【病毒外文文献】2016 An Analysis of Actual Conditions with the Infectious Disease of Middle East Respiratory Syndrome Coronavirus (MERS-

Abstract Back ground Objectives The purpose of this study was to identify problems with infectious diseases on the basis of the spread of Middle East Respiratory Syndrome Corona virus MERS CoV Methods Statistical Analysis For this purpose the data from the Korea Centers for Disease Control and Prevention CDC and the Ministry of Health and Welfare MOHW were coded on the basis of daily briefing A total of 186 persons were diagnosed with MERS The duration of MERS outbreak in South Korea was from May 20 2015 to July 28 2015 when the cessation of the disease was first announced Analysis was performed using SPSS for Windows 12 0 Version Findings Of the 186 persons diagnosed with MERS 36 died 12 were under treatment and 138 leave hospital There were 5 super spreaders the index case 1 14 15 16 and 76 The five super spreaders made more than a half of all the MERS patients infected with the disease An infectious disease can mean a medical disaster To prevent such a disaster it is necessary to make thorough personal hygiene management and institutional program reinforcement Application Improvements It is also necessary to develop systematic manage ment systems that involve planning implementation restoration and prevention with the aim of coping with outbreak of a disaster with an infectious disease An Analysis of Actual Conditions with the Infectious Disease of Middle East Respiratory Syndrome Coronavirus MERS CoV Spreading in South Korea Gyu Yil Choi 1 and Sang Sub Park 2 1 Department Dental Hygiene ChungCheong University Korea edugy 2 Department Emergency Medical Technology ChungCheong University Korea wooonseo Keywords Disaster Index Case Infection MERS CoV Spreading 1 Introduction The World Health Organization WHO 1 reported that MERS is a viral respiratory disease caused by corona virus which broke out in Saudi Arabia in 2 reported that an unknown type of corona virus was isolated from phlegm for pneumonia and renal failure They indicated that the corona virus was associated with bats In 3 reported that it was associated with the contact with camels In 4 found that MERS has such symptoms as fever cough and dif ficulty in breathing and can even cause pneumonia According to WHO 1 26 countries including Saudi Arabia reported MERS outbreak South Korea is also one of the 26 countries According to CDC 5 the index case is a man in his sixties He showed such symptoms as fever and cough after he returned from Bahrain on May 4 2015 He was diagnosed with MERS on May 20 2015 When the index case of MERS appeared in South Korea the central government and people had low aware ness of the hazard of the disease In the initial briefing the healthcare authorities failed to provide clear informa tion about its spread infection channels infection sites mortality and prevention and refused to disclose the list of relevant hospitals As a result some people in the same room or ward as the index case including inpatients visitors doctors and nurses were infected with MERS The rapid spread of Middle East Respiratory Syndrome MERS has brought changes to the daily life since May 20 2015 The changes included closure of educational institutions reduction in hospital visit indi Author for correspondence Indian Journal of Science and Technology Vol 9 25 DOI 10 17485 ijst 2016 v9i25 97228 July 2016 ISSN Print 0974 6846 ISSN Online 0974 5645An Analysis of Actual Conditions with the Infectious Disease of Middle East Respiratory Syndrome Coronavirus MERS CoV Spreading in South Korea Indian Journal of Science and Technology 2 Vol 9 25 July 2016 www indjst org viduals wearing a mask etiquette related to coughing hospital visiting culture reduction of places crowded with people and changes in the tourism industry There were also changes in the awareness of disasters Disasters are divided into the surgery related ones including building collapse fire explosion and traffic accidents and the ones related to internal medicine which involve infectious diseases The infectious disease of MERS caused a disaster related to internal medicine and has changed awareness of disasters caused by infection in internal medicine This study aimed to identify problems with infectious diseases on the basis of the spread of MERS in South Korea give information about infection sites infection channels and the characteristics of super spreaders help make prevention planning and management related to very dangerous viruses and maintain a healthy life and improve the quality of life in the presence of other dan gerous infectious diseases and provide basic data that could help develop infectious disease programs 2 Research Methods 2 1 Research Tools This study was conducted on the duration of MERS out break from May 20 to July 28 2015 The data came from CDC 6 and MOHW 7 that reported on daily status The data released by the Korean Broadcasting System KBS 8 supervising disaster