Transmission characteristics of MERS and SARS in the healthcare setting: a comparative study
Identifieur interne : 002B25 ( Ncbi/Curation ); précédent : 002B24; suivant : 002B26Transmission characteristics of MERS and SARS in the healthcare setting: a comparative study
Auteurs : Gerardo Chowell ; Fatima Abdirizak ; Sunmi Lee [Corée du Sud] ; Jonggul Lee [Corée du Sud] ; Eunok Jung [Corée du Sud] ; Hiroshi Nishiura [Japon] ; Cécile ViboudSource :
- BMC Medicine [ 1741-7015 ] ; 2015.
Descripteurs français
- KwdFr :
- Adulte d'âge moyen, Arabie saoudite (épidémiologie), Coronavirus du syndrome respiratoire du Moyen-Orient, Femelle, Flambées de maladies, Humains, Hôpitaux, Infection croisée (épidémiologie), Infections à coronavirus (transmission), Modèles théoriques, Mâle, République de Corée (épidémiologie), Sujet âgé, Syndrome respiratoire aigu sévère (transmission).
- MESH :
English descriptors
- KwdEn :
- Aged, Coronavirus Infections (transmission), Cross Infection (epidemiology), Disease Outbreaks, Female, Hospitals, Humans, Male, Middle Aged, Middle East Respiratory Syndrome Coronavirus, Models, Theoretical, Republic of Korea (epidemiology), Saudi Arabia (epidemiology), Severe Acute Respiratory Syndrome (transmission).
- MESH :
- epidemiology : Cross Infection, Republic of Korea, Saudi Arabia.
- transmission : Coronavirus Infections, Severe Acute Respiratory Syndrome.
- Aged, Disease Outbreaks, Female, Hospitals, Humans, Male, Middle Aged, Middle East Respiratory Syndrome Coronavirus, Models, Theoretical.
Abstract
The Middle East respiratory syndrome (MERS) coronavirus has caused recurrent outbreaks in the Arabian Peninsula since 2012. Although MERS has low overall human-to-human transmission potential, there is occasional amplification in the healthcare setting, a pattern reminiscent of the dynamics of the severe acute respiratory syndrome (SARS) outbreaks in 2003. Here we provide a head-to-head comparison of exposure patterns and transmission dynamics of large hospital clusters of MERS and SARS, including the most recent South Korean outbreak of MERS in 2015.
To assess the unexpected nature of the recent South Korean nosocomial outbreak of MERS and estimate the probability of future large hospital clusters, we compared exposure and transmission patterns for previously reported hospital clusters of MERS and SARS, based on individual-level data and transmission tree information. We carried out simulations of nosocomial outbreaks of MERS and SARS using branching process models rooted in transmission tree data, and inferred the probability and characteristics of large outbreaks.
A significant fraction of MERS cases were linked to the healthcare setting, ranging from 43.5 % for the nosocomial outbreak in Jeddah, Saudi Arabia, in 2014 to 100 % for both the outbreak in Al-Hasa, Saudi Arabia, in 2013 and the outbreak in South Korea in 2015. Both MERS and SARS nosocomial outbreaks are characterized by early nosocomial super-spreading events, with the reproduction number dropping below 1 within three to five disease generations. There was a systematic difference in the exposure patterns of MERS and SARS: a majority of MERS cases occurred among patients who sought care in the same facilities as the index case, whereas there was a greater concentration of SARS cases among healthcare workers throughout the outbreak. Exposure patterns differed slightly by disease generation, however, especially for SARS. Moreover, the distributions of secondary cases per single primary case varied highly across individual hospital outbreaks (Kruskal–Wallis test;
Our study suggests that the South Korean outbreak followed a similar progression to previously described hospital clusters involving coronaviruses, with early super-spreading events generating a disproportionately large number of secondary infections, and the transmission potential diminishing greatly in subsequent generations. Differences in relative exposure patterns and transmission heterogeneity of MERS and SARS could point to changes in hospital practices since 2003 or differences in transmission mechanisms of these coronaviruses.
