South Korea's Cautionary Tale: Lack of Infection Control Vigilance Allows MERS to Gain Foothold

June 10th, 2015

As the case count breaks 100 and the death toll nears double digits, it has become increasingly clear that South Korea’s plodding infection control response to the index case and the first wave of secondary transmission has allowed Middle Eastern Respiratory Syndrome (MERS) coronavirus to gain a foothold in the country.

Case descriptions posted by the World Health Organization (WHO) – which has sent in a team of MERS experts to help Korea’s beleaguered health care system – describe continuing transmission within hospitals. Many of these incidents suggest a low index of suspicion for MERS and a failure to promptly and appropriately isolate suspect cases. Though the index case tested positive for MERS on May 20 – after a week of illness in and out of three different hospitals – some of the subsequent cases described by the WHO suggest a lack of awareness and vigilance, with transmission occurring between patients and to health care workers and visitors:

• A 72-year-old female developed symptoms on 2 June while admitted to a hospital due to an unrelated medical condition since 12 May. The patient was in the same ward as the first case. She tested positive for MERS on 5 June. Further investigation is ongoing.

• A 54-year-old female was admitted to a hospital due to an unrelated medical condition from 23 to 28 May. She was in the same ward as a patient that was later confirmed to be a MERS case. On 31 May, while isolated at home, she visited the emergency room of another hospital with symptoms. The patient tested positive for MERS on 6 June.

• A 51-year-old male was admitted to a hospital between 26 and 28 May. The patient was in the same ward as another patient that was later confirmed to be a MERS case. He was discharged on 28 May and developed symptoms on 29 May. The patient tested positive for MERS on 6 June.

• A 63-year-old female developed symptoms on 3 June while she was isolated at home. She was a caregiver of a patient who shared the room with a laboratory-confirmed MERS case on 28 May. She tested positive for MERS on 4 June and was transferred to the nationally designated hospital on 5 June.

• A 36-year-old male developed symptoms on 30 May. On 27 May, the patient visited his father at a hospital and stayed in the same zone with a laboratory-confirmed MERS case. Between 1 and 3 June, he was admitted to a different hospital and tested positive for MERS on 6 June.

• A 57-year-old male sought medical care at a hospital to treat an unrelated medical condition on 27 May. During this time, the patient was in the same zone with a laboratory-confirmed MERS case. He was admitted to hospital with symptoms and discharged on the next day. He was isolated on 5 June and tested positive for MERS on 6 June.

• A 55-year-old male developed symptoms on 2 June. On 27 May, the patient visited his mother who was admitted to a hospital that reported several laboratory-confirmed MERS cases. He was isolated on 5 June and tested positive for MERS on the same day.

• A 44-year-old male developed symptoms on 5 June. The patient visited a hospital for an unrelated medical condition on 27 May. During this time, he was in the same zone as a confirmed MERS case. The patient tested positive for MERS on 6 June.

• A 75-year-old male developed symptoms on 4 June. Between 27 and 29 May, the patient visited the emergency room of a hospital that reported several MERS cases. During this time, he stayed in the same zone as a laboratory-confirmed MERS case. He tested positive for MERS on 5 June and died the same day.

For more on this unfolding story see the July 2015 issue of Hospital Infection Control & Prevention