Association between Severity of MERS-CoV Infection and Incubation Period
Identifieur interne : 000060 ( Pmc/Corpus ); précédent : 000059; suivant : 000061Association between Severity of MERS-CoV Infection and Incubation Period
Auteurs : Victor Virlogeux ; Minah Park ; Joseph T. Wu ; Benjamin J. CowlingSource :
- Emerging Infectious Diseases [ 1080-6040 ] ; 2016.
Abstract
We analyzed data for 170 patients in South Korea who had laboratory-confirmed infection with Middle East respiratory syndrome coronavirus. A longer incubation period was associated with a reduction in the risk for death (adjusted odds ratio/1-day increase in incubation period 0.83, 95% credibility interval 0.68–1.03).
Url:
DOI: 10.3201/eid2203.151437
PubMed: 26890291
PubMed Central: 4766874
Links to Exploration step
PMC:4766874Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Association between Severity of MERS-CoV Infection and Incubation
Period</title>
<author><name sortKey="Virlogeux, Victor" sort="Virlogeux, Victor" uniqKey="Virlogeux V" first="Victor" last="Virlogeux">Victor Virlogeux</name>
</author>
<author><name sortKey="Park, Minah" sort="Park, Minah" uniqKey="Park M" first="Minah" last="Park">Minah Park</name>
</author>
<author><name sortKey="Wu, Joseph T" sort="Wu, Joseph T" uniqKey="Wu J" first="Joseph T." last="Wu">Joseph T. Wu</name>
</author>
<author><name sortKey="Cowling, Benjamin J" sort="Cowling, Benjamin J" uniqKey="Cowling B" first="Benjamin J." last="Cowling">Benjamin J. Cowling</name>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PMC</idno>
<idno type="pmid">26890291</idno>
<idno type="pmc">4766874</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766874</idno>
<idno type="RBID">PMC:4766874</idno>
<idno type="doi">10.3201/eid2203.151437</idno>
<date when="2016">2016</date>
<idno type="wicri:Area/Pmc/Corpus">000060</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000060</idno>
</publicationStmt>
<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Association between Severity of MERS-CoV Infection and Incubation
Period</title>
<author><name sortKey="Virlogeux, Victor" sort="Virlogeux, Victor" uniqKey="Virlogeux V" first="Victor" last="Virlogeux">Victor Virlogeux</name>
</author>
<author><name sortKey="Park, Minah" sort="Park, Minah" uniqKey="Park M" first="Minah" last="Park">Minah Park</name>
</author>
<author><name sortKey="Wu, Joseph T" sort="Wu, Joseph T" uniqKey="Wu J" first="Joseph T." last="Wu">Joseph T. Wu</name>
</author>
<author><name sortKey="Cowling, Benjamin J" sort="Cowling, Benjamin J" uniqKey="Cowling B" first="Benjamin J." last="Cowling">Benjamin J. Cowling</name>
</author>
</analytic>
<series><title level="j">Emerging Infectious Diseases</title>
<idno type="ISSN">1080-6040</idno>
<idno type="eISSN">1080-6059</idno>
<imprint><date when="2016">2016</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><p>We analyzed data for 170 patients in South Korea who had laboratory-confirmed
infection with Middle East respiratory syndrome coronavirus. A longer incubation
period was associated with a reduction in the risk for death (adjusted odds
ratio/1-day increase in incubation period 0.83, 95% credibility
interval 0.68–1.03).</p>
</div>
</front>
<back><div1 type="bibliography"><listBibl><biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
</listBibl>
</div1>
</back>
</TEI>
<pmc article-type="brief-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Emerg Infect Dis</journal-id>
<journal-id journal-id-type="iso-abbrev">Emerging Infect. Dis</journal-id>
<journal-id journal-id-type="publisher-id">EID</journal-id>
<journal-title-group><journal-title>Emerging Infectious Diseases</journal-title>