The online version of this article (doi:10.1186/s12916-015-0450-0) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s12916-015-0450-0
PubMed: 26336062
PubMed Central: 4558759
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<term>Female</term>
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<term>Infections à coronavirus (transmission)</term>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>The Middle East respiratory syndrome (MERS) coronavirus has caused recurrent outbreaks in the Arabian Peninsula since 2012. Although MERS has low overall human-to-human transmission potential, there is occasional amplification in the healthcare setting, a pattern reminiscent of the dynamics of the severe acute respiratory syndrome (SARS) outbreaks in 2003. Here we provide a head-to-head comparison of exposure patterns and transmission dynamics of large hospital clusters of MERS and SARS, including the most recent South Korean outbreak of MERS in 2015.</p>
</sec>
<sec><title>Methods</title>
<p>To assess the unexpected nature of the recent South Korean nosocomial outbreak of MERS and estimate the probability of future large hospital clusters, we compared exposure and transmission patterns for previously reported hospital clusters of MERS and SARS, based on individual-level data and transmission tree information. We carried out simulations of nosocomial outbreaks of MERS and SARS using branching process models rooted in transmission tree data, and inferred the probability and characteristics of large outbreaks.</p>
</sec>
<sec><title>Results</title>
<p>A significant fraction of MERS cases were linked to the healthcare setting, ranging from 43.5 % for the nosocomial outbreak in Jeddah, Saudi Arabia, in 2014 to 100 % for both the outbreak in Al-Hasa, Saudi Arabia, in 2013 and the outbreak in South Korea in 2015. Both MERS and SARS nosocomial outbreaks are characterized by early nosocomial super-spreading events, with the reproduction number dropping below 1 within three to five disease generations. There was a systematic difference in the exposure patterns of MERS and SARS: a majority of MERS cases occurred among patients who sought care in the same facilities as the index case, whereas there was a greater concentration of SARS cases among healthcare workers throughout the outbreak. Exposure patterns differed slightly by disease generation, however, especially for SARS. Moreover, the distributions of secondary cases per single primary case varied highly across individual hospital outbreaks (Kruskal–Wallis test; <italic>P</italic>
< 0.0001), with significantly higher transmission heterogeneity in the distribution of secondary cases for MERS than SARS. Simulations indicate a 2-fold higher probability of occurrence of large outbreaks (>100 cases) for SARS than MERS (2 % versus 1 %); however, owing to higher transmission heterogeneity, the largest outbreaks of MERS are characterized by sharper incidence peaks. The probability of occurrence of MERS outbreaks larger than the South Korean cluster (n = 186) is of the order of 1 %.</p>
</sec>
<sec><title>Conclusions</title>
<p>Our study suggests that the South Korean outbreak followed a similar progression to previously described hospital clusters involving coronaviruses, with early super-spreading events generating a disproportionately large number of secondary infections, and the transmission potential diminishing greatly in subsequent generations. Differences in relative exposure patterns and transmission heterogeneity of MERS and SARS could point to changes in hospital practices since 2003 or differences in transmission mechanisms of these coronaviruses.</p>
