MERS Storms the Korean Peninsula

As the outbreak of MERS cases in South Korea continues it appears that what is responsible for the 30--2 of which have been fatal and one of which was imported to China--is a combination of lax infection control coupled with a possible super-spreader event. This camel and bat-linked coronavirus, which has killed about 36% of the 1200 people it has infected thus far, has now been reported in 16 nations (including the US for those of you who have forgotten). 

To recap the events: mid-May a man who traveled to the MERS epicenter, the Middle East, returned to South Korea and was subsequently diagnosed with MERS. Being the 1st MERS case in South Korea and with a consequent delay in diagnosis patient's who were co-located were exposed and infected (primary transmission) then went on to infect others (secondary tranmission) who then went on to infect others (tertiary transmission, which has been confirmed in 2 cases).

This cluster, which is exclusively hospital-based thus far, has vaulted South Korea to the #3 MERS country, behind Saudi Arabia and the UAE.  Such a cluster reinforces the need for meticulous infectious control when dealing with a respiratory virus like MERS that has proven adept at exploiting lapses in infection control. South Korean authorities have since apologized for their handling of the initial stages of this outbreak which have led to over 1300 people being monitored after contact with case patients. 

Also, the index patient is responsible for infected at least 11 (maybe 22) other individuals (Ro = 11 - 22) clearly putting this man in the category of a super-spreader as his disproportionate contagiousness has clearly fueled this outbreak (similar to what occurred with the related SARS in 2003).

These events have, understandably, provoked fear in the South Korean populace and have prompted school closures as well as a travel alert in Taiwan

It is important to remember, at this stage, that no community transmission has occurred in South Korea and, though it is a possibility, swift action on the part of public health authorities can extinguish the outbreak. What also must be emphasized to clinicians world-wide is that MERS (and other infectious diseases) can appear anywhere and, to paraphrase Louis Pasteur, prepared minds are the ones that are lucky enough to discover them before too much damage is done. 

Little Pink Houses and MERS in Indiana

The just revealed news of an imported MERS (Middle East Respiratory Syndrome) case in Indiana--the first in the US--is not surprising. 

MERS has been simmering for 2 years and importations have occurred to several countries, including the UK. 

In this case, an infected healthcare worker (not surprisingly) traveled from Riyadh to London and on to Chicago. The patient then boarded a bus to Indiana.  

Although MERS has a case fatality rate of 30%, this patient appears to be not critically ill. Important actions in the coming days will include searching for secondary cases.

This case illustrates 2 important things:

1. It's a small world and infections on one side of the globe can appear on the other with no border restriction string enough to stop it. 

2. Astute clinicians are crucial. From what I've read, the patient's travel history tipped off physicians who ordered the appropriate tests. 

MERS occurring in the US was something that was expected and planned for--remember 8 SARS cases occurred in the US as well.




The Flush Heard, but not Smelled, Around the World

This Christmas I learned about a seemingly popular gift, at least in my network: Poo-pourri. Poo-pourri is sort of the equivalent of pre-exposure prophylaxis against...the stench of feces. 

One sprays the liquid into the toilet bowl prior to use and the oils contained in the substance neutralize/mask the odor. 

Since my writing is ostensibly educational, a few facts:

  • The sulfur-containing products of intestinal bacterial are what produce the characteristic odor
  • The repertoire of different bacteria present in one's stool is severely altered, for the long term, by antibiotic use for -- a phenomenon that explains how C.diff infection occurs and the rationale for fecal transplantation for severe or recurrent cases
  • A toilet can serve as a rocket launcher for fecal bacteria creating a toilet plume, though this is not thought to be an infection risk (with one caveat below)
  • The Flush Heard Round the World: during the SARS pandemic in 2003, a SARS-infected visitor to a large residential housing complex in Hong Kong experienced diarrhea and his flush created an aerosal the sparked hundreds of cases (see my take on a recent paper on this topic)

Proctologists have nothing on infectious diseases physicians.