</journal-title-group>
<issn pub-type="ppub">1080-6040</issn>
<issn pub-type="epub">1080-6059</issn>
<publisher><publisher-name>Centers for Disease Control and Prevention</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">26890291</article-id>
<article-id pub-id-type="pmc">4766874</article-id>
<article-id pub-id-type="publisher-id">15-1437</article-id>
<article-id pub-id-type="doi">10.3201/eid2203.151437</article-id>
<article-categories><subj-group subj-group-type="second-type"><subject>Expedited</subject>
</subj-group>
<subj-group subj-group-type="heading"><subject>Dispatch</subject>
</subj-group>
<subj-group subj-group-type="article-type"><subject>Dispatch</subject>
</subj-group>
<subj-group subj-group-type="TOC-title"><subject>Association between Severity of MERS-CoV Infection and Incubation Period</subject>
</subj-group>
</article-categories>
<title-group><article-title>Association between Severity of MERS-CoV Infection and Incubation
Period</article-title>
<alt-title alt-title-type="running-head">Severity of MERS-CoV Infection and Incubation
Period</alt-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Virlogeux</surname>
<given-names>Victor</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Park</surname>
<given-names>Minah</given-names>
</name>
</contrib>
<contrib contrib-type="author"><name><surname>Wu</surname>
<given-names>Joseph T.</given-names>
</name>
<xref ref-type="fn" rid="FN1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Cowling</surname>
<given-names>Benjamin J.</given-names>
</name>
<xref ref-type="fn" rid="FN1"><sup>1</sup>
</xref>
</contrib>
<aff id="aff1">Ecole Normale Supérieure de Lyon, Lyon, France (V. Virlogeux);</aff>
<aff id="aff2">The University of Hong Kong, Hong Kong, China (V. Virlogeux, M. Park, J.T. Wu, B.J. Cowling)</aff>
</contrib-group>
<author-notes><corresp id="cor1">Address for correspondence: Benjamin J. Cowling, World Health
Organization Collaborating Centre for Infectious Disease Epidemiology and Control,
School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong
Kong, 21 Sassoon Rd, Pokfulam, Hong Kong, China; email: <email xlink:href="bcowling@hku.hk">bcowling@hku.hk</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>3</month>
<year>2016</year>
</pub-date>
<volume>22</volume>
<issue>3</issue>
<fpage>526</fpage>
<lpage>528</lpage>
<abstract><p>We analyzed data for 170 patients in South Korea who had laboratory-confirmed
infection with Middle East respiratory syndrome coronavirus. A longer incubation
period was associated with a reduction in the risk for death (adjusted odds
ratio/1-day increase in incubation period 0.83, 95% credibility
interval 0.68–1.03).</p>
</abstract>
<kwd-group kwd-group-type="author"><title>Keywords: </title>
<kwd>Middle East respiratory syndrome</kwd>
<kwd>Middle East respiratory syndrome coronavirus</kwd>
<kwd>MERS-CoV</kwd>
<kwd>coronavirus</kwd>
<kwd>viruses</kwd>
<kwd>incubation period</kwd>
<kwd>infection</kwd>
<kwd>illness</kwd>
<kwd>severity</kwd>
<kwd>South Korea</kwd>
</kwd-group>
</article-meta>
</front>
<body><p>The incubation period of an infectious disease is the time from the moment of exposure to
an infectious agent until signs and symptoms of the disease appear (<xref rid="R1" ref-type="bibr"><italic>1</italic>
</xref>
). This major biological parameter is part of the case
definition and is used to determine duration of quarantine and inform policy decisions when
mathematical modeling is used (<xref rid="R2" ref-type="bibr"><italic>2</italic>
</xref>
).
Incubation periods vary from person to person, and their distribution tends to be
right-skewed and unimodal (<xref rid="R3" ref-type="bibr"><italic>3</italic>
</xref>
).
