title: High fatality rates and associated factors in two hospital outbreaks of MERS in Daejeon, the Republic of Korea.
abstract: OBJECTIVE
  To explore the epidemiological and clinical factors predictive of the case fatality rate (CFR) of Middle East respiratory syndrome-coronavirus (MERS-CoV) infection in an outbreak in Daejeon, the Republic of Korea.
  
  
  METHODS
  We reviewed the outbreak investigation reports and medical records of 1 index case and 25 additional MERS cases in hospitals A (14 cases) and B (11 cases), and conducted an in-depth interview with the index case.
  
  
  RESULTS
  The CFR in hospital B was higher than that in hospital A (63.6% vs. 28.6%, respectively). Higher MERS-CoV exposure conditions were also found in hospital B, including aggravated pneumonia in the index case and nebulizer use in a six-bed admission room. The host factors associated with high CFR were pre-existing pneumonia, smoking history, an incubation period of less than 5 days, leukocytosis, abnormal renal function at diagnosis, and respiratory symptoms such as sputum and dyspnea.
  
  
  CONCLUSIONS
  The conditions surrounding MERS-CoV exposure and the underlying poor pulmonary function due to a smoking history or pre-existing pneumonia may explain the high CFR in hospital B. The clinical features described above may enable prediction of the prognosis of MERS cases.
authors.affiliation: Department of Preventive Medicine and Public Health, Chungnam National University School of Medicine, Daejeon, Republic of Korea. Electronic address: hsnam@cnu.ac.kr.
authors.forename: Hae-Sung
authors.initials: HS
authors.lastname: Nam
authors.affiliation: Division of Infectious Disease Surveillance, Korea Centers for Disease Control and Prevention, Cheongju, Republic of Korea.
authors.forename: Jung Wan
authors.initials: JW
authors.lastname: Park
authors.affiliation: Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.
authors.forename: Moran
authors.initials: M
authors.lastname: Ki
authors.affiliation: Department of Preventive Medicine and Public Health, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
authors.forename: Mi-Yeon
authors.initials: MY
authors.lastname: Yeon
authors.affiliation: Department of Nursing, Graduate School, Chungnam National University, Daejeon, Republic of Korea.
authors.forename: Jin
authors.initials: J
authors.lastname: Kim
authors.affiliation: Division of Infectious Disease Surveillance, Korea Centers for Disease Control and Prevention, Cheongju, Republic of Korea.
authors.forename: Seung Woo
authors.initials: SW
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D018352:Coronavirus Infections / Q000453:epidemiology / Q000401:mortality*; D003428:Cross Infection / Q000453:epidemiology / Q000401:mortality*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D065207:Middle East Respiratory Syndrome Coronavirus; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors
keywords: Hospital; Korea; Middle East respiratory syndrome coronavirus; Mortality; Outbreak