Middle East respiratory syndrome: what we learned from the 2015 outbreak in the Republic of Korea
Identifieur interne : 000524 ( Pmc/Checkpoint ); précédent : 000523; suivant : 000525Middle East respiratory syndrome: what we learned from the 2015 outbreak in the Republic of Korea
Auteurs : Myoung-Don Oh ; Wan Beom Park ; Sang-Won Park ; Pyoeng Gyun Choe ; Ji Hwan Bang ; Kyoung-Ho Song ; Eu Suk Kim ; Hong Bin Kim ; Nam Joong KimSource :
- The Korean Journal of Internal Medicine [ 1226-3303 ] ; 2018.
Abstract
Middle East Respiratory Syndrome coronavirus (MERS-CoV) was first isolated from a patient with severe pneumonia in 2012. The 2015 Korea outbreak of MERSCoV involved 186 cases, including 38 fatalities. A total of 83% of transmission events were due to five superspreaders, and 44% of the 186 MERS cases were the patients who had been exposed in nosocomial transmission at 16 hospitals. The epidemic lasted for 2 months and the government quarantined 16,993 individuals for 14 days to control the outbreak. This outbreak provides a unique opportunity to fill the gap in our knowledge of MERS-CoV infection. Therefore, in this paper, we review the literature on epidemiology, virology, clinical features, and prevention of MERS-CoV, which were acquired from the 2015 Korea outbreak of MERSCoV.
Url:
DOI: 10.3904/kjim.2018.031
PubMed: 29506344
PubMed Central: 5840604
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Middle East respiratory syndrome: what we learned from the 2015 outbreak in the Republic of Korea</title><author><name sortKey="Oh, Myoung Don" sort="Oh, Myoung Don" uniqKey="Oh M" first="Myoung-Don" last="Oh">Myoung-Don Oh</name></author><author><name sortKey="Park, Wan Beom" sort="Park, Wan Beom" uniqKey="Park W" first="Wan Beom" last="Park">Wan Beom Park</name></author><author><name sortKey="Park, Sang Won" sort="Park, Sang Won" uniqKey="Park S" first="Sang-Won" last="Park">Sang-Won Park</name></author><author><name sortKey="Choe, Pyoeng Gyun" sort="Choe, Pyoeng Gyun" uniqKey="Choe P" first="Pyoeng Gyun" last="Choe">Pyoeng Gyun Choe</name></author><author><name sortKey="Bang, Ji Hwan" sort="Bang, Ji Hwan" uniqKey="Bang J" first="Ji Hwan" last="Bang">Ji Hwan Bang</name></author><author><name sortKey="Song, Kyoung Ho" sort="Song, Kyoung Ho" uniqKey="Song K" first="Kyoung-Ho" last="Song">Kyoung-Ho Song</name></author><author><name sortKey="Kim, Eu Suk" sort="Kim, Eu Suk" uniqKey="Kim E" first="Eu Suk" last="Kim">Eu Suk Kim</name></author><author><name sortKey="Kim, Hong Bin" sort="Kim, Hong Bin" uniqKey="Kim H" first="Hong Bin" last="Kim">Hong Bin Kim</name></author><author><name sortKey="Kim, Nam Joong" sort="Kim, Nam Joong" uniqKey="Kim N" first="Nam Joong" last="Kim">Nam Joong Kim</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">29506344</idno><idno type="pmc">5840604</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5840604</idno><idno type="RBID">PMC:5840604</idno><idno type="doi">10.3904/kjim.2018.031</idno><date when="2018">2018</date><idno type="wicri:Area/Pmc/Corpus">001379</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001379</idno><idno type="wicri:Area/Pmc/Curation">001379</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">001379</idno><idno type="wicri:Area/Pmc/Checkpoint">000524</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000524</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Middle East respiratory syndrome: what we learned from the 2015 outbreak in the Republic of Korea</title><author><name sortKey="Oh, Myoung Don" sort="Oh, Myoung Don" uniqKey="Oh M" first="Myoung-Don" last="Oh">Myoung-Don Oh</name></author><author><name sortKey="Park, Wan Beom" sort="Park, Wan Beom" uniqKey="Park W" first="Wan Beom" last="Park">Wan Beom Park</name></author><author><name sortKey="Park, Sang Won" sort="Park, Sang Won" uniqKey="Park S" first="Sang-Won" last="Park">Sang-Won Park</name></author><author><name sortKey="Choe, Pyoeng Gyun" sort="Choe, Pyoeng Gyun" uniqKey="Choe P" first="Pyoeng Gyun" last="Choe">Pyoeng Gyun Choe</name></author><author><name sortKey="Bang, Ji Hwan" sort="Bang, Ji Hwan" uniqKey="Bang J" first="Ji Hwan" last="Bang">Ji Hwan Bang</name></author><author><name sortKey="Song, Kyoung Ho" sort="Song, Kyoung Ho" uniqKey="Song K" first="Kyoung-Ho" last="Song">Kyoung-Ho Song</name></author><author><name sortKey="Kim, Eu Suk" sort="Kim, Eu Suk" uniqKey="Kim E" first="Eu Suk" last="Kim">Eu Suk Kim</name></author><author><name sortKey="Kim, Hong Bin" sort="Kim, Hong Bin" uniqKey="Kim H" first="Hong