Variability in incubation periods for infection with Middle East respiratory syndrome
coronavirus (MERS-CoV) has been described (<xref rid="R4" ref-type="bibr"><italic>4</italic>
</xref>
–<xref rid="R8" ref-type="bibr"><italic>8</italic>
</xref>
). Previous studies have not examined whether the length of
the incubation period in a person has any correlation with subsequent clinical
outcomes.</p>
<p>In 2015, South Korea had the largest outbreak of MERS-CoV infections outside the Arabian
Peninsula (<xref rid="R6" ref-type="bibr"><italic>6</italic>
</xref>
). In a previous study,
we reported that patients who died of severe acute respiratory syndrome (SARS) coronavirus
infection had a shorter incubation period compared with infected patients who survived
(<xref rid="R9" ref-type="bibr"><italic>9</italic>
</xref>
). The objective of this study
was to examine the association between severity of MERS-CoV illness and length of
incubation period.</p>
<sec><title>The Study</title>
<p>We retrieved publicly available data from the Korea Center for Disease Control and
Prevention, the Korean Ministry of Health and Welfare, the World Health Organization,
and local news reports in South Korea to compile a list of all confirmed cases that had
been reported by July 26, 2015 (<xref rid="R6" ref-type="bibr"><italic>6</italic>
</xref>
). Exposure data were available for 109 (64%) of 170 patients.
For most cases, information on exposure was recorded as intervals
<underline>></underline>
2 days during which infection was believed to have
occurred, rather than exact dates of presumed infection. For the subset of patients
without available exposure data, we assumed that their incubation time was 0–21
days because 21 days was the longest incubation period reported (<xref rid="R9" ref-type="bibr"><italic>9</italic>
</xref>
<italic>,</italic>
<xref rid="R10" ref-type="bibr"><italic>10</italic>
</xref>
). Data for patients is provided in <xref ref-type="local-data" rid="SD1">Technical Appendix 1</xref>
.</p>
<p>To estimate incubation period distribution, we fitted a gamma distribution that enabled
interval censoring (<xref rid="R6" ref-type="bibr"><italic>6</italic>
</xref>
) by using
Markov Chain Monte Carlo methods in a Bayesian framework (<xref ref-type="local-data" rid="SD1">Technical Appendix 2</xref>
) (<xref rid="R9" ref-type="bibr"><italic>9</italic>
</xref>
). In this analysis and analyses described below, we
specified flat priors for each parameter and drew 10,000 samples from the posterior
distributions after a burn-in of 5,000 iterations.</p>
<p>To evaluate potential factors, such as age and sex, that could be associated with length
of incubation period, we fitted a multiple linear regression model to the data with the
log incubation period as response variable and age and sex as explanatory variables. To
determine the association between incubation period and severity of disease, we first
estimated the difference in mean incubation period between patients who died and those
who survived. However, this analysis could not account for potential confounders.
Therefore, we specified a multivariable logistic regression model in which death was the
binary response variable and predictors included age, sex, and the incubation time for
each patient (<xref rid="R9" ref-type="bibr"><italic>9</italic>
</xref>
). We performed
this analysis by using an exact likelihood approach and incubation times resampled from
the 10,000 posterior samples in each iteration (<xref ref-type="local-data" rid="SD1">Technical Appendix 2</xref>
). All analyses were conducted by using R version 3.0.2
(R Foundation for Statistical Computing, Vienna, Austria). Raw data and R syntax
enabling reproduction of results are available from the Dryad Digital Repository
(<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.5061/dryad.v3456">http://dx.doi.org/10.5061/dryad.v3456</ext-link>
).</p>
<p>Of 170 patients in this study, 36 (21%) died. Mean patient age was 54.6 years, and 98
(58%) were male. Patients who died were significantly older than patients who survived
(68.9 years vs. 50.8 years; p<0.001). No differences regarding age, sex, and
case-fatality risk were observed between patients with or without recorded exposure
data. We estimated a mean incubation period of MERS-CoV in all 170 patients of 6.9 days
(95% credibility interval [CrI] 6.3–7.5 days) by using a gamma distribution. Age
