Estimating and modelling the transmissibility of Middle East Respiratory Syndrome CoronaVirus during the 2015 outbreak in the Republic of Korea

Xu Sheng Zhang*, Richard Pebody, Andre Charlett, Daniela de Angelis, Paul Birrell, Hunseok Kang, Marc Baguelin, Yoon Hong Choi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)


Background: Emerging respiratory infections represent a significant public health threat. Because of their novelty, there are limited measures available to control their early spread. Learning from past outbreaks is important for future preparation. The Middle Eastern Respiratory Syndrome CoronaVirus (MERS-CoV) 2015 outbreak in the Republic of Korea (ROK) provides one such opportunity. Objectives: We demonstrated through quantitative methodologies how to estimate MERS-CoV's transmissibility and identified the effective countermeasures that stopped its spread. Methods: Using the outbreak data, statistical methods were employed to estimate the basic reproductive number R0, the average number of secondary cases produced by a typical primary case during its entire infectious period in a fully susceptible population. A transmission dynamics model was also proposed to estimate R0 and to identify the most effective countermeasures. The consistency between results will provide cross-validation of the approaches. Results: R0 ranged from 2.5 with 95% confidence interval (CI): [1.7, 3.1] (using the sequential Bayesian method) to 7.2 with 95% CI: [5.3, 9.4] (using the Nowcasting method). Estimates from transmission model were higher but overlapped with these. Personal protection and rapid confirmation of cases were identified as the most important countermeasures. Conclusions: Our estimates were in agreement with others from the ROK outbreak, albeit significantly higher than estimates based on other small outbreaks and sporadic cases of MERS-CoV. The large-scale outbreak in the ROK was jointly due to the high transmissibility in the healthcare-associated setting and the Korean culture-associated contact behaviour. Limiting such behaviour by rapidly identifying and isolating cases and avoiding high-risk contacts effectively stopped further transmission.

Original languageEnglish
Pages (from-to)434-444
Number of pages11
JournalInfluenza and other Respiratory Viruses
Issue number5
Publication statusPublished - Sep 2017

Bibliographical note

Funding Information:
This study was supported by the Public Health England. We are grateful to two anonymous reviewers for their helpful comments on the manuscript.

Publisher Copyright:
© 2017 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.


  • Middle Eastern Respiratory Syndrome CoronaVirus
  • South Korean outbreak
  • mathematical modelling
  • parameter estimation
  • statistical analysis
  • transmissibility


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