Bin" last="Kim">Hong Bin Kim</name></author><author><name sortKey="Kim, Nam Joong" sort="Kim, Nam Joong" uniqKey="Kim N" first="Nam Joong" last="Kim">Nam Joong Kim</name></author></analytic><series><title level="j">The Korean Journal of Internal Medicine</title><idno type="ISSN">1226-3303</idno><idno type="eISSN">2005-6648</idno><imprint><date when="2018">2018</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Middle East Respiratory Syndrome coronavirus (MERS-CoV) was first isolated from a patient with severe pneumonia in 2012. The 2015 Korea outbreak of MERSCoV involved 186 cases, including 38 fatalities. A total of 83% of transmission events were due to five superspreaders, and 44% of the 186 MERS cases were the patients who had been exposed in nosocomial transmission at 16 hospitals. The epidemic lasted for 2 months and the government quarantined 16,993 individuals for 14 days to control the outbreak. This outbreak provides a unique opportunity to fill the gap in our knowledge of MERS-CoV infection. Therefore, in this paper, we review the literature on epidemiology, virology, clinical features, and prevention of MERS-CoV, which were acquired from the 2015 Korea outbreak of MERSCoV.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Zaki, Am" uniqKey="Zaki A">AM Zaki</name></author><author><name sortKey="Van Boheemen, S" uniqKey="Van Boheemen S">S van Boheemen</name></author><author><name sortKey="Bestebroer, Tm" uniqKey="Bestebroer T">TM Bestebroer</name></author><author><name sortKey="Osterhaus, Ad" uniqKey="Osterhaus A">AD Osterhaus</name></author><author><name sortKey="Fouchier, Ra" uniqKey="Fouchier R">RA Fouchier</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Arabi, Ym" uniqKey="Arabi Y">YM Arabi</name></author><author><name sortKey="Balkhy, Hh" uniqKey="Balkhy H">HH Balkhy</name></author><author><name sortKey="Hayden, Fg" uniqKey="Hayden 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Korean J Intern Med</journal-id><journal-id journal-id-type="iso-abbrev">Korean J. Intern. Med</journal-id><journal-id journal-id-type="publisher-id">KJIM</journal-id><journal-title-group><journal-title>The Korean Journal of Internal Medicine</journal-title></journal-title-group><issn pub-type="ppub">1226-3303</issn><issn pub-type="epub">2005-6648</issn><publisher><publisher-name>The Korean Association of Internal Medicine</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">29506344</article-id><article-id pub-id-type="pmc">5840604</article-id><article-id pub-id-type="doi">10.3904/kjim.2018.031</article-id><article-id pub-id-type="publisher-id">kjim-2018-031</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review</subject></subj-group></article-categories><title-group><article-title>Middle East respiratory syndrome: what we learned from the 2015 outbreak in the Republic of Korea</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Oh</surname><given-names>Myoung-don</given-names></name><xref ref-type="corresp" rid="c1-kjim-2018-031"></xref></contrib><contrib contrib-type="author"><name><surname>Park</surname><given-names>Wan Beom</given-names></name></contrib><contrib contrib-type="author"><name><surname>Park</surname><given-names>Sang-Won</given-names></name></contrib><contrib contrib-type="author"><name><surname>Choe</surname><given-names>Pyoeng Gyun</given-names></name></contrib><contrib contrib-type="author"><name><surname>Bang</surname><given-names>Ji Hwan</given-names></name></contrib><contrib contrib-type="author"><name><surname>Song</surname><given-names>Kyoung-Ho</given-names></name></contrib><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Eu Suk</given-names></name></contrib><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Hong Bin</given-names></name></contrib><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Nam Joong</given-names></name></contrib><aff id="af1-kjim-2018-031"> Department of Internal Medicine, Seoul National University College of Medicine, Seoul,<country>Korea</country></aff></contrib-group><author-notes><corresp id="c1-kjim-2018-031">Correspondence to Myoung-don Oh, M.D. Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-2945 Fax: +82-2-762-9662 E-mail: <email>mdohmd@snu.ac.kr</email></corresp><fn id="fn1-kjim-2018-031"><label>*</label><p>This paper was contributed by the Korean Society of Infectious Diseases.