, 9.4] (using the Nowcasting method). Estimates from transmission model were higher but overlapped with these. Personal protection and rapid confirmation of cases were identified as the most important countermeasures.ConclusionsOur estimates were in agreement with others from the ROK outbreak, albeit significantly higher than estimates based on other small outbreaks and sporadic cases of MERS‐CoV. The large‐scale outbreak in the ROK was jointly due to the high transmissibility in the healthcare‐associated setting and the Korean culture‐associated contact behaviour. Limiting such behaviour by rapidly identifying and isolating cases and avoiding high‐risk contacts effectively stopped further transmission.
Highlights
Measuring transmissibility of an emerging respiratory infectious disease is vital to preparedness of authorities and design of the optimal intervention strategies
We revisit the estimation of reproductive number of MERS-CoV using statistical methods on the outbreak data released by Korea Centers for Disease Control and Prevention (KCDC)[22] by considering the actual situation of transmission events, we propose a transmission dynamics model to explore how the variation in transition rates affects the decomposition of the key pathways of the spread
The characterisations based on the previous small outbreaks and sporadic cases suggest that MERS-CoV is severe but not very contagious.[10,11,12]
Summary
Measuring transmissibility of an emerging respiratory infectious disease is vital to preparedness of authorities and design of the optimal intervention strategies. Following the 2003 SARS outbreak, especially the 2009 pandemic flu, effort has been made to rapidly estimate the reproductive number and many statistical methods[2,3,4,5,6,7] were proposed for this task. These methods have been made in publicly available software.[8,9]
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