Airflow as a Possible Transmission Route of Middle East Respiratory Syndrome at an Initial Outbreak Hospital in Korea
Identifieur interne : 000D39 ( Pmc/Curation ); précédent : 000D38; suivant : 000D40Airflow as a Possible Transmission Route of Middle East Respiratory Syndrome at an Initial Outbreak Hospital in Korea
Auteurs : Minki Sung ; Seongmin Jo ; Sang-Eun Lee ; Moran Ki ; Bo Youl Choi ; Jinkwan Hong [Corée du Sud]Source :
- International Journal of Environmental Research and Public Health [ 1661-7827 ] ; 2018.
Abstract
In this study, the results of an airflow investigation conducted on 7 June 2015 as part of a series of epidemiologic investigations at Pyeongtaek St. Mary’s Hospital, South Korea, were investigated. The study involved 38 individuals who were infected directly and indirectly with Middle East Respiratory Syndrome (MERS), by a super-spreader patient. Tracer gas experiments conducted on the eighth floor, where the initial patient was hospitalized, confirmed that the tracer gas spread to adjacent patient rooms and rooms across corridors. In particular, the experiment with an external wind direction and speed similar to those during the hospitalization of the initial patient revealed that the air change rate was 17–20 air changes per hour (ACH), with air introduced through the window in the room of the infected patient (room 8104). The tracer gas concentration of room 8110, which was the farthest room, was 7.56% of room 8104, indicating that a high concentration of gas has spread from room 8104 to rooms across the corridor. In contrast, the tracer gas was barely detected in a maternity ward to the south of room 8104, where there was no secondary infected patient. Moreover, MERS is known to spread mainly by droplets through close contact, but long-distance dispersion is probable in certain environments, such as that of a super-spreader patient hospitalized in a room without ventilation, hospitals with a central corridor type, and indoor airflow dispersion due to external wind.
Url:
DOI: 10.3390/ijerph15122757
PubMed: 30563206
PubMed Central: 6313554
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PMC:6313554Le document en format XML
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<front><div type="abstract" xml:lang="en"><p>In this study, the results of an airflow investigation conducted on 7 June 2015 as part of a series of epidemiologic investigations at Pyeongtaek St. Mary’s Hospital, South Korea, were investigated. The study involved 38 individuals who were infected directly and indirectly with Middle East Respiratory Syndrome (MERS), by a super-spreader patient. Tracer gas experiments conducted on the eighth floor, where the initial patient was hospitalized, confirmed that the tracer gas spread to adjacent patient rooms and rooms across corridors. In particular, the experiment with an external wind direction and speed similar to those during the hospitalization of the initial patient revealed that the air change rate was 17–20 air changes per hour (ACH), with air introduced through the window in the room of the infected patient (room 8104). The tracer gas concentration of room 8110, which was the farthest room, was 7.56% of room 8104, indicating that a high concentration of gas has spread from room 8104 to rooms across the corridor. In contrast, the tracer gas was barely detected in a maternity ward to the south of room 8104, where there was no secondary infected patient. Moreover, MERS is known to spread mainly by droplets through close contact, but long-distance dispersion is probable in certain environments, such as that of a super-spreader patient hospitalized in a room without ventilation, hospitals with a central corridor type, and indoor airflow dispersion due to external wind.</p>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Environ Res Public Health</journal-id>
<journal-id journal-id-type="iso-abbrev">Int J Environ Res Public Health</journal-id>
<journal-id journal-id-type="publisher-id">ijerph</journal-id>
<journal-title-group><journal-title>International Journal of Environmental Research and Public Health</journal-title>
</journal-title-group>
<issn pub-type="ppub">1661-7827</issn>
<issn pub-type="epub">1660-4601</issn>
<publisher><publisher-name>MDPI</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">30563206</article-id>
<article-id pub-id-type="pmc">6313554</article-id>
<article-id pub-id-type="doi">10.3390/ijerph15122757</article-id>
<article-id pub-id-type="publisher-id">ijerph-15-02757</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Airflow as a Possible Transmission Route of Middle East Respiratory Syndrome at an Initial Outbreak Hospital in Korea</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="true">https://orcid.org/0000-0001-8915-2710</contrib-id>
<name><surname>Sung</surname>
<given-names>Minki</given-names>
</name>
