title: Probable transmission chains of Middle East respiratory syndrome coronavirus and the multiple generations of secondary infection in South Korea.
abstract: BACKGROUND
  In May 2015, South Korea reported its first case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in a 68-year-old man with a history of travel in the Middle East. In the presence of secondary infections, an understanding of the transmission dynamics of the virus is crucial. The aim of this study was to characterize the transmission chains of MERS-CoV infection in the current South Korean outbreak.
  
  
  METHODS
  Individual-level data from multiple sources were collected and used for epidemiological analyses.
  
  
  RESULTS
  As of July 14, 2015, 185 confirmed cases of MERS have been reported in the Korean outbreak. Three generations of secondary infection, with over half belonging to the second generation, could be delineated. Hospital infection was found to be the most important cause of virus transmission, affecting largely non-healthcare workers (154/184). Healthcare switching has probably accounted for the emergence of multiple generations of secondary infection. Fomite transmission may explain a significant proportion of the infections occurring in the absence of direct contact with infected cases.
  
  
  CONCLUSIONS
  Publicly available data from multiple sources, including the media, are useful to describe the epidemic history of an outbreak. The effective control of MERS-CoV hinges on the upholding of infection control standards and an understanding of health-seeking behaviours in the community.
authors.affiliation: Stanley Ho Centre for Infectious Diseases, 205 Postgraduate Education Centre, The Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, People's Republic of China. Electronic address: sslee@cuhk.edu.hk.
authors.forename: Shui Shan
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Stanley Ho Centre for Infectious Diseases, 205 Postgraduate Education Centre, The Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, People's Republic of China.
authors.forename: Ngai Sze
authors.initials: NS
authors.lastname: Wong
mesh_terms: D060085:Coinfection / Q000453:epidemiology; D018352:Coronavirus Infections / Q000453:epidemiology* / Q000635:transmission*; D003428:Cross Infection / Q000453:epidemiology / Q000635:transmission; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology
keywords: Coronavirus; Epidemiology; Infectious diseases outbreaks; MERS