MERS-COV (35): SOUTH KOREA ex KUWAIT

Posted on 09TH SEP 2018
tagged MERS-CoV, South Korea; Kuwait

A ProMED-mail post
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International Society for Infectious Diseases
http://www.isid.org

[1]
Date: Sat 8 Sep 2018
Source: Reuters report [edited]
https://www.reuters.com/article/us-southkorea-health-mers/south-korean-m...

A South Korean man, 61, was diagnosed with the potentially deadly Middle East respiratory syndrome (MERS) and is being treated at a hospital in Seoul, the Korea Centers for Disease Control and Prevention (KCDC) said on Saturday [8 Sep 2018].

The patient returned to Seoul on Friday [7 Sep 2018] after a business trip to Kuwait from [Thu 16 Aug 2018 to Thu 6 Sep 2018], according to the KCDC.

This is the 1st time since July 2015 that an outbreak of MERS has been reported in South Korea.

"As far as found by now, 20 people, including flight attendants and medical staff, have been in close contact with the patient, and they are under isolation at home," KCDC director Jeong Eun-kyeong told a press briefing.

The patient, who was suffering from diarrhea, headed directly to Samsung Medical Center from the airport, Jeong said. He is now in an isolation ward at Seoul National University Hospital.

The KCDC director said all flights from Middle East countries have been put into quarantine. "The KCDC and local governments will do our best to prevent spread of the MERS," Jeong noted.

The infectious disease swept South Korea in 2015 leading to 38 fatalities. MERS is thought to be carried by camels, and most of the known human-to-human transmission has occurred in healthcare settings.

[Byline: Hayoung Choi]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

******
[2]
Date: Sat 8 Sep 2018
Source: Yonhap News (4th LD - update) [edited]
http://english.yonhapnews.co.kr/search1/2603000000.html?cid=AEN201809080...

A patient in Seoul was diagnosed on Saturday [8 Sep 2018] with the 1st case of Middle East Respiratory Syndrome (MERS) in South Korea since 2015. The 61-year-old man, whose personal information was withheld for privacy reasons, was diagnosed with the disease at about 4 p.m. Saturday [8 Sep 2018], the Korea Centers for Disease Control and Prevention (KCDC) said. It is the 1st case of MERS diagnosed in South Korea since 2015, when an outbreak killed 38 people and triggered widespread panic.

According to the KCDC, the man took a business trip to Kuwait from [Thu 16 Aug 2018 to Thu 6 Sep 2018] and returned home via the United Arab Emirates on Friday [7 Sep 2018]. He visited a local hospital during his stay in Kuwait for diarrhea but showed the same symptom again on his way back home. He was rushed to the emergency room of Samsung Medical Center in southern Seoul upon his arrival at Incheon International Airport.

The Samsung hospital checked the patient in an isolated section of the emergency room and reported him to the health authorities as a suspected case of MERS for showing symptoms of fever, phlegm, and pneumonia. He was then moved to Seoul National University (SNU) Hospital in central Seoul and tested positive for the disease.

"The man currently is not in critical condition and does not have such symptoms as shortness of breath and a decrease in blood pressure, but we have to watch him closely, because his conditions may deteriorate in the next 1-2 weeks judging from our experiences from the previous outbreak," Kim Nam-jung, a doctor treating the patient at the SNU Hospital, said.

MERS is a viral respiratory disease with a fatality rate of 20-46 percent. It is caused by a novel coronavirus carried by camels and can be spread when someone is in close contact with a patient for a sustained period.

A total of 20 people, including flight attendants and medical staff, are under isolation at home for coming in close contact with the patient, but the number could rise in the future, the KCDC said.

The authorities believe there is a high chance that the patient was infected with the disease in Kuwait, because he stayed in Dubai for only a short time for a transfer. The government said it will try to find out if any Koreans were infected with the disease after being in close contact with him in Kuwait.

"We don't see that the patient was exposed much to regional society since he was isolated upon his arrival at the Samsung hospital," Jeong Eun-kyeong, director of the KCDC, said during a press briefing at the Central Government Complex in Seoul. "We'll do our best to investigate and manage people who contacted him in order to prevent any secondary infections."

As part of efforts to effectively control the new outbreak, the government raised the status of the KCDC to that of a vice-ministerial level organization. Prime Minister Lee Nak-yon instructed the Ministry of Health and Welfare to do all it can do to prevent the possible spread of the viral respiratory disease.

