International Journal of Infectious Diseases (May 2017)

High fatality rates and associated factors in two hospital outbreaks of MERS in Daejeon, the Republic of Korea

  • Hae-Sung Nam,
  • Jung Wan Park,
  • Moran Ki,
  • Mi-Yeon Yeon,
  • Jin Kim,
  • Seung Woo Kim

DOI
https://doi.org/10.1016/j.ijid.2017.02.008
Journal volume & issue
Vol. 58, no. C
pp. 37 – 42

Abstract

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Objectives: 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.

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