broadcasting at the national level in South Korea were used The daily status was based on briefing made by governmental bodies every morn ing The briefing included MERS status of last day The contents of MERS related briefing were also posted on the homepages of CDC and MOHW The daily status included such items as gender age the date of diagnosis latent period infection sites spreaders patient division underlying disease and patients condition The underlying diseases for the dead were anatomically and physiologically classified They were systematically classified into respiratory cardiovascular endocrine neu ral and urologic diseases malignant tumor and others Underlying diseases were identified in the cases of death according to anatomical physiological and systematic classification The South Korean government made a report on the initial outbreak of MERS on May 20 2015 The data con cerning the daily status of MERS as released by CDC 6 and MOHW 7 and those concerning the status of MERS as released by KBS 8 after the report were collected The data were divided in terms of the general characteristics status of MERS and super spreaders The period until the first declaration of the end to MERS outbreak on July 28 2015 was coded 186 persons were diagnosed with MERS from May 20 to July 28 2015 Of the 186 persons diagnosed with MERS 36 died 12 were under treatment and 138 leave hospital during this period MERS related briefing was coded and analyzed on the basis of those diagnosed with the disease on a daily basis If information about the patients who were dead who were under treatment and who leave hospital was missing or failed to have details the data from the broad casting system in charge of national disasters the Korean Broadcasting System KBS 8 were referred Analysis was performed using SPSS for Windows 12 0 Version The general characteristics of MERS patients are presented in Table 1 Of the 186 patients males 59 7 were more likely to get infected with MERS than females 40 3 Males in their fifties 14 0 and females in their sixties 8 6 were more likely to get infected with MERS Older age groups were more likely to get infected with MERS 2 2 Analysis The contents of MERS related briefing were coded on the basis of daily status before analysis Coding was based on the socio demographic characteristics and the character istics of MERS Analysis was performed using SPSS for Windows 12 0 Version Table 1 Characteristics of general Gender N 186 Male N 111 Female N 75 Age 10 s 1 0 5 20 s 4 2 2 9 4 8 30 s 18 9 7 8 4 3 40 s 19 10 2 11 5 9 50 s 26 14 0 14 7 5 60 s 21 11 3 16 8 6 70 s 17 9 1 13 7 0 80 s 5 2 7 4 2 2 Gyu Yil Choi and Sang Sub Park Indian Journal of Science and Technology 3 Vol 9 25 July 2016 www indjst org 3 Results 3 1 MERS Infection Status by Gender The MERS status by gender is presented in Table 2 As for the infection stage both males 40 3 and females 26 3 were more likely to be third infection cases As for patients conditions there were more leaves from hos pital than deaths However the mortality rate was 19 4 36 out of 186 MERS patients 12 9 for males and 6 5 for females Of the MERS patients both males 51 6 and females 27 4 were more likely to be ordinary persons Taking into account the fact that doctors and nurses examining and caring for patients were more vulnerable to MERS infection it is necessary to prevent hospital workers from the infection The latent period of MERS was 11 36 days on aver age The period between MERS diagnosis and death for the MERS patients was 9 30 days on average The period between MERS diagnosis and leave from hospital for the MERS patients was 15 67 days on average Some cases were unidentified in terms of the infec tion stage thus the healthcare authorities were poor at MERS path analysis and management 3 2 MERS Infection Status by Patients Conditions The MERS infection status by patients conditions is pre sented in Table 3 Of the 186 MERS patients 36 died 138 were leave from hospital and 12 were under treatment Ordinary persons were very likely to die 35 97 2 out of 36 cases of death The patients with the third infec tion were very likely to die 29 80 6 3 3 Association with Estimated duration of Contact with Super spreader The association with the estimated duration of contact with a super spreader is presented in Table 4 Believing that the MERS spread depended on the estimated dura tion of contact for the MERS patients the duration of contact with the five super spreaders 1 14 15 16 and 76 was estimated Of the patients super spreaders caused infection as follows 1 infected 29 persons 14 infected 85 p ersons Table 2 MERS infection status by gender Gender N 186 Male N 111 Female N 75 Infection stage Initial infection 1 0 5 Secondary infection 17 9 1 13 7 0 Third infection 75 40 3 49 26 3 Fourth infection 14 7 5 9 4 8 Unidentified 4 2 2 4 2 2 Patient s condition Death 24 12 9 12 6 5 Leave hospital 77 41 4 61 32 8 Treatment 10 5 4 2 1 1 Patient division Ordinary person 96 51 6 51 27 4 Doctor Nurse 7 3 8 16 8 6 