Monday, November 02, 2015

Korean Respiratory Outbreak Investigation – Day 5

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Click to Watch Yonhap Television News English Nov. 1st (approx. 1 minute).


#10,683

 

The epidemiological investigation into South Korea’s atypical pneumonia outbreak linked to the Konkuk University’s Animal Life Sciences building continues into its 5th day, with no specific cause as yet determined. 

 

Tests for the `usual suspects’ influenza, parainfluenza, adenovirus, coronavirus, bocavirus, Legionella,  etc. -  along with some exotics like Q fever and Brucellosis – have all come back negative.

 

There are currently 50 cases of x-ray confirmed mild or moderate pneumonia, and another 26 suspect cases with mild `flu-like’ symptoms.  Another 1,500 people – who either had contact with the affected building, or with those who have fallen ill – are being monitored.

 

Yesterday the Korean CDC announced they would begin a case-control study, in an attempt to determine the risk factors for infection (and hopefully the source).  Meanwhile, more in-depth testing continues, with environmental sampling at the life sciences building looking for mold, fungi, or chemical contamination that might explain this event.


Cultures of slow growing fungi can take weeks to complete (see Incubation of fungal cultures: how long is long enough?) and follow up serological testing is still a couple of weeks away, and so we may not get any definitive answers soon.

 

For now, all of the pneumonia cases appear to have a history of working at or visiting the animal life sciences building, and no secondary transmission to their contacts has been recorded.  The Korean CDC is cautiously optimistic that this indicates an environmental exposure of some sort, and that spread beyond the facility is therefore unlikely. 


It is unclear from the reports  whether any of the 26 `suspect’ cases fall outside of this building-contact category.  With the winter respiratory season underway, a certain number of non-related respiratory viruses are probably complicating the issue, so we’ll just have to wait and see. 

 

Below you’ll find the (translated) CDC press release for today, which provides admirable detail on the investigation.   

 

Konkuk respiratory disease occurred on 5 primary investigation

Centers for Disease Control (General Manager Yang byeongguk) is Konkuk University respiratory diseases in relation to the outbreak 11.2 days 0 until a total of 76 cases received your report of the (cumulative) 50 out of this is confirmed chest radiation on the pneumonia findings suspected * classified and distributed to institutions in seven said that under the quarantine treatment.

- Suspected: chest X-phase with 10.8 days of life since the founding of the University Animal Science College visited the building character and if you have fever over 37.5 ℃ suspected pneumonia findings

* Chest radiography result suspected cases classified as patients who do not meet the definition: 26 people

Chest radiography and symptoms of mild cases without waiting unclassified: 0 people

Doubt that we are 50 inpatient acute patients showing atypical pneumonia (acute atypical pneumonia) symptoms are not severe cases, 19 patients hospitalized after showing improvement of symptoms.

(Epidemiology) in parallel with the time and place of occurrence, contact abnormalities, such as basic materials analysis on 50 patients with doctors, patients for risk factors and propagation paths identified - has an epidemiological investigation in the conduct of such controls.

(Onset) caused the initial symptoms of patients with suspected work 10.19 days, 10.25 was intensively occurs between 1-27 days (29 people, 58% of the total),

- The building is closed after the state reduced the occurrence of new cases.

(Occurring location) to permanent workers in all 50 patients suspected animal Life Sciences building, all 50 people in the workforce and 3-7 layers,

- They are commonly exposed to contaminants through a laboratory environment and population estimates to have occurred.

* Building a laboratory that number: 24 (total of 234 people working, symptoms occur monitored)

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(Contact abnormalities) cases showing that 50 suspected patients living with fever and respiratory symptoms during or up to 87 people is not present,

- But the point is that no additional confirmation of the close contacts of cases may indicate disease or disease disseminative low probability that this disease does not spread between people, yet does not completely rule out the possibility of propagation.

(Case - control investigation) patients for more precise etiology identification and propagation path - the introduction of a control survey method,

- Proceed to the survey was 11.1 days for patients with (suspected), 11.2 days for the control group underwent (asymptomatic workers at all times the property of the party) is also the same investigation and will conduct a comparative analysis between the two groups.

(Clinical) found at the time, was born mild symptoms such as fever, muscle aches usually appear, respiratory symptoms showed a relatively rare pneumonia findings,

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Chest X-ray findings of pneumonia nonspecific phase and appears in common,

After initially admitted to 48 people and 46 of them showed fever symptoms such as loss're going to be a relatively lightly severity that has passed only two showed fever has been estimated at a low disease.

* The two suspected patients did not show symptoms of a fever in the early 50 people

- Case 1: (initial) headache, muscle aches, chills → (currently) no heat, symptom improvement, improvement findings of pneumonia

- Case 2: (Default) cough, headache → (currently) no heat, keep symptoms, pneumonia findings maintenance

- However, it is confirmed by a pathology of lung tissue taken for some lung abnormalities seen on the CT scan.

(Pathogen tests) bacteria seven kinds and viral genes and antibodies (primary) for the nine kinds of tests were conducted to 90% (45 patients) or more of the total suspected cases, of Legionella, brucellosis, Q fever, including three weeks after the second antibody tests will be performed.

* Rhino virus confirmed in four patients, but this is Konkuk University and respiratory diseases as one kinds of cold viruses that are prevalent in the current domestic Relevance Low

In addition, bacteria and virus scan using the remaining samples ‧ underway for fungal culture test for patients suspected of 30 people, this may take a few days - a few months depending on the type of fungus and usually 2-4 careful observation is necessary.

(Environmental research) to 10.28 days of environmental samples collected inside the building (air trapping, feed, smears) are currently under examination, which will take about two weeks.

Meanwhile, the service staff (protective clean ‧) ‧ other college students 192 people entrant is further confirmed by the property and made a total of 1,664 symptoms caused by the current monitoring disease management for patients headquarters call center 109,

* Be subject by date (10.30 days), 964 people → (10.31 days) 1472 people → (11.1 days) 1664 people

Public Health and suspected cases competent to perform monitoring and symptom occurs for 50 partner 87 people,

Results of monitoring suspected cases were not confirmed until now.

* SK Group employed 527 test takers found 109 maintains a call center to report symptoms occurred during induction system (no specific cases identified to date)

Centers for Disease Control are investigating and taking the necessary steps as possible for the attribution and management of respiratory disease caused this,

Actively cooperate with relevant ministries and academic medical specialist ‧ To this end, progress is often plan to inform the public and the media.

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