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                  <text>Dominio científico: Coronavirus</text>
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                <text>2015 Middle East Respiratory Syndrome Coronavirus (MERS-CoV) nosocomial outbreak in South Korea: insights from modeling</text>
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                <text>Ying-Hen Hsieh</text>
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                <text>Background. Since the emergence of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in 2012, more than 1,300 laboratory confirmed cases of MERS-CoV infections have been reported in Asia, North Africa, and Europe by July 2015. The recent MERS-CoV nosocomial outbreak in South Korea quickly became the second largest such outbreak with 186 total cases and 36 deaths in a little more than one month, second only to Saudi Arabia in country-specific number of reported cases.Methods. We use a simple mathematical model, the Richards model, to trace the temporal course of the South Korea MERS-CoV outbreak. We pinpoint its outbreak turning point and its transmissibility via basic reproduction number R0 in order to ascertain the occurrence of this nosocomial outbreak and how it was quickly brought under control.Results. The estimated outbreak turning point of ti = 23.3 days (95% CI [22.6–24.0]), or 23–24 days after the onset date of the index case on May 11, pinpoints June 3–4 as the time of the turning point or the peak incidence for this outbreak by onset date. R0 is estimated to range between 7.0 and 19.3.Discussion and Conclusion. The turning point of the South Korea MERS-CoV outbreak occurred around May 27–29, when control measures were quickly implemented after laboratory confirmation of the first cluster of nosocomial infections by the index patient. Furthermore, transmissibility of MERS-CoV in the South Korea outbreak was significantly higher than those reported from past MERS-CoV outbreaks in the Middle East, which is attributable to the nosocomial nature of this outbreak. Our estimate of R0 for the South Korea MERS-CoV nosocomial outbreak further highlights the importance and the risk involved in cluster infections and superspreading events in crowded settings such as hospitals. Similar to the 2003 SARS epidemic, outbreaks of infectious diseases with low community transmissibility like MERS-CoV could still occur initially with large clusters of nosocomial infections, but can be quickly and effectively controlled with timely intervention measures.</text>
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                <text>DOI: 10.7717/peerj.1505</text>
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                <text>Medicine</text>
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                <text>Ying-Hen Hsieh, Cathy W.S. Chen, Sze-Bi Hsu</text>
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                <text>We studied the severe acute respiratory syndrome (SARS) outbreak in Taiwan, using the daily case-reporting data from May 5 to June 4 to learn how it had spread so rapidly. Our results indicate that most SARS-infected persons had symptoms and were admitted before their infections were reclassified as probable cases. This finding could indicate efficient admission, slow reclassification process, or both. The high percentage of nosocomial infections in Taiwan suggests that infection from hospitalized patients with suspected, but not yet classified, cases is a major factor in the spread of disease. Delays in reclassification also contributed to the problem. Because accurate diagnostic testing for SARS is currently lacking, intervention measures aimed at more efficient diagnosis, isolation of suspected SARS patients, and reclassification procedures could greatly reduce the number of infections in future outbreaks.</text>
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                <text>severe acute respiratory syndrome, SARS-CoV, infectious diseases, Epidemiology, Taiwan, nosocomial infections</text>
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                <text>DOI: 10.3201/eid1002.030515</text>
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                <text>Emerging Infectious Diseases</text>
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                <text>Centers for Disease Control and Prevention</text>
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                <text>Infectious and parasitic diseases, Medicine</text>
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                <text>DOI: 10.3201/eid1008.040329</text>
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                <text>During the 2003 outbreak of severe acute respiratory syndrome (SARS) in Taiwan, &gt;150,000 persons were quarantined, 24 of whom were later found to have laboratory-confirmed SARS-coronavirus (SARS-CoV) infection. Since no evidence exists that SARS-CoV is infective before the onset of symptoms and the quarantined persons were exposed but not symptomatic, we questioned the quarantine’s effectiveness. Using the SARS Taiwan quarantine data, we found that the onset-to-diagnosis time of previously quarantined confirmed case-patients was significantly shortened compared to that for those who had not been quarantined. Thus, quarantine for SARS in Taiwan screened potential infective persons for swift diagnosis and hospitalization after onset, thereby indirectly reducing infections. Full-scale quarantine measures implemented on April 28 led to a significant improvement in onset-to-diagnosis time of all SARS patients, regardless of previous quarantine status. We discuss the temporal effects of quarantine measures and other interventions on detection and isolation as well as the potential usefulness of quarantine in faster identification of persons with SARS and in improving isolation measures.</text>