</sec>
<sec><title>Electronic supplementary material</title>
<p>The online version of this article (doi:10.1186/s12916-015-0450-0) contains supplementary material, which is available to authorized users.</p>
</sec>
</div>
</front>
<back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Cauchemez, S" uniqKey="Cauchemez S">S Cauchemez</name>
</author>
<author><name sortKey="Fraser, C" uniqKey="Fraser C">C Fraser</name>
</author>
<author><name sortKey="Van Kerkhove, Md" uniqKey="Van Kerkhove M">MD Van Kerkhove</name>
</author>
<author><name sortKey="Donnelly, Ca" uniqKey="Donnelly C">CA Donnelly</name>
</author>
<author><name sortKey="Riley, S" uniqKey="Riley S">S Riley</name>
</author>
<author><name sortKey="Rambaut, A" uniqKey="Rambaut A">A Rambaut</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Muller, Ma" uniqKey="Muller M">MA Muller</name>
</author>
<author><name sortKey="Meyer, B" uniqKey="Meyer B">B Meyer</name>
</author>
<author><name sortKey="Corman, Vm" uniqKey="Corman V">VM Corman</name>
</author>
<author><name sortKey="Al Masri, M" uniqKey="Al Masri M">M Al-Masri</name>
</author>
<author><name sortKey="Turkestani, A" uniqKey="Turkestani A">A Turkestani</name>
</author>
<author><name sortKey="Ritz, D" uniqKey="Ritz D">D Ritz</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Kayali, G" uniqKey="Kayali G">G Kayali</name>
</author>
<author><name sortKey="Peiris, M" uniqKey="Peiris M">M Peiris</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Breban, R" uniqKey="Breban R">R Breban</name>
</author>
<author><name sortKey="Riou, J" uniqKey="Riou J">J Riou</name>
</author>
<author><name sortKey="Fontanet, A" uniqKey="Fontanet A">A Fontanet</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Chowell, G" uniqKey="Chowell G">G Chowell</name>
</author>
<author><name sortKey="Blumberg, S" uniqKey="Blumberg S">S Blumberg</name>
</author>
<author><name sortKey="Simonsen, L" uniqKey="Simonsen L">L Simonsen</name>
</author>
<author><name sortKey="Miller, Ma" uniqKey="Miller M">MA Miller</name>
</author>
<author><name sortKey="Viboud, C" uniqKey="Viboud C">C Viboud</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Cotten, M" uniqKey="Cotten M">M Cotten</name>
</author>
<author><name sortKey="Watson, Sj" uniqKey="Watson S">SJ Watson</name>
</author>
<author><name sortKey="Kellam, P" uniqKey="Kellam P">P Kellam</name>
</author>
<author><name sortKey="Al Rabeeah, Aa" uniqKey="Al Rabeeah A">AA Al-Rabeeah</name>
</author>
<author><name sortKey="Makhdoom, Hq" uniqKey="Makhdoom H">HQ Makhdoom</name>
</author>
<author><name sortKey="Assiri, A" uniqKey="Assiri A">A Assiri</name>
</author>
</analytic>
</biblStruct>
<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><analytic><author><name sortKey="Fisman, Dn" uniqKey="Fisman D">DN Fisman</name>
</author>
<author><name sortKey="Tuite, Ar" uniqKey="Tuite A">AR Tuite</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Oboho, Ik" uniqKey="Oboho I">IK Oboho</name>
</author>
<author><name sortKey="Tomczyk, Sm" uniqKey="Tomczyk S">SM Tomczyk</name>
</author>
<author><name sortKey="Al Asmari, Am" uniqKey="Al Asmari A">AM Al-Asmari</name>
</author>
<author><name sortKey="Banjar, Aa" uniqKey="Banjar A">AA Banjar</name>
</author>
<author><name sortKey="Al Mugti, H" uniqKey="Al Mugti H">H Al-Mugti</name>
</author>
<author><name sortKey="Aloraini, Ms" uniqKey="Aloraini M">MS Aloraini</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Assiri, A" uniqKey="Assiri A">A Assiri</name>
