Journal List > J Bacteriol Virol > v.45(4) > 1034192

Je, Bae, Kim, Seok, and Hwang: The Preparedness for Re-emerged and Emerging Infectious Diseases: A Lesson Through Outbreak of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in South Korea

Abstract

The Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe acute respiratory disease and systemic dysfunction that may eventually lead to the death of the patients. After MERS-CoV was first diagnosed in the South Korea, in May 2015, it affected 186 individuals and claimed 37 lives in short span of time (case fatality rate = 19.9%). Compared to MERS-CoV in the Middle East, MERS-CoV in South Korea appeared to be more transmissible, and induced multiple human-to-human transmission. These knowledge gaps caused the failure of early prevention, and disseminated MERS-CoV brought out a great loss of lives and economy. The MERS-CoV outbreak revealed the potential weakness of public health system in South Korea, and promoted the reestablishment of preventive strategies for imported infectious diseases. In these regards, we analyzed the potential for additional import of re-emerged and emerging infectious diseases, such as dengue fever, malaria, chikungunya fever and hepatitis A, from Africa or South-East Asia. Then we suggest the investment expansion and the administration of global networks for effective research and control for newly or re-emerged infectious diseases. In conclusion, it is required to expect and prepare for the surveillance of the importation of foreign pathogens, and constitute the internal collaborative systems for rapid detection and risk communication. In addition, we should take an active part in the global networks to perform rapid preparedness and control for re-emerged or emerging infectious diseases.

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Figure 1.
Epicurve of confirmed MERS cases and deaths in Republic of Korea, China, Saudi Arabia and other countries. Data from WHO
jbv-45-339f1.tif
Figure 2.
Search interest for "MERS" over time in Google search. Numbers represent search interest relative to the highest point on the chart. Boxes represent news headlines closely related to search terms at the time.
jbv-45-339f2.tif
Figure 3.
Search term frequency of re-emerged and emerging infectious diseases in Pubmed, 1960–2014.
jbv-45-339f3.tif
Figure 4.
National Electronic Disease Surveillance System (NEDSS) of CDC
jbv-45-339f4.tif
Figure 5.
The schematic proposed presentation of the internal collaborative network system for surveillance and control for infectious disease.
jbv-45-339f5.tif
Table 1.
Vaccines for MERS-CoV under development
Vaccine type Viral antigen Experimental models Reference
Adenoviral vector Full-length S BALB/c Mice [21]
MVA vector Full-length S BALB/c Mice [22]
Recombinant protein S-RBD (358-588) Rabbits [23]
S-RBD (377-662) BALB/c Mice [24]
Consensus DNA Full-length S Mice, camels, NHPs [25]
Nanoparticles Full-length S BALB/c Mice [26]

MVA, Modified vaccinia virus Ankara; RBD, Receptor-binding domain; NHPs, Non-human primates

Table 2.
The characteristics of MERS-CoV in South Korea
  MERS-CoV in Middle East MERS-CoV in South Korea
Mortality About 40% About 20%
Transmission Low High, Superspeading
Third-order infection A few Many, Severe
Major infection source Camel-to-human Human-to-human in hospital
Table 3.
Imported cases of re-emerged and emerging infectious diseases in South Korea, 2014
  2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Dengue fever 6 9 14 16 34 35 97 51 59 125 72 149 251 164
Malaria 67 36 64 38 45 30 35 29 26 51 64 53 60 80
Shigellosis 10 10 6 23 44 20 41 62 35 104 107 42 65 38
Typhoid fever 13 11 10 12 19 25 19 10 12 20 31 22 14 22
Hepatitis A 0 0 0 0 0 0 0 0 0 0 22 18 18 21
Measles 0 1 2 0 1 5 2 1 1 1 3 2 3 21
Influenza A 0 0 0 0 0 0 0 0 1494 17 0 0 0 0
Chikungunya fever 0 0 0 0 0 0 0 0 0 0 0 0 2 1

Data from 2014 Infectious disease annual report published by the Korea Centers for Disease Control and Prevention [39].

Table 4.
Imported cases of Dengue fever, Hepatitis A, and Measles in South Korea, 2014
Dengue fever
  Philippines Indonesia Thailand Malaysia Cambodia Vietnam India Others
No. of confirm med cases 56 29 15 13 10 9 8 24
Hepatitis A
  Philippines India China Myanmar Singapore Cambodia Unknown Others
No. of confirm med cases 4 4 3 2 1 1 3 3
Measles
  Philippines China Vietnam Singapore        
No. of confirm med cases 11 5 4 1        

Bold characters represent the 10 most visited countries in 2014.

Data from 2014 Infectious disease annual report published by the Korea Centers for Disease Control and Prevention [39].

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