The first case of the 2015 Korean Middle East Respiratory Syndrome outbreak.

Kyung Min Kim,Changhwan Lee,Moran Ki,Seung Woo Kim,Yong-Shik Park,Keon-Joo Lee,Jungmo Ahn

doi:10.4178/epih/e2015049

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.

Highlights

The outbreak in Korea started with a patient who arrived in May 2015 from Saudi Arabia, a country that had an outbreak of a large number of Middle East Respiratory Syndrome (MERS) cases, and subsequently spread
During his trips within the Middle East, he had no contact with animals and did not eat or drink outside the hotels where he stayed.While staying in Riyadh, he travelled with a driver, a guide, and the Bahrain business facility manager, none of whom showed the symptoms suspected of MERS
On May 19, he was reported to the Korea Centers for Disease Control and Prevention (KCDC) as a case suspected of MERS in consideration of the clinical courses that deteriorated despite the antibiotic therapy and his history of travel to the Middle East within the previous two weeks, which was revealed during a consultation with physician

Summary

Introduction

Human-to-human transmission is known to occur after transmission from a camel to a human, but the exact route has not been sufficiently investigated [2]. The outbreak in Korea started with a patient who arrived in May 2015 from Saudi Arabia, a country that had an outbreak of a large number of MERS cases, and subsequently spread. From May 20, when a diagnosis of MERS was confirmed, the Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention (KCDC), in cooperation with a Epidemiology and Health 2015;37:e2015049 group of civilian volunteers in epidemiology, traced the infection route and performed preventive measures for the spread of additional infections

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Conclusion