</author>
<author><name sortKey="Mcgeer, A" uniqKey="Mcgeer A">A McGeer</name>
</author>
<author><name sortKey="Perl, Tm" uniqKey="Perl T">TM Perl</name>
</author>
<author><name sortKey="Price, Cs" uniqKey="Price C">CS Price</name>
</author>
<author><name sortKey="Al Rabeeah, Aa" uniqKey="Al Rabeeah A">AA Al Rabeeah</name>
</author>
<author><name sortKey="Cummings, Da" uniqKey="Cummings D">DA Cummings</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Goh, Kt" uniqKey="Goh K">KT Goh</name>
</author>
<author><name sortKey="Cutter, J" uniqKey="Cutter J">J Cutter</name>
</author>
<author><name sortKey="Heng, Bh" uniqKey="Heng B">BH Heng</name>
</author>
<author><name sortKey="Ma, S" uniqKey="Ma S">S Ma</name>
</author>
<author><name sortKey="Koh, Bk" uniqKey="Koh B">BK Koh</name>
</author>
<author><name sortKey="Kwok, C" uniqKey="Kwok C">C Kwok</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Varia, M" uniqKey="Varia M">M Varia</name>
</author>
<author><name sortKey="Wilson, S" uniqKey="Wilson S">S Wilson</name>
</author>
<author><name sortKey="Sarwal, S" uniqKey="Sarwal S">S Sarwal</name>
</author>
<author><name sortKey="Mcgeer, A" uniqKey="Mcgeer A">A McGeer</name>
</author>
<author><name sortKey="Gournis, E" uniqKey="Gournis E">E Gournis</name>
</author>
<author><name sortKey="Galanis, E" uniqKey="Galanis E">E Galanis</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="De Wit, E" uniqKey="De Wit E">E de Wit</name>
</author>
<author><name sortKey="Rasmussen, Al" uniqKey="Rasmussen A">AL Rasmussen</name>
</author>
<author><name sortKey="Falzarano, D" uniqKey="Falzarano D">D Falzarano</name>
</author>
<author><name sortKey="Bushmaker, T" uniqKey="Bushmaker T">T Bushmaker</name>
</author>
<author><name sortKey="Feldmann, F" uniqKey="Feldmann F">F Feldmann</name>
</author>
<author><name sortKey="Brining, Dl" uniqKey="Brining D">DL Brining</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Franks, Tj" uniqKey="Franks T">TJ Franks</name>
</author>
<author><name sortKey="Chong, Py" uniqKey="Chong P">PY Chong</name>
</author>
<author><name sortKey="Chui, P" uniqKey="Chui P">P Chui</name>
</author>
<author><name sortKey="Galvin, Jr" uniqKey="Galvin J">JR Galvin</name>
</author>
<author><name sortKey="Lourens, Rm" uniqKey="Lourens R">RM Lourens</name>
</author>
<author><name sortKey="Reid, Ah" uniqKey="Reid A">AH Reid</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Assiri, A" uniqKey="Assiri A">A Assiri</name>
</author>
<author><name sortKey="Al Tawfiq, Ja" uniqKey="Al Tawfiq J">JA Al-Tawfiq</name>
</author>
<author><name sortKey="Al Rabeeah, Aa" uniqKey="Al Rabeeah A">AA Al-Rabeeah</name>
</author>
<author><name sortKey="Al Rabiah, Fa" uniqKey="Al Rabiah F">FA Al-Rabiah</name>
</author>
<author><name sortKey="Al Hajjar, S" uniqKey="Al Hajjar S">S Al-Hajjar</name>
</author>
<author><name sortKey="Al Barrak, A" uniqKey="Al Barrak A">A Al-Barrak</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Donnelly, Ca" uniqKey="Donnelly C">CA Donnelly</name>
</author>
<author><name sortKey="Ghani, Ac" uniqKey="Ghani A">AC Ghani</name>
</author>
<author><name sortKey="Leung, Gm" uniqKey="Leung G">GM Leung</name>
</author>
<author><name sortKey="Hedley, Aj" uniqKey="Hedley A">AJ Hedley</name>
</author>
<author><name sortKey="Fraser, C" uniqKey="Fraser C">C Fraser</name>
</author>
<author><name sortKey="Riley, S" uniqKey="Riley S">S Riley</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Lloyd Smith, Jo" uniqKey="Lloyd Smith J">JO Lloyd-Smith</name>
