The Republic of Korea's minister of health and welfare, Moon Hyungpyo, and Dr. Keiji Fukuda, World Health Organization (WHO) assistant director-general of health security and emergencies. Photo courtesy of WHO
A joint mission by the World Health Organization and the Republic of Korea’s Ministry of Health and Welfare to review the outbreak of Middle East Respiratory Syndrome coronavirus (MERS CoV) in the Republic of Korea has recommended that continuing strengthening of contact tracing, monitoring and quarantine as well as expanded laboratory testing will prevent further spread of the virus.
The mission concluded that while the outbreak that began last month has been large and complex, it is showing a similar epidemiological pattern to previous hospital-associated MERS CoV outbreaks in the Middle East, which have been fully controlled by strong basic public health measures such as infection prevention and control.
“We know that there has been much anxiety about whether the virus in the Republic of Korea has increased its ability to transmit itself between humans,” says Dr. Keiji Fukuda, WHO assistant director-general for health security who has co-led the mission with Dr. Jong-Koo Lee, director of the Center for Global Medicine at Seoul National University. “However, based on available sequencing studies of this virus, it does not appear to have changed to make itself more transmissible.”
The mission confirmed that the virus is currently clustered around healthcare facilities and found no evidence that it was circulating in the community. “However, continued monitoring for this is critical,” says Fukuda.
Fukuda also warned that while the Korean authorities were already putting in place many of the recommendations the mission has made and that the number of new infections may be decreasing, the size and complexity of the outbreak means it will be a number of weeks before the true impact of the stronger disease control measures will be seen. “I want to strongly emphasize that we still need to wait and see before drawing firm conclusions,” he stresses.
The mission, comprised of experts in epidemiology, risk communications, virology, clinical management, infection prevention and control, as well as public health specialists, identified several reasons why the virus, which arrived in the country with a single infected traveler, was able to go on to infect large numbers of people in a relatively short time. These included:
- The fact that the MERS CoV was unexpected and unfamiliar to most physicians in the Republic of Korea;
- Sub-optimal prevention and control measures in some hospitals, related in part to overcrowding in emergency rooms and patients in rooms with many beds;
- The possible impact of habits and customs such as so-called “doctor-shopping,” where patients seek care at a number of medical facilities, as well as visits to hospitalized patients by many friends and family members.
The mission was unable to conclude whether environmental contamination, inadequate ventilation or other factors played a role in the transmission of the virus in the outbreak, but made a number of recommendations to improve healthcare facilities in the country to reduce the possibility of the virus being spread by these means in the future.
The most important steps recommended by the mission to stop further cases of MERS CoV in the Republic of Korea included:
- Early and complete identification of all contacts;
- Quarantine or isolation and monitoring of all contacts and suspected cases;
- Full implementation of infection, prevention and control measures;
- Prevention of travel, especially internationally, of infected persons and contacts.
There have been 138 confirmed cases of MERS CoV (including one confirmed case in China) reported in the current outbreak so far, with 14 deaths. The virus was first identified in Saudi Arabia in 2012 and much is still unknown about the exact routes of transmission. WHO has welcomed the Republic of Korea’s willingness to share its experience of the outbreak openly and to implement recommendations made by the mission.