Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in South Korea, 2015: epidemiology, characteristics and public health implications

K H Kim, T E Tandi, J W Choi, J M Moon, M S Kim, K H Kim, T E Tandi, J W Choi, J M Moon, M S Kim

Abstract

Background: Since the first case of Middle East respiratory syndrome coronavirus (MERS-CoV) in South Korea was reported on 20th May 2015, there have been 186 confirmed cases, 38 deaths and 16,752 suspected cases. Previously published research on South Korea's MERS outbreak was limited to the early stages, when few data were available. Now that the outbreak has ended, albeit unofficially, a more comprehensive review is appropriate.

Methods: Data were obtained through the MERS portal by the Ministry for Health and Welfare (MOHW) and Korea Centres for Disease Control and Prevention, press releases by MOHW, and reports by the MERS Policy Committee of the Korean Medical Association. Cases were analysed for general characteristics, exposure source, timeline and infection generation. Sex, age and underlying diseases were analysed for the 38 deaths.

Findings: Beginning with the index case that infected 28 others, an in-depth analysis was conducted. The average age was 55 years, which was a little higher than the global average of 50 years. As in most other countries, more men than women were affected. The case fatality rate was 19.9%, which was lower than the global rate of 38.7% and the rate in Saudi Arabia (36.5%). In total, 184 patients were infected nosocomially and there were no community-acquired infections. The main underlying diseases were respiratory diseases, cancer and hypertension. The main contributors to the outbreak were late diagnosis, quarantine failure of 'super spreaders', familial care-giving and visiting, non-disclosure by patients, poor communication by the South Korean Government, inadequate hospital infection management, and 'doctor shopping'. The outbreak was entirely nosocomial, and was largely attributable to infection management and policy failures, rather than biomedical factors.

Keywords: Epidemiology; MERS-CoV outbreak; Public health; South Korea.

Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Figures

Figure 1
Figure 1
Number of confirmed cases (blue circles), deaths (red triangles) and quarantines/isolations (green bars) for Middle East respiratory syndrome in South Korea (20th May to 25th November 2015).
Figure 2
Figure 2
Distribution of transmission of Middle East respiratory syndrome coronavirus clusters and suspected super spreaders in South Korea (20th May to 25th November 2015).

