Friday June 5, 2015
This is to alert health professionals of a new potential risk factor for Middle East respiratory syndrome coronavirus (MERS-CoV): travel to Korea. And to remind them to be vigilant about respiratory illness in returned travellers, especially from the Arabian Peninsula.
In December 2014, the Ministry of Health issued updated information on recognising and managing suspected cases of MERS-CoV. This advice is attached below, as well as on the web site and remains unchanged. However, travel exposures outside the Arabian peninsula within 14 days of symptom onset should also be considered. The main points of this advice are that any suspect cases need to be in negative pressure isolation and tested for MERS-CoV. MERS-CoV is a notifiable and quarantinable disease under the Health Act 1956. As such, any suspected case should immediately be notified to the local Medical Officer of Health.
MERS-CoV outbreak in Korea
As of 3 June 2015, 1179 laboratory-confirmed cases of human infection with Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported to WHO since 2012, including at least 442 deaths. WHO’s risk assessment is at: http://www.who.int/csr/disease/coronavirus_infections/risk-assessment-3june2015/en/
MERS-CoV has been reported from 25 countries; with most (>85%) from Saudi Arabia. Korea reported its first case on 20 May 2015 in a traveller who had been to several countries in the Arabian Peninsula.
The traveller had no known exposures and developed symptoms (initially fever and cough) on 11 May, 7 days after his arrival in Korea. He sought medical treatment at a clinic from 12 May to 15 May; was admitted from 15 to 17 May in a hospital and discharged. On the evening of discharge (17 May), the patient visited the emergency department of another hospital, where a sputum sample was collected on 19 May. MERS-CoV was confirmed positive at the Korea National Institute of Health Laboratory on 20 May and the patient was transferred to the nationally designated treatment facility for isolation.
As of 3 June, 29 confirmed cases have resulted from this index case, including one case who was identified in China. The transmissions have all been at health care facilities, most from exposure to the index case during his first hospitalisation. At 3 June, 1369 contacts were being followed up in quarantine by the Korean health authorities. The case who travelled to Guangdong, China via Hong Kong while symptomatic was rapidly identified and isolated; his contacts in Hong Kong and Guangdong have been traced and placed in quarantine.
This is the largest outbreak of MERS-CoV outside the Arabian Peninsula. The spread in Korea resulted from the failure to isolate the index case when he first presented. Early suspicion of this case would have prevented this outbreak; and provides a timely reminder for health professionals to be aware of the risks of new infections from returned travellers.
Acting Director of Public Health