Middle East respiratory syndrome (MERS) is an emerging zoonosis caused by the novel MERS corona virus isolated in 2012. Most MERS cases have been reported from Arab countries of the Middle East, including Saudi Arabia, United Arab Emirates, Qatar, and Jordan. There have been a few imported cases in many countries, but the exception is Korea, which reported 186 confirmed cases originating from one imported case in a two-month outbreak in 2015. There are many lessons to be learned from the MERS outbreak in Korea, among them, management of contacts. The definition of "close contact" used by the Korean Centers for Disease Control and Prevention (KCDC) for MERS response was not clear and not compatible with the definition of the World Health Organization. This incorrect definition allowed the KCDC make serious mistakes in contact tracing and management in the early epidemic stage of MERS. After the rapid expansion of the outbreak, the KCDC redefined a "close contact" according to the definition of the US CDC. The total number of close contacts was 16,693 in this outbreak, and they were all forced to conduct a self-quarantine for 14 days after the last contact with a MERS patient. It was not clear whether self-quarantine of close contacts was effective to control the outbreak. Given the lack of prepared guidelines or a social support system for them, these measures for the massive number of asymptomatic contacts caused a great deal of confusion in the field A clear response guideline is needed for contact management based on robust evidence from this MERS epidemic in Korea.
Centers for Disease Control and Prevention (U.S.) ; Contact Tracing ; Coronavirus Infections ; Humans ; Jordan ; Korea ; Middle East* ; Qatar ; Saudi Arabia ; United Arab Emirates ; World Health Organization

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

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