</p></fn></author-notes><pub-date pub-type="ppub"><month>3</month><year>2018</year></pub-date><pub-date pub-type="epub"><day>27</day><month>2</month><year>2018</year></pub-date><volume>33</volume><issue>2</issue><fpage>233</fpage><lpage>246</lpage><history><date date-type="received"><day>5</day><month>2</month><year>2018</year></date><date date-type="accepted"><day>13</day><month>2</month><year>2018</year></date></history><permissions><copyright-statement>Copyright © 2018 The Korean Association of Internal Medicine</copyright-statement><copyright-year>2018</copyright-year><license><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/">http://creativecommons.org/licenses/by-nc/4.0/</ext-link>) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Middle East Respiratory Syndrome coronavirus (MERS-CoV) was first isolated from a patient with severe pneumonia in 2012. The 2015 Korea outbreak of MERSCoV involved 186 cases, including 38 fatalities. A total of 83% of transmission events were due to five superspreaders, and 44% of the 186 MERS cases were the patients who had been exposed in nosocomial transmission at 16 hospitals. The epidemic lasted for 2 months and the government quarantined 16,993 individuals for 14 days to control the outbreak. This outbreak provides a unique opportunity to fill the gap in our knowledge of MERS-CoV infection. Therefore, in this paper, we review the literature on epidemiology, virology, clinical features, and prevention of MERS-CoV, which were acquired from the 2015 Korea outbreak of MERSCoV.</p></abstract><kwd-group><kwd>Coronavirus infections</kwd><kwd>Middle East respiratory syndrome coronavirus</kwd><kwd>Coronavirus</kwd><kwd>Korea</kwd><kwd>Disease outbreaks</kwd></kwd-group></article-meta></front><floats-group><fig id="f1-kjim-2018-031" orientation="portrait" position="float"><label>Figure 1.</label><caption><p>Confirmed global cases of Middle East respiratory syndrome coronavirus reported to World Health Organization (WHO) as of November 17, 2017 (n = 2,103). Other countries: Algeria, Austria, Bahrain, China, Egypt, France, Germany, Greece, Iran, Italy, Jordan, Kuwait, Lebanon, Malaysia, the Netherlands, Oman, Philippines, Qatar, Thailand, Tunisia, Turkey, United Arab Emirates, United Kingdom, United States of America, Yemen. Adapted from World Health Organization [<xref rid="b2-kjim-2018-031" ref-type="bibr">2</xref>].</p></caption><graphic xlink:href="kjim-2018-031f1"></graphic></fig><fig id="f2-kjim-2018-031" orientation="portrait" position="float"><label>Figure 2.</label><caption><p>Epidemiological curve for the 2015 Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in the Republic of Korea. (A) Overall epidemiologic curve by date of symptom onset. Red color denotes the index patient. (B) Epidemic curves for each of the three main clusters. Outbreaks at Hospital C, Hospital H, and Hospital M and N are depicted in yellow, green, and purple color, respectively. Adapted from Korea Centers for Disease Control and Prevention [<xref rid="b7-kjim-2018-031" ref-type="bibr">7</xref>].</p></caption><graphic xlink:href="kjim-2018-031f2"></graphic></fig><fig id="f3-kjim-2018-031" orientation="portrait" position="float"><label>Figure 3.</label><caption><p>Progression of Middle East respiratory syndrome (MERS) pneumonia. (A) Severe cases. (B) Mild cases. In severe cases, pneumonia progressed suddenly around 7 days after symptom onset. Adapted from Oh et al., with permission from Massachusetts Medical Society [<xref rid="b50-kjim-2018-031" ref-type="bibr">50</xref>].</p></caption><graphic xlink:href="kjim-2018-031f3"></graphic></fig><fig id="f4-kjim-2018-031" orientation="portrait" position="float"><label>Figure 4.</label><caption><p>Case fatality ratio of Middle East respiratory syndrome during the 2015 Korea outbreak. Case fatality ratio was 10.1% (11/109) in patients without underlying diseases (A), and 35.1% (27/77) with underlying diseases (B). Overall case fatality ratio was 20.4% (38/186).</p></caption><graphic xlink:href="kjim-2018-031f4"></graphic></fig><table-wrap id="t1-kjim-2018-031" orientation="portrait" position="float"><label>Table 1.