and sex had no associations with incubation period.</p>
<p>The mean incubation period was 6.4 days (95% CrI 5.2–7.9 days) for 36 patients
who died compared with 7.1 days (95% CrI 6.3–7.8 days) for 134 patients who
survived (<xref ref-type="fig" rid="F1">Figure</xref>
). The difference in means was 0.62
days (95% CrI −0.99 to 2.04 days). In the multivariable logistic regression
model, we found that a longer incubation period was associated with a marginally reduced
risk for death (odds ratio 0.83/1-day increase in incubation period, 95% CrI
0.68–1.03/day) after adjustment for age and sex (<xref ref-type="local-data" rid="SD1">Technical Appendix 2</xref>
Table 2).</p>
<fig id="F1" fig-type="figure" position="float"><label>Figure</label>
<caption><p>Parametric estimates of incubation period distribution for patients who died of
infection with Middle East respiratory syndrome coronavirus (dashed line) and
patients who survived infection (solid line), South Korea, 2015.</p>
</caption>
<graphic xlink:href="15-1437-F"></graphic>
</fig>
<p>To examine sensitivity of our results, we also fitted the logistic regression models by
using 3 categories for the incubation period. We observed similar results and a reduced
risk for death associated with longer incubation periods (<xref ref-type="local-data" rid="SD1">Technical Appendix 2</xref>
Table 2). Results were also consistent in the
subset of 109 patients with recorded exposure intervals (<xref ref-type="local-data" rid="SD1">Technical Appendix 2</xref>
Table 2).</p>
</sec>
<sec sec-type="conclusions"><title>Conclusions</title>
<p>We estimated the incubation period of MERS-CoV cases during the recent MERS outbreak in
South Korea and found that patients who died had a shorter incubation period than
patients who survived. In a previous study, we found that the length of incubation
period in patients infected with SARS coronavirus was also correlated with severity of
the disease, with a shorter incubation period for patients who died (<xref rid="R9" ref-type="bibr"><italic>9</italic>
</xref>
). The pathogenesis of MERS-CoV and
SARS coronavirus infection is similar (<xref rid="R11" ref-type="bibr"><italic>11</italic>
</xref>
), with a rapid progression to respiratory failure and
intubation occurring ≈1 week after onset of symptoms and up to 5 days earlier in
MERS patients than in SARS patients (<xref rid="R4" ref-type="bibr"><italic>4</italic>
</xref>
,<xref rid="R12" ref-type="bibr"><italic>12</italic>
</xref>
). Moreover, high rates of hemoptysis were observed in
patients infected with MERS-CoV, which suggests severe lung injury (<xref rid="R4" ref-type="bibr"><italic>4</italic>
</xref>
).</p>
<p>MERS-CoV also has higher replication rates and shows broader cell tropism in the lower
human respiratory tract than severe acute respiratory syndrome coronavirus (<xref rid="R13" ref-type="bibr"><italic>13</italic>
</xref>
). These results suggest that a
shorter incubation period could be related to a higher initial infective dose and
consequently to faster or greater pathogen replication. This finding could lead to a
more severe disease induced by more aggressive and damaging inflammatory responses
(<xref rid="R14" ref-type="bibr"><italic>14</italic>
</xref>
). Closer monitoring of
patients who have a shorter incubation period could be considered during such
outbreaks.</p>
<p>Another potential explanation for our findings is that patients with longer incubation
periods were identified and infection confirmed more quickly. This improvement in time
to identification and admission to a hospital led to improved prognosis. Although longer
incubation periods were correlated with shorter delays from onset to laboratory
confirmation, we did not find evidence of a strong mediating effect of delay from onset
to laboratory confirmation on the risk for death. However, with the small sample size,
there was limited statistical power to detect a small-to-moderate effect.</p>
<p>Our study had some limitations. Our estimates of the incubation period were based on
self-reported exposure data, which could be affected by recall bias. Moreover, 61
patients (36%) included in our main analysis had missing exposure data, and inclusion in
a Bayesian framework with a wide interval of 0–21 days was necessary. Both of
