Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in South Korea, 2015: epidemiology, characteristics and public health implications.
BACKGROUND
Since the first case of Middle East respiratory syndrome coronavirus (MERS-CoV) in South Korea was reported on 20thMay 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.


RESULTS
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.
Institute for Occupational and Environmental Health, Korea University, Seoul, Korea.
K H
KH
Kim
Institute for Occupational and Environmental Health, Korea University, Seoul, Korea; Graduate School of Public Health, Korea University, Seoul, Korea; Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea; Ministry of Public Health Yaounde, Yaounde, Cameroon.
T E
TE
Tandi
Institute for Occupational and Environmental Health, Korea University, Seoul, Korea; Graduate School of Public Health, Korea University, Seoul, Korea; Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea; MERS Policy Committee of the Korean Medical Association, Seoul, Korea. Electronic address: shine@korea.ac.kr.
J W
JW
Choi
Institute for Occupational and Environmental Health, Korea University, Seoul, Korea; Graduate School of Public Health, Korea University, Seoul, Korea.
J M
JM
Moon
Institute for Occupational and Environmental Health, Korea University, Seoul, Korea; Graduate School of Public Health, Korea University, Seoul, Korea.
M S
MS
Kim
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D018352:Coronavirus Infections / Q000453:epidemiology* / Q000635:transmission; D003428:Cross Infection / Q000453:epidemiology* / Q000635:transmission; D004196:Disease Outbreaks; D018562:Disease Transmission, Infectious; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods; D008297:Male; D008875:Middle Aged; D065207:Middle East Respiratory Syndrome Coronavirus / Q000302:isolation & purification*; D009026:Mortality; D056910:Republic of Korea / Q000453:epidemiology; D012737:Sex Factors; D055815:Young Adult
Epidemiology; MERS-CoV outbreak; Public health; South Korea