</label><caption><p>Demographic and epidemiological characteristics of 186 patients with MERS-CoV infection [<xref rid="b17-kjim-2018-031" ref-type="bibr">17</xref>]</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="middle" rowspan="1" colspan="1">Characteristic</th><th align="center" valign="middle" rowspan="1" colspan="1">No. (%)</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Age, yr</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> ≤ 9</td><td align="center" valign="top" rowspan="1" colspan="1">0</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 10–19</td><td align="center" valign="top" rowspan="1" colspan="1">1 (0.5)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 20–29</td><td align="center" valign="top" rowspan="1" colspan="1">13 (7.0)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 30–39</td><td align="center" valign="top" rowspan="1" colspan="1">26 (14.0)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 40–49</td><td align="center" valign="top" rowspan="1" colspan="1">29 (15.6)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 50–59</td><td align="center" valign="top" rowspan="1" colspan="1">42 (22.6)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 60–69</td><td align="center" valign="top" rowspan="1" colspan="1">36 (19.4)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 70–79</td><td align="center" valign="top" rowspan="1" colspan="1">30 (16.1)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> ≥ 80</td><td align="center" valign="top" rowspan="1" colspan="1">9 (4.8)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Sex</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Male</td><td align="center" valign="top" rowspan="1" colspan="1">111 (59.7)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Female</td><td align="center" valign="top" rowspan="1" colspan="1">75 (40.3)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Exposure category</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Patients</td><td align="center" valign="top" rowspan="1" colspan="1">82</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Family member/visitors</td><td align="center" valign="top" rowspan="1" colspan="1">63</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Doctors</td><td align="center" valign="top" rowspan="1" colspan="1">8</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Nurses</td><td align="center" valign="top" rowspan="1" colspan="1">15</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Paid care givers</td><td align="center" valign="top" rowspan="1" colspan="1">8</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Technologist at Radiology Department</td><td align="center" valign="top" rowspan="1" colspan="1">2</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Ambulance attendants</td><td align="center" valign="top" rowspan="1" colspan="1">2</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Security guards</td><td align="center" valign="top" rowspan="1" colspan="1">2</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Patient transporter</td><td align="center" valign="top" rowspan="1" colspan="1">1</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Employee at IT Department</td><td align="center" valign="top" rowspan="1" colspan="1">1</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Exposure category uncertain</td><td align="center" valign="top" rowspan="1" colspan="1">2</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Place of exposure</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Hospitals/clinics</td><td align="center" valign="top" rowspan="1" colspan="1">172 (92.5)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Home</td><td align="center" valign="top" rowspan="1" colspan="1">2 (1.1)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Either hospital or home</td><td align="center" valign="top" rowspan="1" colspan="1">6 (3.2)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Ambulance</td><td align="center" valign="top" rowspan="1" colspan="1">3 (1.6)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Uncertain</td><td align="center" valign="top" rowspan="1" colspan="1">3 (1.6)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Generation of transmission</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 1st (index case)</td><td align="center" valign="top" rowspan="1" colspan="1">1 (0.5)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 2nd</td><td align="center" valign="top" rowspan="1" colspan="1">28 (15.1)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 3rd</td><td align="center" valign="top" rowspan="1" colspan="1">120 (64.4)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> 4th</td><td align="center" valign="top" rowspan="1" colspan="1">26 (14.0)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Either 2nd, 3rd, or 4th</td><td align="center" valign="top" rowspan="1" colspan="1">8 (4.4)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"> Uncertain</td><td align="center" valign="top" rowspan="1" colspan="1">3 (1.6)</td></tr></tbody></table><table-wrap-foot><fn><p>MERS-CoV, Middle East respiratory syndrome coronavirus; IT, information technology.