these limitations could have reduced the statistical power of our study to identify an
association. Finally, we did not have information on underlying medical conditions or
the geographic location of cases, or the treatments that were given to cases, and these
variables could have been associated with clinical outcomes.</p>
<p>In conclusion, we found an association between shorter incubation periods among patients
with MERS-CoV infection and a higher risk of death subsequently, similar to the
association previously reported for severe acute respiratory syndrome coronavirus (<xref rid="R9" ref-type="bibr"><italic>9</italic>
</xref>
). This association might occur
because the duration of the incubation period is an early reflection of disease
pathogenesis.</p>
</sec>
<sec sec-type="supplementary-material"><title></title>
<supplementary-material content-type="local-data" id="SD1"><caption><p><bold>Technical Appendix 1.</bold>
Data for patients infected with Middle East
respiratory syndrome coronavirus, South Korea, 2015.</p>
</caption>
<media mimetype="application" mime-subtype="excel" xlink:href="15-1437-Techapp-s1.xlsx" xlink:type="simple" id="d36e280" position="anchor"></media>
</supplementary-material>
<supplementary-material content-type="local-data" id="SD2"><caption><p><bold>Technical Appendix 2.</bold>
Additional details of statistical methods for
analysis of patients infected with Middle East respiratory syndrome coronavirus,
South Korea, 2015.</p>
</caption>
<media mimetype="application" mime-subtype="pdf" xlink:href="15-1437-Techapp-s2.pdf" xlink:type="simple" id="d36e287" position="anchor"></media>
</supplementary-material>
</sec>
</body>
<back><fn-group><fn fn-type="citation"><p><italic>Suggested citation for this article</italic>
: Virlogeux V, Park M, Wu JT,
Cowling BJ. Association between severity of MERS-CoV infection and incubation period.
Emerg Infect Dis. 2016 Mar [<italic>date cited</italic>
]. <ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3201/eid2203.151437">http://dx.doi.org/10.3201/eid2203.151437</ext-link>
</p>
</fn>
<fn id="FN1"><label>1</label>
<p>These senior authors contributed equally to this article.</p>
</fn>
</fn-group>
<ack><p>This study was supported by the Harvard Center for Communicable Disease Dynamics
(National Institute of General Medical Sciences grant no. U54 GM088558); a commissioned
grant from the Health and Medical Research Fund of the Health, Welfare and Food Bureau
of the Hong Kong SAR Government; and the Research Grants Council of the Hong Kong
Special Administrative Region, China (project No. T11-705/14N).</p>
<p>B.J.C. has received support from MedImmune Inc. (Gaithersburg, MD, USA) and Sanofi
Pasteur (Lyon, France). He is also a consultant for Crucell NV (Leiden, the
Netherlands).</p>
</ack>
<bio id="d36e310"><p>Dr. Virlogeux is a MD/PhD student at the University of Medicine Lyon-Est and at the
Ecole Normale Superieure in Lyon, France. His research interests include infectious
disease epidemiology, and the mathematical modelling of epidemic dynamics.</p>
</bio>
<ref-list><title>References</title>
<ref id="R1"><label>1. </label>
<mixed-citation publication-type="journal"><string-name><surname>Fine</surname>
<given-names>PE</given-names>
</string-name>
. <article-title>The interval between
successive cases of an infectious disease.</article-title>
<source>Am J Epidemiol</source>
.
<year>2003</year>
;<volume>158</volume>
:<fpage>1039</fpage>
–<lpage>47</lpage>
.
<pub-id pub-id-type="doi">10.1093/aje/kwg251</pub-id>
<pub-id pub-id-type="pmid">14630599</pub-id>
</mixed-citation>
</ref>
<ref id="R2"><label>2. </label>
<mixed-citation publication-type="journal"><string-name><surname>Lessler</surname>
<given-names>J</given-names>
</string-name>
, <string-name><surname>Reich</surname>
<given-names>NG</given-names>
</string-name>
,
<string-name><surname>Brookmeyer</surname>
<given-names>R</given-names>
</string-name>
, <string-name><surname>Perl</surname>
<given-names>TM</given-names>
</string-name>
,
<string-name><surname>Nelson</surname>
<given-names>KE</given-names>
</string-name>
,
<string-name><surname>Cummings</surname>
<given-names>DA</given-names>
</string-name>
. <article-title>Incubation periods of
acute respiratory viral infections: a systematic review.</article-title>
<source>Lancet Infect Dis</source>
.
<year>2009</year>
;<volume>9</volume>
:<fpage>291</fpage>
–<lpage>300</lpage>
.
