MERS-CoV outbreak following a single patient exposure in an emergency room in South Korea: an epidemiological outbreak study.
MERS-CoV outbreak following a single patient exposure in an emergency room in South Korea: an epidemiological outbreak study.
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DOI：
10.1016/s0140-6736(16)30623-7
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发表时间：
2016-09-03
期刊：
影响因子：
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通讯作者：
Kim YJ
中科院分区：
文献类型：
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作者：
Cho SY;Kang JM;Ha YE;Park GE;Lee JY;Ko JH;Lee JY;Kim JM;Kang CI;Jo IJ;Ryu JG;Choi JR;Kim S;Huh HJ;Ki CS;Kang ES;Peck KR;Dhong HJ;Song JH;Chung DR;Kim YJ
2015年，韩国首尔三星医疗中心的一家三级护理医院急诊室发生了一名患者暴露后，中东呼吸综合征冠状病毒（MERS-CoV）感染大爆发。目的了解我院MERS冠状病毒暴发的流行病学情况。我们确定了2015年5月27日至5月29日期间在急诊室接受索引病例的所有患者和医护人员。根据患者在急诊室的暴露情况对患者进行分类：与索引病例相同的区域（A组）、不同区域（登记区或放射室重叠除外）（B组）和不同区域（C组）。我们记录了MERS-CoV感染的病例，通过痰液样本的实时PCR检测证实。我们分析了病毒的发病率、潜伏期和传播的风险因素。675名患者和218名医护人员被确定为接触者。在82人中确认了MERS-CoV感染（33名患者，8名卫生保健工作者和41名访客）。A组的发病率最高（20% [23/117] vs B组5% [3/58] vs C组1% [4/500]; p<0.0001），医护人员的发病率为2%（5/218）。在排除9例病例后（由于无法确定6例病例的症状发作日期和缺乏3名来访者的数据），中位潜伏期为7天（范围2-17，IQR 5-10）。A组的中位潜伏期显著短于C组（5天[IQR 4-8] vs 11天[6-12]; p<0·0001）。在5月29日到急诊室就诊的患者和访客中，没有确诊病例，他们只接触过可能受污染的环境，没有直接接触过指示病例。MERS-CoV传播的主要风险因素是暴露地点。我们的研究结果显示，在拥挤的急诊室中，MERS-CoV从单个患者身上传播的可能性增加，并提供了令人信服的证据，表明世界各地的卫生保健机构需要为新出现的传染病做好准备。没有。
In 2015, a large outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection occurred following a single patient exposure in an emergency room at the Samsung Medical Center, a tertiary-care hospital in Seoul, South Korea. We aimed to investigate the epidemiology of MERS-CoV outbreak in our hospital. We identified all patients and health-care workers who had been in the emergency room with the index case between May 27 and May 29, 2015. Patients were categorised on the basis of their exposure in the emergency room: in the same zone as the index case (group A), in different zones except for overlap at the registration area or the radiology suite (group B), and in different zones (group C). We documented cases of MERS-CoV infection, confirmed by real-time PCR testing of sputum samples. We analysed attack rates, incubation periods of the virus, and risk factors for transmission. 675 patients and 218 health-care workers were identified as contacts. MERS-CoV infection was confirmed in 82 individuals (33 patients, eight health-care workers, and 41 visitors). The attack rate was highest in group A (20% [23/117] vs 5% [3/58] in group B vs 1% [4/500] in group C; p<0·0001), and was 2% (5/218) in health-care workers. After excluding nine cases (because of inability to determine the date of symptom onset in six cases and lack of data from three visitors), the median incubation period was 7 days (range 2–17, IQR 5–10). The median incubation period was significantly shorter in group A than in group C (5 days [IQR 4–8] vs 11 days [6–12]; p<0·0001). There were no confirmed cases in patients and visitors who visited the emergency room on May 29 and who were exposed only to potentially contaminated environment without direct contact with the index case. The main risk factor for transmission of MERS-CoV was the location of exposure. Our results showed increased transmission potential of MERS-CoV from a single patient in an overcrowded emergency room and provide compelling evidence that health-care facilities worldwide need to be prepared for emerging infectious diseases. None.