Caregiver 8 4 3 Medical assistant 8 4 3 Latent period 11 36days Date of death after official diagnosis 9 30days Date of Leave hospital after official diagnosis 15 67days Table 3 MERS infection status by patients conditions Patient s condition N 186 Death N 36 Leave hospital N 138 Treatment N 12 Patient division Ordinary person 35 97 2 104 75 4 8 66 7 Doctor Nurse 21 15 2 2 16 7 Caregiver 7 5 1 1 8 3 Medical assistant 1 2 8 6 4 3 1 8 3 Infection stage Initial infection 1 8 3 Secondary infection 5 13 9 25 18 1 Third infection 29 80 6 87 63 0 8 66 7 Fourth infection 2 5 6 19 13 8 2 16 7 Unidentified 7 5 1 1 8 3 An Analysis of Actual Conditions with the Infectious Disease of Middle East Respiratory Syndrome Coronavirus MERS CoV Spreading in South Korea Indian Journal of Science and Technology 4 Vol 9 25 July 2016 www indjst org 15 infected 6 persons 16 infected 23 persons and 76 infected 11 persons The number of the infection cases depended on the duration of contact with a super spreader 1 infected 20 out of 29 persons during the estimated contact period between May 15 and 17 2015 14 infected 47 out of 85 persons during the estimated contact period of May 27 2015 15 infected 3 out of 6 persons during the estimated contact period between May 27 and 29 2015 16 infected 10 out of 23 persons during the estimated contact period between May 28 and 30 2015 76 infected 5 out of 11 persons during the estimated contact period of June 6 2015 3 4 Association with Estimated duration of Contact with MERS stricken Hospital The association with the estimated duration of contact with a MERS stricken hospital is presented in Table 5 It is believed that the MERS spread depended on the esti mated duration of contact for the MERS patients Five hospitals A B C D and E were found to be vulner able to MERS outbreak The MERS outbreak status in the five hospitals is as follows Hospital A had 36 cases Hospital B had 90 cases Hospital C had 14 cases Hospital D had 6 cases and Hospital E had 5 cases It is believed that MERS outbreak depended on the estimated duration of contact in each hospital 20 out of 36 persons were infected in Hospital A during the estimated contact period between May 15 and 17 2015 46 out of 90 persons were infected in Hospital B during the estimated contact period of May 27 2015 5 out of 14 persons were infected in Hospital C during the estimated contact period between May 25 and 28 2015 3 out of 6 persons were infected in Hospital D during the estimated contact period between May 27 and 29 2015 3 out of 5 persons were infected in Hospital E during the estimated contact period of June 5 2015 3 5 MERS Outbreak Sites by Patient Division The MERS outbreak sites by patient division are pre sented in Table 6 Of the 186 MERS patients ordinary persons formed 79 0 doctors nurses 12 4 caregivers 4 3 and medical assistants 4 3 Of the 186 MERS patients ordinary persons were more likely to get infected with MERS in emergency rooms 73 persons 39 2 in the same ward 44 23 7 and in the same room 21 11 3 In particular doctors nurses were more likely to get infected with MERS both in the same room and in the emergency rooms Patients are more likely to visit an emergency room than any other facility in a hospital when either an acci dent or an infectious disease occurs For this reason an emergency room is very likely to spread a pathogen dur ing its latent period It is therefore necessary to make more efficient guidelines for infectious disease patients visiting emergency rooms and to reinforce relevant prevention Table 5 Association with estimated duration of contact with MERS stricken hospital Stricken hospital A B C D E Estimated duration of contact May 15 17 2015 20 persons May 27 2015 46 persons May 25 28 2015 5 persons May 27 29 2015 3 persons June 5 2015 3 persons Number of patients at Hospital A 36person Number of patients at Hospital B 90person Number of patients at Hospital C 14person Number of patients at Hospital D 6person Number of patients at Hospital E 5person Table 4 Association with estimated duration of contact with super spreader Super spreaders 1 14 15 16 76 Estimated duration of contact May 15 17 2015 20 persons May 27 2015 47 persons May 27 29 2015 3 persons May 28 30 2015 10 persons June 6 2015 5 persons Number of cases of infection from 1 29person Number of cases of infection from 14 85person Number of cases of infection from 15 6person Number of cases of infection from 16 23person Number of cases of infection from 76 11personGyu Yil Choi and Sang Sub Park Indian Journal of Science and Technology 5 Vol 9 25 July 2016 www indjst org The most frequent underlying disease was hyperten sion 9 cases followed by cancer 7 and asthma 6 4 Discussion The purpose of this study was to analyze the problems with infectious diseases on the basis of the MERS spread in South Korea For this purpose the data concerning the daily status of MERS as released by CDC 6 and MOHW 7 and those released by KBS 8 supervising disaster broad casting at the national level