<pub-id pub-id-type="doi">10.1016/S1473-3099(09)70069-6</pub-id>
<pub-id pub-id-type="pmid">19393959</pub-id>
</mixed-citation>
</ref>
<ref id="R3"><label>3. </label>
<mixed-citation publication-type="journal"><string-name><surname>Sartwell</surname>
<given-names>PE</given-names>
</string-name>
. <article-title>The distribution of
incubation periods of infectious disease.</article-title>
<source>Am J Hyg</source>
.
<year>1950</year>
;<volume>51</volume>
:<fpage>310</fpage>
–<lpage>8</lpage>
.<pub-id pub-id-type="pmid">15413610</pub-id>
</mixed-citation>
</ref>
<ref id="R4"><label>4. </label>
<mixed-citation publication-type="journal"><string-name><surname>Assiri</surname>
<given-names>A</given-names>
</string-name>
,
<string-name><surname>Al-Tawfiq</surname>
<given-names>JA</given-names>
</string-name>
,
<string-name><surname>Al-Rabeeah</surname>
<given-names>AA</given-names>
</string-name>
,
<string-name><surname>Al-Rabiah</surname>
<given-names>FA</given-names>
</string-name>
,
<string-name><surname>Al-Hajjar</surname>
<given-names>S</given-names>
</string-name>
,
<string-name><surname>Al-Barrak</surname>
<given-names>A</given-names>
</string-name>
, <etal></etal>
<article-title>Epidemiological, demographic, and clinical characteristics of 47 cases
of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a
descriptive study.</article-title>
<source>Lancet Infect Dis</source>
.
<year>2013</year>
;<volume>13</volume>
:<fpage>752</fpage>
–<lpage>61</lpage>
.
<pub-id pub-id-type="doi">10.1016/S1473-3099(13)70204-4</pub-id>
<pub-id pub-id-type="pmid">23891402</pub-id>
</mixed-citation>
</ref>
<ref id="R5"><label>5. </label>
<mixed-citation publication-type="journal"><string-name><surname>Assiri</surname>
<given-names>A</given-names>
</string-name>
, <string-name><surname>McGeer</surname>
<given-names>A</given-names>
</string-name>
, <string-name><surname>Perl</surname>
<given-names>TM</given-names>
</string-name>
, <string-name><surname>Price</surname>
<given-names>CS</given-names>
</string-name>
, <string-name><surname>Al
Rabeeah</surname>
<given-names>AA</given-names>
</string-name>
,
<string-name><surname>Cummings</surname>
<given-names>DA</given-names>
</string-name>
, <etal></etal>
<article-title>Hospital outbreak of Middle East respiratory syndrome
coronavirus.</article-title>
<source>N Engl J Med</source>
.
<year>2013</year>
;<volume>369</volume>
:<fpage>407</fpage>
–<lpage>16</lpage>
.
<pub-id pub-id-type="doi">10.1056/NEJMoa1306742</pub-id>
<pub-id pub-id-type="pmid">23782161</pub-id>
</mixed-citation>
</ref>
<ref id="R6"><label>6. </label>
<mixed-citation publication-type="journal"><string-name><surname>Cowling</surname>
<given-names>BJ</given-names>
</string-name>
, <string-name><surname>Park</surname>
<given-names>M</given-names>
</string-name>
, <string-name><surname>Fang</surname>
<given-names>VJ</given-names>
</string-name>
, <string-name><surname>Wu</surname>
<given-names>P</given-names>
</string-name>
, <string-name><surname>Leung</surname>
<given-names>GM</given-names>
</string-name>
, <string-name><surname>Wu</surname>
<given-names>JT</given-names>
</string-name>
. <article-title>Preliminary
epidemiological assessment of MERS-CoV outbreak in South Korea, May to June
2015.</article-title>
<source>Euro Surveill</source>
.
<year>2015</year>
;<volume>20</volume>
:<fpage>7</fpage>
–<lpage>13</lpage>
.
