Fatality risks for nosocomial outbreaks of Middle East respiratory syndrome coronavirus in the Middle East and South Korea.
Middle East respiratory syndrome coronavirus (MERS-CoV) was first isolated in 2012. The largest known outbreak outside the Middle East occurred in South Korea in 2015. As of 29 June 2016, 1769 laboratory-confirmed cases (630 deaths; 35.6 % case fatality rate [CFR]) had been reported from 26 countries, particularly in the Middle East. However, the CFR for hospital outbreaks was higher than that of family clusters in the Middle East and Korea. Here, we compared the mortality rates for 51 nosocomial outbreaks in the Middle East and one outbreak of MERS-CoV in South Korea. Our findings showed the CFR in the Middle East was much higher than that in South Korea (25.9 % [56/216] vs. 13.8 % [24/174], p = 0.003). Infected individuals who died were, on average, older than those who survived in both the Middle East (64 years [25-98] vs. 46 years [2-85], p = 0.000) and South Korea (68 years [49-82] vs. 53.5 years [16-87], p = 0.000). Similarly, the co-morbidity rates for the fatal cases were statistically higher than for the nonfatal cases in both the Middle East (64.3 % [36/56] vs. 28.1 % [45/160], p = 0.000) and South Korea (45.8 % [11/24] vs. 12.0 % [18/150], p = 0.000). The median number of days from onset to confirmation of infection in the fatal cases was longer than that for survivors from the Middle East (8 days [1-47] vs. 4 days [0-14], p = 0.009). Thus, older age, pre-existing concurrent diseases, and delayed confirmation increase the odds of a fatal outcome in nosocomial MERS-CoV outbreaks in the Middle East and South Korea.
Department of Endocrinology, The 421 Hospital of Chinese People's Liberation Army, Guangzhou, China.
Jianping
J
Sha
Emergency Offices, Baoan District Centre for Disease Control and Prevention, Shenzhen, China.
Yuan
Y
Li
Department of Senior Cadres, The 421 Hospital of the Chinese People's Liberation Army, Guangzhou, China.
Xiaowen
X
Chen
Department of Endocrinology, The 421 Hospital of Chinese People's Liberation Army, Guangzhou, China.
Yan
Y
Hu
Department of Endocrinology, The 421 Hospital of Chinese People's Liberation Army, Guangzhou, China.
Yajin
Y
Ren
Emergency Offices, Jinan Centre for Disease Control and Prevention, Jinan, Shandong Province, China.
Xingyi
X
Geng
School of Public Health, Shanghai Jiaotong University School of Medicine, 227 Chongqing South Road, Shanghai, 200025, China. zhangzhiruo@sjtu.edu.cn.
Zhiruo
Z
Zhang
Department of Infectious Diseases, Zhejiang Provincial Centre for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, 310051, Zhejiang Province, China. liushelan@gmail.com.
Shelan
S
Liu
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D018352:Coronavirus Infections / Q000453:epidemiology / Q000401:mortality*; D003428:Cross Infection / Q000453:epidemiology / Q000401:mortality*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D009026:Mortality; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D055815:Young Adult
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