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August 25, 2015

Middle East Respiratory Syndrome: A Global Health Challenge

Author Affiliations
  • 1O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC
  • 2Georgetown University School of Medicine, Washington, DC
JAMA. 2015;314(8):771-772. doi:10.1001/jama.2015.7646

In May 2013, World Health Organization (WHO) Director-General Margaret Chan warned that a novel coronavirus, Middle East respiratory syndrome coronavirus (MERS-CoV), posed “a threat to the entire world.”1 Her warning was prescient. As of June 12, 2015, WHO had been notified of 1289 individuals with laboratory-confirmed infections in 25 countries, of whom at least 455 individuals (37%) had died.2 More than 85% of cases have been diagnosed in the Kingdom of Saudi Arabia.

Unlike the distantly related, more contagious, but less fatal severe acute respiratory syndrome coronavirus (SARS-CoV), MERS-CoV had not been publicly linked to a “super-spreading” event (1 patient linked to ≥10 infections) until May 2015 in the Republic of Korea. When the index case, a man aged 68 years from the Republic of Korea, returned to Incheon International Airport (located 30 miles west of Seoul) on May 4, he was asymptomatic. He reportedly had traveled to Bahrain, United Arab Emirates, the Kingdom of Saudi Arabia, and Qatar, but initially declared travel only to outbreak-free Bahrain. He became symptomatic on May 11 and sought care in 2 outpatient clinics and 2 hospitals. He was eventually admitted to Pyeongtaek St Mary’s hospital, Gyeonggi province, but MERS-CoV was unconfirmed until May 20, reportedly initiating chains of transmission that increased to involve 126 cases with 11 deaths as of June 10. The index patient was still hospitalized as of June 12.