</p></fn></table-wrap-foot></table-wrap><table-wrap id="t2-kjim-2018-031" orientation="portrait" position="float"><label>Table 2.</label><caption><p>Epidemiological findings and clinical outcomes of 2015 MERS-CoV outbreak in the Republic of Korea</p></caption><table frame="hsides" rules="groups"><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Incubation time: 2–14 days</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Infectious period: 1–11 day of illness onset</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Duration of fever: 8 days (median)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Symptom onset to rRT-PCR (–) conversion: 17 days (median)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Five superspreaders infected 83% of cases</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Pneumonia (CXR infiltrates): 80.8% of the laboratory confirmed MERS-CoV (+) patients</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Pneumonia progressed suddenly at around day 7 of illness onset</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Symptom onset to mechanical ventilation: 9 days (median)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Mechanical ventilation required in 24.5% of the laboratory confirmed MERS-CoV (+) patients</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Symptom onset to death: 14 days (median)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Case fatality ratio: 20.4% (38/186)</td></tr></tbody></table><table-wrap-foot><fn><p>MERS-CoV, Middle East respiratory syndrome coronavirus; rRT-PCR, real-time reverse transcription polymerase chain reaction; CXR, chest X-ray.</p></fn></table-wrap-foot></table-wrap><table-wrap id="t3-kjim-2018-031" orientation="portrait" position="float"><label>Table 3.</label><caption><p>Lessons learned from the 2015 outbreak of MERS-CoV in the Republic of Korea</p></caption><table frame="hsides" rules="groups"><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">A single, missed case may trigger a huge, nationwide outbreak</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">The first line of defense is not the thermal scanner at the airport. It is doctors in the community clinics/hospitals.</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Due to sudden deterioration of pneumonia around day 7 of illness, patients may visit emergency department, or be admitted to intensive care unit.</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Superspreading events may occur in healthcare settings, especially at the emergency department.</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Patients may transmit MERS-CoV as early as 2 days after symptom onset. Early detection and isolation is of critical impor- tance.</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Aggressive strategy for quarantine maybe necessary, especially when large number of individuals are exposed in the health- care settings.</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Huge socioeconomic impact with an estimated 8.5 billion US dollars</td></tr></tbody></table><table-wrap-foot><fn><p>MERS-CoV, Middle East respiratory syndrome coronavirus.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc><affiliations><list></list><tree><noCountry><name sortKey="Bang, Ji Hwan" sort="Bang, Ji Hwan" uniqKey="Bang J" first="Ji Hwan" last="Bang">Ji Hwan Bang</name><name sortKey="Choe, Pyoeng Gyun" sort="Choe, Pyoeng Gyun" uniqKey="Choe P" first="Pyoeng Gyun" last="Choe">Pyoeng Gyun Choe</name><name sortKey="Kim, Eu Suk" sort="Kim, Eu Suk" uniqKey="Kim E" first="Eu Suk" last="Kim">Eu Suk Kim</name><name sortKey="Kim, Hong Bin" sort="Kim, Hong Bin" uniqKey="Kim H" first="Hong Bin" last="Kim">Hong Bin Kim</name><name sortKey="Kim, Nam Joong" sort="Kim, Nam Joong" uniqKey="Kim N" first="Nam Joong" last="Kim">Nam Joong Kim</name><name sortKey="Oh, Myoung Don" sort="Oh, Myoung Don" uniqKey="Oh M" first="Myoung-Don" last="Oh">Myoung-Don Oh</name><name sortKey="Park, Sang Won" sort="Park, Sang Won" uniqKey="Park S" first="Sang-Won" last="Park">Sang-Won Park</name><name sortKey="Park, Wan Beom" sort="Park, Wan Beom" uniqKey="Park W" first="Wan Beom" last="Park">Wan Beom Park</name><name sortKey="Song, Kyoung Ho" sort="Song, Kyoung Ho" uniqKey="Song K" first="Kyoung-Ho" last="Song">Kyoung-Ho Song</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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