</author>
<author><name sortKey="Schreiber, Sj" uniqKey="Schreiber S">SJ Schreiber</name>
</author>
<author><name sortKey="Kopp, Pe" uniqKey="Kopp P">PE Kopp</name>
</author>
<author><name sortKey="Getz, Wm" uniqKey="Getz W">WM Getz</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Fisman, Dn" uniqKey="Fisman D">DN Fisman</name>
</author>
<author><name sortKey="Leung, Gm" uniqKey="Leung G">GM Leung</name>
</author>
<author><name sortKey="Lipsitch, M" uniqKey="Lipsitch M">M Lipsitch</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Anderson, Rm" uniqKey="Anderson R">RM Anderson</name>
</author>
<author><name sortKey="May, Rm" uniqKey="May R">RM May</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Nishiura, H" uniqKey="Nishiura H">H Nishiura</name>
</author>
<author><name sortKey="Chowell, G" uniqKey="Chowell G">G Chowell</name>
</author>
<author><name sortKey="Heesterbeek, H" uniqKey="Heesterbeek H">H Heesterbeek</name>
</author>
<author><name sortKey="Wallinga, J" uniqKey="Wallinga J">J Wallinga</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Blumberg, S" uniqKey="Blumberg S">S Blumberg</name>
</author>
<author><name sortKey="Lloyd Smith, Jo" uniqKey="Lloyd Smith J">JO Lloyd-Smith</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Mcdonald, Lc" uniqKey="Mcdonald L">LC McDonald</name>
</author>
<author><name sortKey="Simor, Ae" uniqKey="Simor A">AE Simor</name>
</author>
<author><name sortKey="Su, Ij" uniqKey="Su I">IJ Su</name>
</author>
<author><name sortKey="Maloney, S" uniqKey="Maloney S">S Maloney</name>
</author>
<author><name sortKey="Ofner, M" uniqKey="Ofner M">M Ofner</name>
</author>
<author><name sortKey="Chen, Kt" uniqKey="Chen K">KT Chen</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Gopalakrishna, G" uniqKey="Gopalakrishna G">G Gopalakrishna</name>
</author>
<author><name sortKey="Choo, P" uniqKey="Choo P">P Choo</name>
</author>
<author><name sortKey="Leo, Ys" uniqKey="Leo Y">YS Leo</name>
</author>
<author><name sortKey="Tay, Bk" uniqKey="Tay B">BK Tay</name>
</author>
<author><name sortKey="Lim, Yt" uniqKey="Lim Y">YT Lim</name>
</author>
<author><name sortKey="Khan, As" uniqKey="Khan A">AS Khan</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Blumberg, S" uniqKey="Blumberg S">S Blumberg</name>
</author>
<author><name sortKey="Lloyd Smith, Jo" uniqKey="Lloyd Smith J">JO Lloyd-Smith</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Althaus, Cl" uniqKey="Althaus C">CL Althaus</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Lipsitch, M" uniqKey="Lipsitch M">M Lipsitch</name>
</author>
<author><name sortKey="Cohen, T" uniqKey="Cohen T">T Cohen</name>
</author>
<author><name sortKey="Cooper, B" uniqKey="Cooper B">B Cooper</name>
</author>
<author><name sortKey="Robins, Jm" uniqKey="Robins J">JM Robins</name>
</author>
<author><name sortKey="Ma, S" uniqKey="Ma S">S Ma</name>
</author>
<author><name sortKey="James, L" uniqKey="James L">L James</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Riley, S" uniqKey="Riley S">S Riley</name>
</author>
<author><name sortKey="Fraser, C" uniqKey="Fraser C">C Fraser</name>
</author>
<author><name sortKey="Donnelly, Ca" uniqKey="Donnelly C">CA Donnelly</name>
</author>
<author><name sortKey="Ghani, Ac" uniqKey="Ghani A">AC Ghani</name>
</author>
<author><name sortKey="Abu Raddad, Lj" uniqKey="Abu Raddad L">LJ Abu-Raddad</name>
</author>
<author><name sortKey="Hedley, Aj" uniqKey="Hedley A">AJ Hedley</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Nishiura, H" uniqKey="Nishiura H">H Nishiura</name>