<pub-id pub-id-type="doi">10.2807/1560-7917.ES2015.20.25.21163</pub-id>
<pub-id pub-id-type="pmid">26132767</pub-id>
</mixed-citation>
</ref>
<ref id="R7"><label>7. </label>
<mixed-citation publication-type="journal"><string-name><surname>Cauchemez</surname>
<given-names>S</given-names>
</string-name>
, <string-name><surname>Fraser</surname>
<given-names>C</given-names>
</string-name>
, <string-name><surname>Van
Kerkhove</surname>
<given-names>MD</given-names>
</string-name>
,
<string-name><surname>Donnelly</surname>
<given-names>CA</given-names>
</string-name>
, <string-name><surname>Riley</surname>
<given-names>S</given-names>
</string-name>
,
<string-name><surname>Rambaut</surname>
<given-names>A</given-names>
</string-name>
, <etal></etal>
<article-title>Middle East respiratory syndrome coronavirus: quantification of the
extent of the epidemic, surveillance biases, and transmissibility.</article-title>
<source>Lancet Infect Dis</source>
.
<year>2014</year>
;<volume>14</volume>
:<fpage>50</fpage>
–<lpage>6</lpage>
.
<pub-id pub-id-type="doi">10.1016/S1473-3099(13)70304-9</pub-id>
<pub-id pub-id-type="pmid">24239323</pub-id>
</mixed-citation>
</ref>
<ref id="R8"><label>8. </label>
<mixed-citation publication-type="journal"><collab>Centers for Disease Control and
Prevention</collab>
. <article-title>Update: severe respiratory illness associated
with Middle East respiratory syndrome coronavirus (MERS-CoV)—worldwide,
2012–2013.</article-title>
<source>MMWR Morb Mortal Wkly Rep</source>
.
<year>2013</year>
;<volume>62</volume>
:<fpage>480</fpage>
–<lpage>3</lpage>
.<pub-id pub-id-type="pmid">23760190</pub-id>
</mixed-citation>
</ref>
<ref id="R9"><label>9. </label>
<mixed-citation publication-type="journal"><string-name><surname>Virlogeux</surname>
<given-names>V</given-names>
</string-name>
, <string-name><surname>Fang</surname>
<given-names>VJ</given-names>
</string-name>
, <string-name><surname>Wu</surname>
<given-names>JT</given-names>
</string-name>
, <string-name><surname>Ho</surname>
<given-names>L-M</given-names>
</string-name>
,
<string-name><surname>Peiris</surname>
<given-names>JS</given-names>
</string-name>
, <string-name><surname>Leung</surname>
<given-names>GM</given-names>
</string-name>
, <etal></etal>
<article-title>Brief report: incubation period duration and severity of clinical
disease following severe acute respiratory syndrome coronavirus
infection.</article-title>
<source>Epidemiology</source>
.
<year>2015</year>
;<volume>26</volume>
:<fpage>666</fpage>
–<lpage>9</lpage>
.
<pub-id pub-id-type="doi">10.1097/EDE.0000000000000339</pub-id>
<pub-id pub-id-type="pmid">26133021</pub-id>
</mixed-citation>
</ref>
<ref id="R10"><label>10. </label>
<mixed-citation publication-type="webpage">South Korean woman has MERS – a week after
quarantine over. The Straits Times; <year>2015</year>
[cited 2015 Oct 15]. <ext-link ext-link-type="uri" xlink:href="http://www.straitstimes.com/asia/east-asia/s-korean-woman-has-mers-a-week-after-quarantine-over">http://www.straitstimes.com/asia/east-asia/s-korean-woman-has-mers-a-week-after-quarantine-over</ext-link>
</mixed-citation>
</ref>
<ref id="R11"><label>11. </label>
<mixed-citation publication-type="journal"><string-name><surname>Hui</surname>
<given-names>DS</given-names>
</string-name>
,
<string-name><surname>Memish</surname>
<given-names>ZA</given-names>
</string-name>
, <string-name><surname>Zumla</surname>
<given-names>A</given-names>
</string-name>
. <article-title>Severe acute
respiratory syndrome vs. the Middle East respiratory syndrome.</article-title>
<source>Curr Opin Pulm Med</source>
.
<year>2014</year>
;<volume>20</volume>
:<fpage>233</fpage>
–<lpage>41</lpage>
.