<xref ref-type="aff" rid="af1-ijerph-15-02757">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Jo</surname>
<given-names>Seongmin</given-names>
</name>
<xref ref-type="aff" rid="af1-ijerph-15-02757">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lee</surname>
<given-names>Sang-Eun</given-names>
</name>
<xref ref-type="aff" rid="af2-ijerph-15-02757">2</xref>
</contrib>
<contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="true">https://orcid.org/0000-0002-8892-7104</contrib-id>
<name><surname>Ki</surname>
<given-names>Moran</given-names>
</name>
<xref ref-type="aff" rid="af3-ijerph-15-02757">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Choi</surname>
<given-names>Bo Youl</given-names>
</name>
<xref ref-type="aff" rid="af4-ijerph-15-02757">4</xref>
</contrib>
<contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="true">https://orcid.org/0000-0002-5064-837X</contrib-id>
<name><surname>Hong</surname>
<given-names>JinKwan</given-names>
</name>
<xref ref-type="aff" rid="af5-ijerph-15-02757">5</xref>
<xref rid="c1-ijerph-15-02757" ref-type="corresp">*</xref>
</contrib>
</contrib-group>
<aff id="af1-ijerph-15-02757"><label>1</label>
Department of Architectural Engineering, Sejong University, 209, Seoul 05006, Korea;<email>mksung@sejong.ac.kr</email>
(M.S.);<email>joseongmin01@naver.com</email>
(S.J.)</aff>
<aff id="af2-ijerph-15-02757"><label>2</label>
Division of Vectors and Parasitic Diseases, Korea Centers for Disease Control and Prevention, Cheongju 28159, Korea;<email>ondalgl@korea.kr</email>
</aff>
<aff id="af3-ijerph-15-02757"><label>3</label>
Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea;<email>moranki@ncc.re.kr</email>
</aff>
<aff id="af4-ijerph-15-02757"><label>4</label>
Department of Preventive Medicine, Hanyang University Medical College, Seoul 04763, Korea;<email>bychoi@hanyang.ac.kr</email>
</aff>
<aff id="af5-ijerph-15-02757"><label>5</label>
Department of HVAC & Firefighting Engineering, Gachon University, Seongnam 13120, Korea</aff>
<author-notes><corresp id="c1-ijerph-15-02757"><label>*</label>
Correspondence: <email>jkhong@gachon.ac.kr</email>
; Tel.: +82-31-750-5306</corresp>
</author-notes>
<pub-date pub-type="epub"><day>06</day>
<month>12</month>
<year>2018</year>
</pub-date>
<pub-date pub-type="ppub"><month>12</month>
<year>2018</year>
</pub-date>
<volume>15</volume>
<issue>12</issue>
<elocation-id>2757</elocation-id>
<history><date date-type="received"><day>04</day>
<month>11</month>
<year>2018</year>
</date>
<date date-type="accepted"><day>04</day>
<month>12</month>
<year>2018</year>
</date>
</history>
<permissions><copyright-statement>© 2018 by the authors.</copyright-statement>
<copyright-year>2018</copyright-year>
<license license-type="open-access"><license-p>Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>
).</license-p>
</license>
</permissions>
<abstract><p>In this study, the results of an airflow investigation conducted on 7 June 2015 as part of a series of epidemiologic investigations at Pyeongtaek St. Mary’s Hospital, South Korea, were investigated. The study involved 38 individuals who were infected directly and indirectly with Middle East Respiratory Syndrome (MERS), by a super-spreader patient. Tracer gas experiments conducted on the eighth floor, where the initial patient was hospitalized, confirmed that the tracer gas spread to adjacent patient rooms and rooms across corridors. In particular, the experiment with an external wind direction and speed similar to those during the hospitalization of the initial patient revealed that the air change rate was 17–20 air changes per hour (ACH), with air introduced through the window in the room of the infected patient (room 8104). The tracer gas concentration of room 8110, which was the farthest room, was 7.56% of room 8104, indicating that a high concentration of gas has spread from room 8104 to rooms across the corridor. In contrast, the tracer gas was barely detected in a maternity ward to the south of room 8104, where there was no secondary infected patient. Moreover, MERS is known to spread mainly by droplets through close contact, but long-distance dispersion is probable in certain environments, such as that of a super-spreader patient hospitalized in a room without ventilation, hospitals with a central corridor type, and indoor airflow dispersion due to external wind.</p>
</abstract>
<kwd-group><kwd>Middle East Respiratory Syndrome</kwd>
<kwd>infection outbreak</kwd>
<kwd>airflow analysis</kwd>
<kwd>transmission route</kwd>
<kwd>ventilation</kwd>
<kwd>tracer gas</kwd>
</kwd-group>
</article-meta>
</front>
<floats-group><fig id="ijerph-15-02757-f001" orientation="portrait" position="float"><label>Figure 1</label>
<caption><p>Setup of the tracer experiment using sulfur hexafluoride (SF6) gas: (<bold>a</bold>
) dosing and sampling points; (<bold>b</bold>
) sliding doors of rooms 8103 and 8104.</p>
</caption>
<graphic xlink:href="ijerph-15-02757-g001"></graphic>
</fig>
