Viral Shedding and Environmental Cleaning in Middle East Respiratory Syndrome Coronavirus Infection

Song, Joon Young; Cheong, Hee Jin; Choi, Min Joo; Jeon, Ji Ho; Kang, Seong Hee; Jeong, Eun Ju; Yoon, Jin Gu; Lee, Saem Na; Kim, Sung Ran; Noh, Ji Yun; Kim, Woo Joo

Case 1 was a healthy 35-year old man. Initially, he presented diarrhea, vomiting, abdominal pain and fever lasting seven days, and was admitted to a 300-bed hospital on May 27, 2015. Three days later, the patient complained of chest discomfort, and lobar consolidation was found on right upper lobe. MERS-CoV infection was diagnosed by the real-time RT-PCR method, using a target upstream of envelope gene (UpE) and open reading frame (ORF) 1a gene. The assay was performed with sputum samples using one-step real-time RT-PCR kit (DiaPlexQTM, SolGent Co., Ltd, Daejeon, Korea). According to the manufacture's instruction, the results were regarded positive only if both MERS-CoV genes were detected with cutoff Ct value of ≤38. If Ct value was estimated to be 38.1-40 on repetitive test, the sample was considered weakly positive. Because of rapid aggravation of pneumonia, patient was transferred to Korea University Guro Hospital. The patient was treated by antiviral combinations including ribavirin (2,000 mg po loading dose, followed by 1,200 mg po q8 h for 4 days then 600 mg po q8 h for 6 days) and pegylated interferon α2a (Pegasys ® , 180 μg SC once/week for two weeks). Fever subsided on fifth day after antiviral treatment, but cough persisted up to 14th days. Initial MERS-CoV load was high, and viral RNA was persistently detected up to 31 days after fever onset (Table 1) . On admission in June 5, 2015, a 58-year old woman (Case 2) presented four-day-fever, respiratory and gastrointestinal symptoms, and complicated by pneumonia. Triple antiviral combination was administered to the patient. In addition to ribavirin (2,000 mg po loading dose, followed by 1,200 mg po q8 h for 4 days then 600 mg po q8 h for 6 days) and pegylated interferon α2a (Pegasys ® , 180 μg SC once/week for two weeks), lopinavir/ritonavir (Kaletra ® , 400 mg/100 mg po q12 h for 10 days) was co-administered. Initial viral load was rather lower compared to that of patient 1, and viral shedding lasted 19 days from fever onset (Table 1 ). Both patients recovered without any sequelae.