References

    1. Petersen E., Hui D.S., Perlman S., Zumla A. Middle East respiratory syndrome – advancing the public health, and research agenda on MERS – lessons from the South Korea outbreak. Int J Infect Dis. 2015;36:54–55.
    1. World Health Organization . WHO; Geneva: 2015. Middle East respiratory syndrome coronavirus (MERS-CoV) Available at: [last accessed October 2015]
    1. European Centre for Disease Prevention and Control . ECDC; Stockholm: 2015. Middle East respiratory syndrome coronavirus (MERSCoV) 21st update.
    1. Jun K. The Wall Street Journal; 2015. How MERS could affect South Korea's economy. Available at: [last accessed October 2015]
    1. Kelland K. Reuters; 2015. Transparency, teamwork key to beating deadly South Korea MERS outbreak. Available at: [last accessed October 2015]
    1. Kupferschmidt K. Did poor ventilation lead to MERS ‘superspread’ in Korea? Science 2015. Available at: [last accessed October 2015].
    1. Choi J.W., Kim K.H., Cho Y.M., Kim S.H. Current epidemiological situation of Middle East respiratory syndrome coronavirus clusters and implications for public health response in South Korea. J Korean Med Assoc. 2015;58:487–497.
    1. Zumla A., Hui D.S., Perlman S. Middle East respiratory syndrome. Lancet. 2015;386:995–1007.
    1. Ki M. 2015 MERS outbreak in Korea: hospital-to-hospital transmission. Epidemiol Health. 2015;37:e2015033.
    1. Chowell G., Abdirizak F., Lee S. Transmission characteristics of MERS and SARS in the healthcare setting: a comparative study. BMC Med. 2015;13:210.
    1. . Centre for Disease control and Prevention, Korea; 2015. MERS portal. Available at: [last accessed October 2015]
    1. Policy Briefing Room . 2015. Policy briefing room homepage. Policy briefing, Korea; Available at: [last accessed October 2015]
    1. Woolhouse M.E., Dye C., Etard J.F. Heterogeneities in the transmission of infectious agents: implications for the design of control programs. Proc Natl Acad Sci USA. 1997;94:338–342.
    1. Lloyd-Smith J.O., Schreiber S.J., Kopp P.E., Getz W.M. Superspreading and the effect of individual variation on disease emergence. Nature. 2005;438:355–359.
    1. Alghamdi I.G., Hussain I.I., Almalki S.S., Alghamdi M.S., Alghamdi M.M., El-sheemy M.A. The pattern of Middle East respiratory syndrome coronavirus in Saudi Arabia: a descriptive epidemiological analysis of data from the Saudi Ministry of Health. Int J Gen Med. 2014;7:417–423.
    1. Assiri A., McGeer A., Perl T.M. Hospital outbreak of Middle East respiratory syndrome coronavirus. N Engl J Med. 2013;369:407–416.
    1. Wang J., Sheng W., Fang C. Clinical manifestations, laboratory findings, and treatment outcomes of SARS patients. Emerg Infect Dis. 2004;10:818–824.
    1. Hui D.S.C., Chan M.C.H., Wu A.K., Ng P.C. Severe acute respiratory syndrome (SARS): epidemiology and clinical features. Postgrad Med J. 2004;80:373–381.
    1. Hui D.S., Perlman S., Zumla A. Spread of MERS to South Korea and China. Lancet Respir Med. 2015;3:509–510.
    1. Oboho I.K., Tomczyk S.A., Al-Asmari A.M. 2014 MERS-CoV outbreak in Jeddah – a link to health care facilities. N Engl J Med. 2015;372:846–854.
    1. Lee S.S., Wong N.S. Probable transmission chains of Middle East respiratory syndrome coronavirus and the multiple generations of secondary infection in South Korea. Int J Infect Dis. 2015;38:65–67.
    1. World Health Organization . WHO; Geneva: 2015. WHO | MERS-CoV joint mission findings discussion. Available at: [last accessed October 2015]
    1. Banach D.B., Bearman G.M., Morgan D.J., Munoz-Price L.S. Infection control precautions for visitors to healthcare facilities. Expert Rev Anti Infect Ther. 2015;13:1047–1050.
    1. Fung I.C., Tse Z.T.H., Chan B.S.B., Fu K.W. Middle East respiratory syndrome in the Republic of Korea: transparency and communication are key. Western Pac Surveill Response J. 2015;6:1–2.
    1. Jack A. Why the panic? South Korea's MERS response questioned. BMJ. 2015;350:h3403.
    1. . WPRO; 2015. High-level messages. Available at: [last accessed October 2015]
    1. Sherertz R.J., Reagan D.R., Hampton K.D. A cloud adult: the Staphylococcus aureus-virus interaction revisited. Ann Intern Med. 1996;124:539–547.
    1. Lim P.L. Middle East respiratory syndrome (MERS) in Asia: lessons gleaned from the South Korean outbreak. Trans R Soc Trop Med Hyg. 2015;109:541–542.
    1. Kim Y. Healthcare policy and healthcare utilization behavior to improve hospital infection control after the Middle East respiratory syndrome outbreak. J Korean Med Assoc. 2015;58:598.
    1. Lee K.H. Emergency medical services in response to the Middle East respiratory syndrome outbreak in Korea. J Korean Med Assoc. 2015;58:611.
    1. Choi J.W., Kim K.H., Moon J.M., Kim M.S. Public health crisis response and establishment of a crisis communication system in South Korea: lessons learned from the MERS outbreak. J Korean Med Assoc. 2015;58:624.
    1. Choi J.W. Lessons learned from Middle East respiratory syndrome coronavirus cluster in Korea. J Korean Med Assoc. 2015;58:595.
    1. Choi J.W., Lee J.S., Kim K.H. Proposed master plan for reform of the national infectious disease prevention, and management system in Korea. J Korean Med Assoc. 2015;58:723.

Source: PubMed

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