</author>
<author><name sortKey="Kuratsuji, T" uniqKey="Kuratsuji T">T Kuratsuji</name>
</author>
<author><name sortKey="Quy, T" uniqKey="Quy T">T Quy</name>
</author>
<author><name sortKey="Phi, Nc" uniqKey="Phi N">NC Phi</name>
</author>
<author><name sortKey="Van Ban, V" uniqKey="Van Ban V">V Van Ban</name>
</author>
<author><name sortKey="Ha, Le" uniqKey="Ha L">LE Ha</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Chowell, G" uniqKey="Chowell G">G Chowell</name>
</author>
<author><name sortKey="Fenimore, Pw" uniqKey="Fenimore P">PW Fenimore</name>
</author>
<author><name sortKey="Castillo Garsow, Ma" uniqKey="Castillo Garsow M">MA Castillo-Garsow</name>
</author>
<author><name sortKey="Castillo Chavez, C" uniqKey="Castillo Chavez C">C Castillo-Chavez</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Gumel, Ab" uniqKey="Gumel A">AB Gumel</name>
</author>
<author><name sortKey="Ruan, S" uniqKey="Ruan S">S Ruan</name>
</author>
<author><name sortKey="Day, T" uniqKey="Day T">T Day</name>
</author>
<author><name sortKey="Watmough, J" uniqKey="Watmough J">J Watmough</name>
</author>
<author><name sortKey="Brauer, F" uniqKey="Brauer F">F Brauer</name>
</author>
<author><name sortKey="Van Den Driessche, P" uniqKey="Van Den Driessche P">P van den Driessche</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Cori, A" uniqKey="Cori A">A Cori</name>
</author>
<author><name sortKey="Boelle, Py" uniqKey="Boelle P">PY Boelle</name>
</author>
<author><name sortKey="Thomas, G" uniqKey="Thomas G">G Thomas</name>
</author>
<author><name sortKey="Leung, Gm" uniqKey="Leung G">GM Leung</name>
</author>
<author><name sortKey="Valleron, Aj" uniqKey="Valleron A">AJ Valleron</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Wong, T" uniqKey="Wong T">T Wong</name>
</author>
<author><name sortKey="Wallington, T" uniqKey="Wallington T">T Wallington</name>
</author>
<author><name sortKey="Mcdonald, Lc" uniqKey="Mcdonald L">LC McDonald</name>
</author>
<author><name sortKey="Abbas, Z" uniqKey="Abbas Z">Z Abbas</name>
</author>
<author><name sortKey="Christian, M" uniqKey="Christian M">M Christian</name>
</author>
<author><name sortKey="Low, De" uniqKey="Low D">DE Low</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Zeng, G" uniqKey="Zeng G">G Zeng</name>
</author>
<author><name sortKey="Xie, Sy" uniqKey="Xie S">SY Xie</name>
</author>
<author><name sortKey="Li, Q" uniqKey="Li Q">Q Li</name>
</author>
<author><name sortKey="Ou, Jm" uniqKey="Ou J">JM Ou</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Tuan, Pa" uniqKey="Tuan P">PA Tuan</name>
</author>
<author><name sortKey="Horby, P" uniqKey="Horby P">P Horby</name>
</author>
<author><name sortKey="Dinh, Pn" uniqKey="Dinh P">PN Dinh</name>
</author>
<author><name sortKey="Mai, Lt" uniqKey="Mai L">LT Mai</name>
</author>
<author><name sortKey="Zambon, M" uniqKey="Zambon M">M Zambon</name>
</author>
<author><name sortKey="Shah, J" uniqKey="Shah J">J Shah</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Leung, Gm" uniqKey="Leung G">GM Leung</name>
</author>
<author><name sortKey="Hedley, Aj" uniqKey="Hedley A">AJ Hedley</name>
</author>
<author><name sortKey="Ho, Lm" uniqKey="Ho L">LM Ho</name>
</author>
<author><name sortKey="Chau, P" uniqKey="Chau P">P Chau</name>
</author>
<author><name sortKey="Wong, Io" uniqKey="Wong I">IO Wong</name>
</author>
<author><name sortKey="Thach, Tq" uniqKey="Thach T">TQ Thach</name>
</author>
</analytic>
</biblStruct>
</listBibl>
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