Selected article for: "disease progression and viral load"
Author: Park, Sun Hee; Kim, Yeon-Sook; Jung, Younghee; Choi, Soo young; Cho, Nam-Hyuk; Jeong, Hye Won; Heo, Jung Yeon; Yoon, Ji Hyun; Lee, Jacob; Cheon, Shinhye; Sohn, Kyung Mok
Title: Outbreaks of Middle East Respiratory Syndrome in Two Hospitals Initiated by a Single Patient in Daejeon, South Korea
  • Document date: 2016_6_30
    • ID: soiimy63_34
    Snippet: Multiple factors may influence this pattern of transmission. Firstly, an increase in the viral loads as disease progresses could be an important factor. Despite limited evidence about the viral shedding kinetics of MERS-CoV over the disease course, it is expected that viral load increases with disease progression up to a point [21] . Therefore, it seems plausible that close contacts in Hospital B were exposed to a higher infective dose than those.....
    Document: Multiple factors may influence this pattern of transmission. Firstly, an increase in the viral loads as disease progresses could be an important factor. Despite limited evidence about the viral shedding kinetics of MERS-CoV over the disease course, it is expected that viral load increases with disease progression up to a point [21] . Therefore, it seems plausible that close contacts in Hospital B were exposed to a higher infective dose than those in Hospital A. In addition, worsening respiratory symptoms and the consequent need for respiratory procedures during the later stage of disease could facilitate viral transmission [22, 23] . Since the index case received nebulizer therapy in a six-bed room, aerosols generated by the nebulizer might amplify viral transmission to those who shared the room in Hospital B. The shorter incubation period and rapid disease progression among secondary cases in Hospital B are consistent with these explanations. In contrast, individuals in Hospital A might have been exposed to different levels of viral loads depending on when and for how long they were exposed during the disease progression in the first week of illness of the index case. These differences in exposure can partly explain the wide range of incubation periods and diverse clinical features among secondary cases in Hospital A. Secondly, underlying comorbidities in secondary cases can affect the explosive nature of transmission and the clinical consequences. Given that the index patient was hospitalized in the pulmonary ward in Hospital B, a large proportion of affected patients had underlying pulmonary diseases. This comorbidity combined with a high infective dose could exacerbate the disease progression, resulting in the high mortality among secondary cases in Hospital B.

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