"We should prevent the possible spread of MERS by quickly and thoroughly conducting an epidemiological investigation," Lee told the health minister after being briefed on the new outbreak. Lee will preside over an emergency meeting of relevant ministers to discuss measures to prevent the disease's spread on Sunday [9 Sep 2018] afternoon, according to his office.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[As a reminder, during the period of late May through early July 2015, there was a major outbreak of MERS-CoV in South Korea, with a total of 185 cases reported from South Korea and one additional case who travelled from South Korea to China, where he was diagnosed and treated. The index case was a business man who had travelled to the Middle East (multiple countries including Bahrain and Saudi Arabia). The index case did not give a history of travel to the Middle East when evaluated in the medical facilities he sought assistance. Unfortunately, he was a "superspreader," and a number of individuals he infected were also superspreaders. The situation of healthcare management and health facility-seeking behavior on the part of the population led to multiple hospitals involved in this outbreak and a total of 186 cases associated with this event. (I suggest a journey through the "see also" list below to see that outbreak as it unfolded.) Many lessons were learned from that outbreak that are reflected in the management of this current case as reported by the news media reports included above. A travel history of this current case was identified at the 1st encounter of this patient by the health sector, and the patient was evaluated in a secluded area of the emergency room (which was not the realities during the 2015 outbreak, as many patients roamed freely in emergency rooms when 1st seen by the health sector).

This current case gives a history of travel and work in Kuwait, with a short stopover in Dubai en route home. He also gives a history of being seen at a health facility in Kuwait with a diarrheal illness (diarrhea can be part of the presenting symptoms with a MERS-CoV infection), so it is possible he was already infected with the MERS-CoV leading to his medical visit in Kuwait. It is also possible that the diarrheal incident was not due to a MERS-CoV infection, and he may have been seen in a health facility where there was another patient with active MERS-CoV infection that had not been diagnosed. I suspect that over the next few days more information on this will become available and will be reflected in either direct Ministry of Health (MOH) press releases and/or a report from the MOH submitted to the WHO Emergencies, Preparedness and Response Disease Outbreak News.

According to the ECDC Risk Assessment of Fri 24 Aug 2018, Kuwait has reported 4 cases of MERS-CoV infection, and Dubai has not reported any cases since MERS-CoV was identified in September 2012 (see https://ecdc.europa.eu/sites/portal/files/documents/RRA-Severe-respirato...). Of additional note is that Thailand reported a case of MERS-CoV infection ex Kuwait in 2016, suggesting that there is MERS-CoV transmission in Kuwait, albeit rarely reported through the years. Hence, it is highly likely transmission occurred during this patient's travel to and within Kuwait. - Mod.MPP

HealthMap/ProMED-mail maps:
South Korea: http://healthmap.org/promed/p/195
Kuwait: http://healthmap.org/promed/p/129]

