A year has passed since the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea. This 2015 outbreak led to a better understanding of healthcare infection control. The first Korean patient infected by Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was diagnosed on May 20, 2015, after he returned from Qatar and Bahrain. Thereafter, 186 Korean people were infected with the MERS-CoV in a short time through human-to-human transmission. All these cases were linked to healthcare settings, and 25 (13.5 %) infected patients were healthcare workers. Phylogenetic analysis suggested that the MERS-CoV isolate found in the Korean patient was closely related to the Qatar strain, and did not harbor transmission efficiency-improving mutations. Nevertheless, with the same infecting virus strain, Korea experienced the largest MERS-CoV outbreak outside the Arabian Peninsula, primarily due to the different characteristics of population density and the healthcare system. We aimed to review the epidemiological features and existing knowledge on the Korean MERS outbreak, and suggest methods to prevent future epidemics.
Bahrain ; Coronavirus Infections* ; Delivery of Health Care ; Disease Outbreaks* ; Humans ; Infection Control ; Korea ; Middle East Respiratory Syndrome Coronavirus ; Middle East* ; Population Density ; Qatar ; Republic of Korea*

On May 20th 2015, a 68 year old man was the first to be diagnosed with Middle East Respiratory Syndrome-Corona Virus (MERS-CoV) in Korea. He travelled to Bahrain, Saudi Arabia, and Qatar for 16 days. On May 4th 2015, the patient entered Korea, with febrile sense and respiratory symptoms that appeared on May 11th. The MERS-CoV Outbreak became worse and several patients had to be admitted throughout various hospitals starting at the beginning of June. This situation led to a nationwide chaos. The Rapid Response Team (RRT) was organized after the Korean government's calling for specialists that were composed of 15 Infectious disease Doctors and 2 Infection Control professionals on the 8th of June 2015. The main purpose of the RRT were: 1) consultation to the Government controlling MERS-CoV outbreak. 2) Visit hospitals that were exposed to MERS-CoV infected patients, and to provide advice regarding infection control strategy for rehabilitating of the exposed hospitals. Since June 8th, the RRT visited more than 10 hospitals and an effective consultation was carried out. Most of the hospitals were recovering from the MERS outbreak since early July. Cooperation between the government and private sector experts was very effective. The efforts of government and private sector experts overcame the initial chaos situation. It could prevent further deterioration of the MERS outbreak.
Bahrain ; Communicable Diseases ; Coronavirus ; Coronavirus Infections* ; Humans ; Infection Control ; Korea ; Middle East Respiratory Syndrome Coronavirus ; Middle East* ; Private Sector ; Qatar ; Saudi Arabia ; Specialization

PURPOSE: This study aimed to determine the prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency among infants with neonatal indirect hyperbilirubinemia (NIH); compare G6PD-deficient and G6PD-normal patients regarding hyperbilirubinemia and need for exchange transfusions (ET); and assess risk factors for ET and kernicterus. METHODS: This is a case-control retrospective study. Medical records of NIH patients admitted to the Pediatric Department, Salmaniya Medical Complex, Bahrain, between January 2007 and June 2010 were reviewed. Data on sex, age at presentation, hospitalization duration, need for ET, hemoglobin (Hb) level, reticulocyte count, direct Coombs test, serum total and indirect bilirubin levels, thyroid function, blood and urine cultures, G6PD status, and blood groups were collected and compared between the G6PD-deficent and G6PD-normal patients. RESULTS: Of 1,159 NIH patients admitted, 1,129 were included, of whom 646 (57%) were male. Among 1,046 patients tested, 442 (42%) were G6PD deficient, 49 (4%) needed ET, and 11 (1%) had suspected Kernicterus. The G6PD-deficient patients were mainly male (P<0.0001), and had lower Hb levels (P<0.0001) and higher maximum bilirubin levels (P=0.001). More G6PD-deficient patients needed ET (P<0.0001). G6PD deficiency (P=0.006), lower Hb level (P=0.002), lower hematocrit count (P=0.02), higher bilirubin level (P<0.0001), higher maximal bilirubin level (P<0.0001), and positive blood culture result (P<0.0001) were significant risk factors for ET. Maximal bilirubin level was a significant risk factor for kernicterus (P=0.021) and independently related to ET (P=0.03). CONCLUSION: G6PD deficiency is an important risk factor for severe NIH. In G6PD-deficent neonates, management of NIH should be hastened to avoid irreversible neurological complications.
Bahrain ; Bilirubin ; Blood Group Antigens ; Case-Control Studies ; Coombs Test ; Glucose-6-Phosphate* ; Glucosephosphate Dehydrogenase Deficiency* ; Glucosephosphate Dehydrogenase* ; Hematocrit ; Hospitalization ; Humans ; Hyperbilirubinemia ; Hyperbilirubinemia, Neonatal* ; Infant ; Infant, Newborn ; Kernicterus ; Male ; Medical Records ; Prevalence ; Reticulocyte Count ; Retrospective Studies ; Risk Factors ; Thyroid Gland

Since April 2012, more than 1,600 laboratory-confirmed human infections with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) have been reported, occurring primarily in countries in the Arabian Peninsula; the majority in Saudi Arabia. The MERS outbreak in Korea, which began in May 2015 through the importation of a single case who had recently traveled to Bahrain, the United Arab Emirates, Saudi Arabia, and Qatar. As of November 28th, 186 secondary and tertiary cases had been reported; 38 deaths, mainly associated with underlying chronic illnesses, were reported. One case was exported to China and has been recorded as the first MERS case in China. Thirty-seven confirmed cases were associated with the index case, who was hospitalized from May 15 to May 17. Emergency room at one of the nation's largest hospitals had been affected by hospital-to-hospital and intra-hospital transmissions of MERS-CoV, resulting in an outbreak of 90 infected patients. The vast majority of 186 confirmed cases are linked to a single transmission chain associated with health facilities. The median age of patients is 55 years, with a range of 16 to 87 years. The majority (61%) of patients are men. Twenty-five (14%) of the cases involve healthcare workers. The overall median incubation period was six days, but it was four days for secondary cases and six days for tertiary cases. There has been no evidence of airborne transmission and sustained human-to-human transmission in communities. Intensified public health measures, including contact tracing, quarantine and isolation of all contacts and suspected cases, and infection prevention and control have brought the MERSCoV under control in Korea. Since 4 July no new cases have been reported.
Bahrain ; China ; Chronic Disease ; Contact Tracing ; Coronavirus ; Delivery of Health Care ; Emergency Service, Hospital ; Epidemiology ; Health Facilities ; Humans ; Korea* ; Male ; Middle East* ; Public Health ; Qatar ; Quarantine ; Saudi Arabia ; United Arab Emirates