title: Environmental Contamination and Viral Shedding in MERS Patients During MERS-CoV Outbreak in South Korea.
abstract: BACKGROUND
  Although Middle East Respiratory Syndrome coronavirus (MERS-CoV) is characterized by a risk of nosocomial transmission, the detailed mode of transmission and period of virus shedding from infected patients are poorly understood. The aims of this study were to investigate the potential role of environmental contamination by MERS-CoV in healthcare settings and to define the period of viable virus shedding from MERS patients.
  
  
  METHODS
  We investigated environmental contamination from 4 patients in MERS-CoV units of 2 hospitals. MERS-CoV was detected by reverse transcription polymerase chain reaction (PCR) and viable virus was isolated by cultures.
  
  
  RESULTS
  Many environmental surfaces of MERS patient rooms, including points frequently touched by patients or healthcare workers, were contaminated by MERS-CoV. Viral RNA was detected up to five days from environmental surfaces following the last positive PCR from patients' respiratory specimens. MERS-CoV RNA was detected in samples from anterooms, medical devices, and air-ventilating equipment. In addition, MERS-CoV was isolated from environmental objects such as bed sheets, bedrails, IV fluid hangers, and X-ray devices. During the late clinical phase of MERS, viable virus could be isolated in 3 of the 4 enrolled patients on day 18 to day 25 after symptom onset.
  
  
  CONCLUSIONS
  Most of touchable surfaces in MERS units were contaminated by patients and health care workers and the viable virus could shed through respiratory secretion from clinically fully recovered patients. These results emphasize the need for strict environmental surface hygiene practices, and sufficient isolation period based on laboratory results rather than solely on clinical symptoms.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon.
authors.forename: Seo Yu
authors.initials: SY
authors.lastname: Bin
authors.affiliation: Departments of Internal Medicine, and.
authors.forename: Jung Yeon
authors.initials: JY
authors.lastname: Heo
authors.affiliation: Microbiology, College of Medicine and Medical Research Institute, and.
authors.forename: Min-Suk
authors.initials: MS
authors.lastname: Song
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon.
authors.forename: Jacob
authors.initials: J
authors.lastname: Lee
authors.affiliation: Microbiology, College of Medicine and Medical Research Institute, and.
authors.forename: Eun-Ha
authors.initials: EH
authors.lastname: Kim
authors.affiliation: Microbiology, College of Medicine and Medical Research Institute, and Zoonotic Infectious Diseases Research Center, Chungbuk National University, Seowon-Gu, Cheongju, Republic of Korea.
authors.forename: Su-Jin
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Microbiology, College of Medicine and Medical Research Institute, and Zoonotic Infectious Diseases Research Center, Chungbuk National University, Seowon-Gu, Cheongju, Republic of Korea.
authors.forename: Hyeok-Il
authors.initials: HI
authors.lastname: Kwon
authors.affiliation: Microbiology, College of Medicine and Medical Research Institute, and Zoonotic Infectious Diseases Research Center, Chungbuk National University, Seowon-Gu, Cheongju, Republic of Korea.
authors.forename: Se Mi
authors.initials: SM
authors.lastname: Kim
authors.affiliation: Microbiology, College of Medicine and Medical Research Institute, and Zoonotic Infectious Diseases Research Center, Chungbuk National University, Seowon-Gu, Cheongju, Republic of Korea.
authors.forename: Young-Il
authors.initials: YI
authors.lastname: Kim
authors.affiliation: Microbiology, College of Medicine and Medical Research Institute, and Zoonotic Infectious Diseases Research Center, Chungbuk National University, Seowon-Gu, Cheongju, Republic of Korea.
authors.forename: Young-Jae
authors.initials: YJ
authors.lastname: Si
authors.affiliation: Microbiology, College of Medicine and Medical Research Institute, and Zoonotic Infectious Diseases Research Center, Chungbuk National University, Seowon-Gu, Cheongju, Republic of Korea.
authors.forename: In-Won
authors.initials: IW
authors.lastname: Lee
authors.affiliation: Microbiology, College of Medicine and Medical Research Institute, and.
authors.forename: Yun Hee
authors.initials: YH
authors.lastname: Baek
authors.affiliation: Microbiology, College of Medicine and Medical Research Institute, and.
authors.forename: Won-Suk
authors.initials: WS
authors.lastname: Choi
authors.affiliation: Departments of Internal Medicine, and.
authors.forename: Jinsoo
authors.initials: J
authors.lastname: Min
authors.affiliation: Departments of Internal Medicine, and.
authors.forename: Hye Won
authors.initials: HW
authors.lastname: Jeong
authors.affiliation: Microbiology, College of Medicine and Medical Research Institute, and Zoonotic Infectious Diseases Research Center, Chungbuk National University, Seowon-Gu, Cheongju, Republic of Korea.
authors.forename: Young Ki
authors.initials: YK
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D001512:Bedding and Linens / Q000821:virology; D018352:Coronavirus Infections / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission* / Q000821:virology*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology; D004196:Disease Outbreaks / Q000517:prevention & control; D004866:Equipment Contamination; D004865:Equipment and Supplies, Hospital / Q000821:virology*; D005260:Female; D050456:Fomites; D006282:Health Personnel; D006801:Humans; D008875:Middle Aged; D065207:Middle East Respiratory Syndrome Coronavirus / Q000235:genetics / Q000302:isolation & purification*; D012367:RNA, Viral / Q000302:isolation & purification; D060888:Real-Time Polymerase Chain Reaction; D056910:Republic of Korea / Q000453:epidemiology; D017422:Sequence Analysis, DNA; D017201:Virus Shedding
chemical_list: D012367:RNA, Viral
keywords: MERS-CoV; South Korea; environmental contamination; prolonged viral shedding; transmission mode