were used The occurrence of super spreaders and MERS stricken hospitals depended on the estimated duration of contact The infection was more likely to be at the third stage and some cases were unidentified in terms of the infection stage thus the infection related disaster path analysis and management system was inefficient The fact that the infection stage for 36 19 3 out of 186 MERS cases was not determined seems to be another problem with infection related disas ters The infection was very likely to occur in emergency rooms It is therefore necessary to develop a system for emergency medical providers preventing and managing infection related disasters According to CDC 5 a super spreader refers to the one who has infected 4 persons The super spreaders infecting 4 persons were 1 14 15 16 and 76 While CDC 5 reported that 1 infected 28 persons with MERS this study found that 1 infected 29 persons There was such a gap in the number of the infection cases It is because this study used the data concerning the daily status of MERS as released by CDC 6 and MOHW 7 and those released by KBS 8 supervising disaster broadcasting at the national level After the initial MERS outbreak in Middle East 9 12 conducted research on MERS In contrast little research on the infectious disease of MERS was conducted in South Korea which is not considered as a Middle Eastern region In this context a person who visited Middle East and returned to South Korea rapidly spread the MERS pathogen It is believed that the MERS outbreak has brought changes to awareness of infection related disas ters Kim 13 contended that the immediate cause of the MERS crisis was the failure of the government to cope with it at its initial stage The government refused to hurry to reveal the name of hospitals with MERS or close the cen tral originator The failure to cope with it at its initial stage was due to poor expertise and the absence of leadership in Table 6 MERS outbreak sites by patient division Patient division N 186 Ordinary person N 147 Doctor Nurse N 23 Caregiver N 8 Medical assistant N 8 Outbreak site Unidentified 2 1 1 Middle East 1 Same room 21 11 3 1 0 5 5 2 5 Same ward 44 23 7 10 5 4 3 1 6 1 0 5 Examination based on questioning 3 1 6 Emergency room 73 39 2 7 3 8 4 2 2 Outpatient clinic 4 2 2 Ambulance 1 0 5 2 1 1 Radiography 1 0 5 Intensive care unit 1 0 5 Intrafamilial infection 2 1 1 Table 7 Underlying disease in cases of death from MERS Underlying disease Ranking Underlying diseases of death hypertension 9 1 Cancer 7 2 Asthma 6 3 COPD 3 4 Pneumonia 2 5 Cardiac valve disease 2 5 Hepatocirrhosis 2 5 Diabetes mellitus 2 5 Others 13 Each 1case 9 Underlying disease in 24 out of 36 cases of death 46 cases of underlying diseases including overlap ones 3 6 Underlying Disease in cases of Death from MERS The underlying diseases in the cases of death from MERS are presented in Table 7 24 out of 36 cases of death had an underlying disease The 24 cases involved 21 underlying diseases A total of 46 cases involved underlying diseases including overlap ones An Analysis of Actual Conditions with the Infectious Disease of Middle East Respiratory Syndrome Coronavirus MERS CoV Spreading in South Korea Indian Journal of Science and Technology 6 Vol 9 25 July 2016 www indjst org the control tower It is also caused by the environment in the emergency rooms as well as by family caring culture 14 reported that the super spreader 14 infected as many as 83 persons The period of contact with 14 was estimated to be between May 27 and 29 This study found that 14 infected 84 persons The exposure was very likely to occur on May 27 during the estimated contact period 15 mentioned the law concerning infectious disease prevention and management and indicated problems with quarantine and isolation measures 16 indicated that the MERS crisis was related to the geographical back ground spatial spread infectious disease outbreak and spread and the problems with hospitals 17 noted that the MERS outbreak brought changes to the pattern of using public transportation The MERS outbreak in South Korea has changed the awareness of infection related disasters and revealed the problems in coping with the infection related disaster It is necessary to improve planning management and pre vention of infection related disasters as well as hospital culture activate the emergency medical service system and make institutional reinforcement including informa tion disclosure Despite its significance this study has some limi tations first it only used the data concerning the daily status released by CDC 6 and MOHW 7 and those released by KBS 8 supervising disaster broadcasting at the national level second healthcare authorities failed to disclose information completely third it set the period until July 28 not the date of the end to MERS outbreak Care should be taken to generalize the results of this study on MERS 5 Conclusions This study aimed to identify problems with infectious diseases on the basis of the spread of MERS Five su