<pub-id pub-id-type="doi">10.1097/MCP.0000000000000046</pub-id>
<pub-id pub-id-type="pmid">24626235</pub-id>
</mixed-citation>
</ref>
<ref id="R12"><label>12. </label>
<mixed-citation publication-type="journal"><string-name><surname>Peiris</surname>
<given-names>JS</given-names>
</string-name>
, <string-name><surname>Chu</surname>
<given-names>CM</given-names>
</string-name>
, <string-name><surname>Cheng</surname>
<given-names>VC</given-names>
</string-name>
, <string-name><surname>Chan</surname>
<given-names>KS</given-names>
</string-name>
, <string-name><surname>Hung</surname>
<given-names>IF</given-names>
</string-name>
, <string-name><surname>Poon</surname>
<given-names>LL</given-names>
</string-name>
, <etal></etal>
<article-title>Clinical progression and viral load in a community outbreak of
coronavirus-associated SARS pneumonia: a prospective study.</article-title>
<source>Lancet</source>
.
<year>2003</year>
;<volume>361</volume>
:<fpage>1767</fpage>
–<lpage>72</lpage>
.
<pub-id pub-id-type="doi">10.1016/S0140-6736(03)13412-5</pub-id>
<pub-id pub-id-type="pmid">12781535</pub-id>
</mixed-citation>
</ref>
<ref id="R13"><label>13. </label>
<mixed-citation publication-type="journal"><string-name><surname>Chan</surname>
<given-names>RW</given-names>
</string-name>
, <string-name><surname>Chan</surname>
<given-names>MC</given-names>
</string-name>
,
<string-name><surname>Agnihothram</surname>
<given-names>S</given-names>
</string-name>
, <string-name><surname>Chan</surname>
<given-names>LL</given-names>
</string-name>
, <string-name><surname>Kuok</surname>
<given-names>DI</given-names>
</string-name>
, <string-name><surname>Fong</surname>
<given-names>JH</given-names>
</string-name>
, <etal></etal>
<article-title>Tropism of and innate immune responses to the novel human
betacoronavirus lineage C virus in human ex vivo respiratory organ
cultures.</article-title>
<source>J Virol</source>
.
<year>2013</year>
;<volume>87</volume>
:<fpage>6604</fpage>
–<lpage>14</lpage>
.
<pub-id pub-id-type="doi">10.1128/JVI.00009-13</pub-id>
<pub-id pub-id-type="pmid">23552422</pub-id>
</mixed-citation>
</ref>
<ref id="R14"><label>14. </label>
<mixed-citation publication-type="journal"><string-name><surname>Ho</surname>
<given-names>M-S</given-names>
</string-name>
, <string-name><surname>Chen</surname>
<given-names>W-J</given-names>
</string-name>
, <string-name><surname>Chen</surname>
<given-names>H-Y</given-names>
</string-name>
, <string-name><surname>Lin</surname>
<given-names>S-F</given-names>
</string-name>
, <string-name><surname>Wang</surname>
<given-names>M-C</given-names>
</string-name>
, <string-name><surname>Di</surname>
<given-names>J</given-names>
</string-name>
, <etal></etal>
<article-title>Neutralizing antibody response and SARS severity.</article-title>
<source>Emerg Infect Dis</source>
.
<year>2005</year>
;<volume>11</volume>
:<fpage>1730</fpage>
–<lpage>7</lpage>
.
<pub-id pub-id-type="doi">10.3201/eid1111.040659</pub-id>
<pub-id pub-id-type="pmid">16318725</pub-id>
</mixed-citation>
</ref>
</ref-list>
</back>
</pmc>
</record>
Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Sante/explor/MersV1/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000060 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 000060 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien |wiki= Sante |area= MersV1 |flux= Pmc |étape= Corpus |type= RBID |clé= PMC:4766874 |texte= Association between Severity of MERS-CoV Infection and Incubation Period }}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i -Sk "pubmed:26890291" \ | HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd \ | NlmPubMed2Wicri -a MersV1
![]() | This area was generated with Dilib version V0.6.33. | ![]() |