<fig id="ijerph-15-02757-f002" orientation="portrait" position="float"><label>Figure 2</label>
<caption><p>Map showing infection on the eighth floor of Pyeongtaek St. Mary’s Hospital.</p>
</caption>
<graphic xlink:href="ijerph-15-02757-g002"></graphic>
</fig>
<fig id="ijerph-15-02757-f003" orientation="portrait" position="float"><label>Figure 3</label>
<caption><p>Tracer gas experimental results.</p>
</caption>
<graphic xlink:href="ijerph-15-02757-g003"></graphic>
</fig>
<fig id="ijerph-15-02757-f004" orientation="portrait" position="float"><label>Figure 4</label>
<caption><p>Wind direction and speed measured at a weather station of National Weather Service located 3.6 km away from the hospital during the tracer experiment.</p>
</caption>
<graphic xlink:href="ijerph-15-02757-g004"></graphic>
</fig>
<fig id="ijerph-15-02757-f005" orientation="portrait" position="float"><label>Figure 5</label>
<caption><p>Outdoor airflow during the stay of the initial patient: (<bold>a</bold>
) wind profile; (<bold>b</bold>
) wind rose graph.</p>
</caption>
<graphic xlink:href="ijerph-15-02757-g005"></graphic>
</fig>
<table-wrap id="ijerph-15-02757-t001" orientation="portrait" position="float"><object-id pub-id-type="pii">ijerph-15-02757-t001_Table 1</object-id>
<label>Table 1</label>
<caption><p>Average concentration of SF6 in patient rooms (ppm). The values in parentheses indicate the ratios of the SF6 concentration to the average concentration in room 8104.</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">Room Number</th>
<th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">8104</th>
<th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">8103</th>
<th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">8106</th>
<th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">8110</th>
<th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">8113</th>
<th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">8218</th>
</tr>
</thead>
<tbody><tr><td rowspan="2" align="center" valign="middle" colspan="1">Average</td>
<td align="center" valign="middle" rowspan="1" colspan="1">49.5</td>
<td align="center" valign="middle" rowspan="1" colspan="1">0.18</td>
<td align="center" valign="middle" rowspan="1" colspan="1">0.71</td>
<td align="center" valign="middle" rowspan="1" colspan="1">2.09</td>
<td align="center" valign="middle" rowspan="1" colspan="1">0.63</td>
<td align="center" valign="middle" rowspan="1" colspan="1">0.048</td>
</tr>
<tr><td align="center" valign="middle" rowspan="1" colspan="1">(100%)</td>
<td align="center" valign="middle" rowspan="1" colspan="1">(0.36%)</td>
<td align="center" valign="middle" rowspan="1" colspan="1">(1.43%)</td>
<td align="center" valign="middle" rowspan="1" colspan="1">(4.22%)</td>
<td align="center" valign="middle" rowspan="1" colspan="1">(1.27%)</td>
<td align="center" valign="middle" rowspan="1" colspan="1">(0.10%)</td>
</tr>
<tr><td rowspan="2" align="center" valign="middle" colspan="1">Maximum</td>
<td align="center" valign="middle" rowspan="1" colspan="1">67.7</td>
<td align="center" valign="middle" rowspan="1" colspan="1">0.56</td>
<td align="center" valign="middle" rowspan="1" colspan="1">2.07</td>
<td align="center" valign="middle" rowspan="1" colspan="1">3.74</td>
<td align="center" valign="middle" rowspan="1" colspan="1">1.67</td>
<td align="center" valign="middle" rowspan="1" colspan="1">0.12</td>
</tr>
<tr><td align="center" valign="middle" rowspan="1" colspan="1">(137%)</td>
<td align="center" valign="middle" rowspan="1" colspan="1">(1.13%)</td>
<td align="center" valign="middle" rowspan="1" colspan="1">(4.18%)</td>
<td align="center" valign="middle" rowspan="1" colspan="1">(7.56%)</td>
<td align="center" valign="middle" rowspan="1" colspan="1">(3.37%)</td>
<td align="center" valign="middle" rowspan="1" colspan="1">(0.24%)</td>
</tr>
<tr><td align="center" valign="middle" rowspan="1" colspan="1">Infected case</td>
<td align="center" valign="middle" rowspan="1" colspan="1">5/5</td>
<td align="center" valign="middle" rowspan="1" colspan="1">1/3</td>
<td align="center" valign="middle" rowspan="1" colspan="1">0/1</td>
<td align="center" valign="middle" rowspan="1" colspan="1">2/6</td>
<td align="center" valign="middle" rowspan="1" colspan="1">1/9</td>
<td align="center" valign="middle" rowspan="1" colspan="1">0/1</td>
</tr>
<tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Distance from 8104</td>
<td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">0 m</td>
<td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">1 m</td>
<td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">6.3 m</td>
<td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">28 m</td>
<td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">24 m</td>
<td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">18 m</td>
</tr>
</tbody>
</table>
</table-wrap>
</floats-group>
</pmc>
</record>
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