See Also
2016
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MERS-CoV (92): Saudi Arabia (RI,MK), Thailand ex Kuwait WHO conf 20160826.4444226
2015
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MERS-CoV (159): South Korea, mortality 20151204.3839901
MERS-CoV (136): Kuwait WHO, Saudi Arabia MOH, camel, Hajj 20150924.3666811
MERS-CoV (111): Saudi Arabia, South Korea, RFI 20150820.3592362
MERS-CoV (107): Saudi Arabia, South Korea, WHO 20150813.3575351
MERS-CoV (106): Saudi Arabia, South Korea 20150811.3571792
MERS-CoV (100): Saudi Arabia, South Korea 20150804.3558326
MERS-CoV (99): South Korea, Saudi Arabia, MOH 20150804.3556273
MERS-CoV (98): Saudi Arabia, South Korea, MOH, WHO 20150730.3545902
MERS-CoV (97): South Korea, Saudi Arabia 20150726.3536078
MERS-CoV (96): South Korea, Saudi Arabia 20150725.3535141
MERS-CoV (95): South Korea, Saudi Arabia, WHO 20150724.3531897
MERS-CoV (94): South Korea, Saudi Arabia 20150723.3530233
MERS-CoV (93): South Korea, Saudi Arabia, WHO 20150722.3526694
MERS-CoV (92): South Korea, Saudi Arabia, WHO 20150716.3516675
MERS-CoV (91): South Korea, Saudi Arabia 20150713.3507926
MERS-CoV (90): South Korea, Saudi Arabia, Thailand, Philippines, WHO 20150713.3505516
MERS-CoV (89): Philippines, South Korea, Saudi Arabia, WHO 20150709.3496123
MERS-CoV (88): Philippines ex Middle East, South Korea, Saudi Arabia, RFI 20150706.3488115
MERS-CoV (87): South Korea, Saudi Arabia 20150705.3486383
MERS-CoV (86): South Korea, Saudi Arabia, WHO 20150704.3484493
MERS-CoV (85): South Korea, Saudi Arabia, RFI 20150703.3480481
MERS-CoV (84): South Korea, Saudi Arabia, RFI 20150701.3477232
MERS-CoV (83): South Korea, Saudi Arabia, WHO 20150630.3475176
MERS-CoV (82): South Korea, Saudi Arabia, Thailand, RFI 20150629.3472461
MERS-CoV (81): South Korea, Saudi Arabia, RFI 20150628.3470885
MERS-CoV (80): South Korea, Saudi Arabia, WHO 20150628.3469457
MERS-CoV (79): South Korea, Saudi Arabia, UAE, WHO, RFI 20150626.3467405
MERS-CoV (78): South Korea, Saudi Arabia, WHO 20150626.484575
MERS-CoV (77): South Korea, Saudi Arabia 20150624.3462955
MERS-CoV (76): South Korea, Saudi Arabia, Thailand, WHO 20150624.3459401
MERS-CoV (75): South Korea, Saudi Arabia, Thailand 20150623.3457227
MERS-CoV (74): South Korea, Saudi Arabia, Thailand ex Oman 20150621.3454450
MERS-CoV (73): South Korea, Saudi Arabia, Thailand, WHO, RFI 20150620.3453094
MERS-CoV (72): South Korea, Saudi Arabia, Thailand, WHO, RFI 20150619.3451230
MERS-CoV (71): Thailand ex Oman, South Korea, Saudi Arabia, UAE 20150618.3447481
MERS-CoV (69): South Korea, Saudi Arabia, WHO NOT PHEIC 20150617.3445791
MERS-CoV (68): South Korea, Saudi Arabia, UAE, WHO 20150616.3442296
MERS-CoV (67): South Korea, Saudi Arabia 20150616.3439726
MERS-CoV (66): South Korea, Saudi Arabia 20150615.3437614
MERS-CoV (65): South Korea, Saudi Arabia, WHO 20150613.3435317
MERS-CoV (64): South Korea, Saudi Arabia, WHO, RFI 20150612.3433313
MERS-CoV (62): South Korea, Saudi Arabia, WHO 20150611.3430149
MERS-CoV (61): South Korea, Saudi Arabia, UAE, WHO 20150610.3426177
MERS-CoV (60): South Korea, Saudi Arabia, WHO 20150610.3423669
MERS-CoV (59): South Korea, Saudi Arabia, WHO, viral sequencing 20150609.3420029
MERS-CoV (58): South Korea, Saudi Arabia 20150607.3417452
MERS-CoV (57): South Korea, Saudi Arabia, viral sequencing, WHO 20150606.3416003
MERS-CoV (56): South Korea, China, Saudi Arabia, Oman, WHO 20150605.3413986
MERS-CoV (55): South Korea, Saudi Arabia, WHO, viral sequences 20150604.3411121
MERS-CoV (54): South Korea, Saudi Arabia, WHO 20150604.3407535
MERS-CoV (53): South Korea, Saudi Arabia, Qatar, WHO, RFI 20150601.3402059
MERS-CoV (52): Oman, Saudi Arabia, South Korea, WHO, RFI 20150531.3399248
MERS-CoV (51): South Korea, Saudi Arabia, new cases, RFI 20150530.3397494
MERS-CoV (50): South Korea, China ex South Korea conf. Saudi Arabia 20150529.3395374
MERS-CoV (49): South Korea, China ex South Korea susp, Saudi Arabia, Qatar 20150528.3393353
MERS-CoV (47): South Korea, Saudi Arabia, United Arab Emirates, Qatar, WHO 20150526.3383778
MERS-CoV (45): Saudi Arabia, South Korea, RFI 20150522.3378310
MERS-CoV (44): S Korea ex Middle East, Saudi Arabia, UAE, WHO, RFI 20150520.3374579

2014
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MERS-CoV - Eastern Mediterranean (17): Kuwait, UAE, Saudi Arabia, WHO, RFI 20140320.2345849
2013
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MERS-CoV - Eastern Mediterranean (88): Kuwait, WHO, Spain 20131119.2062587
MERS-CoV - Eastern Mediterranean (86): Kuwait, 1st rep, susp, RFI 20131113.2052320
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