title: Extensive Viable Middle East Respiratory Syndrome (MERS) Coronavirus Contamination in Air and Surrounding Environment in MERS Isolation Wards.
abstract: The largest outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) outside the Middle East occurred in South Korea in 2015 and resulted in 186 laboratory-confirmed infections, including 36 (19%) deaths. Some hospitals were considered epicenters of infection and voluntarily shut down most of their operations after nearly half of all transmissions occurred in hospital settings. However, the ways that MERS-CoV is transmitted in healthcare settings are not well defined.
  
  
  
  We explored the possible contribution of contaminated hospital air and surfaces to MERS transmission by collecting air and swabbing environmental surfaces in 2 hospitals treating MERS-CoV patients. The samples were tested by viral culture with reverse transcription polymerase chain reaction (RT-PCR) and immunofluorescence assay (IFA) using MERS-CoV Spike antibody, and electron microscopy (EM).
  
  
  
  The presence of MERS-CoV was confirmed by RT-PCR of viral cultures of 4 of 7 air samples from 2 patients' rooms, 1 patient's restroom, and 1 common corridor. In addition, MERS-CoV was detected in 15 of 68 surface swabs by viral cultures. IFA on the cultures of the air and swab samples revealed the presence of MERS-CoV. EM images also revealed intact particles of MERS-CoV in viral cultures of the air and swab samples.
  
  
  
  These data provide experimental evidence for extensive viable MERS-CoV contamination of the air and surrounding materials in MERS outbreak units. Thus, our findings call for epidemiologic investigation of the possible scenarios for contact and airborne transmission, and raise concern regarding the adequacy of current infection control procedures.
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul.
authors.forename: Sung-Han
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Respiratory Viruses Research Laboratory, Institut Pasteur Korea, Seongnam-si, Gyeonggi Province.
authors.forename: So Young
authors.initials: SY
authors.lastname: Chang
authors.affiliation: Department of Architectural Engineering, Sejong University, Seoul.
authors.forename: Minki
authors.initials: M
authors.lastname: Sung
authors.affiliation: Respiratory Viruses Research Laboratory, Institut Pasteur Korea, Seongnam-si, Gyeonggi Province.
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Park
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine.
authors.forename: Hong
authors.initials: H
authors.lastname: Bin Kim
authors.affiliation: Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi Province.
authors.forename: Heeyoung
authors.initials: H
authors.lastname: Lee
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Seoul Medical Center.
authors.forename: Jae-Phil
authors.initials: JP
authors.lastname: Choi
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Won Suk
authors.initials: WS
authors.lastname: Choi
authors.affiliation: Respiratory Viruses Research Laboratory, Institut Pasteur Korea, Seongnam-si, Gyeonggi Province.
authors.forename: Ji-Young
authors.initials: JY
authors.lastname: Min
mesh_terms: D018352:Coronavirus Infections / Q000453:epidemiology / Q000635:transmission* / Q000821:virology; D004196:Disease Outbreaks; D004783:Environmental Microbiology; D006761:Hospitals; D006801:Humans; D017053:Infection Control; D065207:Middle East Respiratory Syndrome Coronavirus / Q000302:isolation & purification*; D056910:Republic of Korea / Q000453:epidemiology
keywords: MERS; contamination; transmission