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                <text>DOI: 10.3201/eid1102.040190</text>
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                <text>DOI: 10.3201/eid1008.040115</text>
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                <text>Ying-Hen Hsieh, Yuansen Cheng</text>
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                <text>We used a single equation with discrete phases to fit the daily cumulative case data from the 2003 severe acute respiratory syndrome outbreak in Toronto. This model enabled us to estimate turning points and case numbers during the 2 phases of this outbreak. The 3 estimated turning points are March 25, April 27, and May 24. The estimated case number during the first phase of the outbreak between February 23 and April 26 is 140.53 (95% confidence interval [CI] 115.88–165.17) if we use the data from February 23 to April 4; and 249 (95% CI: 246.67–251.25) at the end of the second phase on June 12 if we use the data from April 28 to June 4. The second phase can be detected by using case data just 3 days past the beginning of the phase, while the first and third turning points can be identified only ≈10 days afterwards. Our modeling procedure provides insights into ongoing outbreaks that may facilitate real-time public health responses.</text>
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                <text>SARS, emerging infectious disease, Canada, Toronto, turning point, Richards model</text>
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                <text>DOI: 10.3201/eid1201.050396</text>
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                <text>Infectious and parasitic diseases, Medicine</text>
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                <text>A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)</text>
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                <text>Ying-Hui Jin, Lin Cai, Zhen-Shun  Cheng, Hong Cheng, Tong Deng, Yi-Pin Fan, Cheng Fang, Di Huang, Luqi Huang, Qiao Huang, Yong HAN, Bo Hu, Fen Hu, Bing-Hui Li, Yi-Rong Li, Ke Liang, Li-Kai Lin, Lisha Luo, Jing Ma, Lin-Lu Ma, Zhi-Yong Peng, Yunbao Pan, Zhenyu Pan, Xuequn Ren, Hui-Min Sun, Ying Wang, Yunyun Wang, Hong Weng, Chao-Jie Wei, Dongfang Wei, Jian Xia, Yong Xiong, Hai-bo Xu, Xiaomei Yao, Tai-Sheng Ye, Yufeng Yuan, Xiaochun Zhang, Ying Wen Zhang, Yingao Zhang, Huamin Zhang, Yan Zhao, Ming-Juan Zhao, Hao Zi, Xian-Tao Zeng, Yongyan Wang, Xinghuan Wang, for the Zhongnan Hospital of Wuhan Unive Novel Coronavirus Management and Research Team, Evidence-Based Medicine Chapter, China International Exchange and Promoti for Medical and Health Care (CPAM)</text>
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                <text>10.11855/j.issn.0577-7402.2020.01.01</text>
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                <text>Medical Journal of Chinese People's Liberation Army</text>
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                <text>Ying-Hui Jin, Lin Cai, Zhen-Shun  Cheng, Hong Cheng, Tong Deng, Yi-Pin Fan, Cheng Fang, Di Huang, Luqi Huang, Qiao Huang, Yong HAN, Bo Hu, Fen Hu, Bing-Hui Li, Yi-Rong Li, Ke Liang, Li-Kai Lin, Lisha Luo, Jing Ma, Lin-Lu Ma, Zhi-Yong Peng, Yunbao Pan, Zhenyu Pan, Xuequn Ren, Hui-Min Sun, Ying Wang, Yunyun Wang, Hong Weng, Chao-Jie Wei, Dongfang Wu, Jian Xia, Yong Xiong, Hai-bo Xu, Xiaomei Yao, Yufeng Yuan, Tai-Sheng Ye, Xiaochun Zhang, Ying Wen Zhang, Yingao Zhang, Huamin Zhang, Yan Zhao, Ming-Juan Zhao, Hao Zi, Xian-Tao Zeng, Yongyan Wang, Xinghuan Wang, , for the Zhongnan Hospital of Wuhan University Novel Coronavirus Management and Research Team, Evidence-Based Medicine Chapter of China International Exchange and Promotive Association for Medical and Health Care (CPAM)</text>
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                <text>Abstract In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province; and then named “2019 novel coronavirus (2019-nCoV)” by the World Health Organization (WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development; we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control (including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.</text>
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                <text>DOI: 10.1186/s40779-020-0233-6</text>
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                <text>Ying-Tzu Tseng, Chia-Hui Chang, Shiu-Mei Wang, Kuo-Jung Huang, Chin-Tien Wang</text>
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                <text>Severe acute respiratory syndrome coronavirus (SARS-CoV) membrane (M) proteins are capable of self-assembly and release in the form of membrane-enveloped vesicles, and of forming virus-like particles (VLPs) when coexpressed with SARS-CoV nucleocapsid (N) protein. According to previous deletion analyses, M self-assembly involves multiple M sequence regions. To identify important M amino acid residues for VLP assembly, we coexpressed N with multiple M mutants containing substitution mutations at the amino-terminal ectodomain, carboxyl-terminal endodomain, or transmembrane segments. Our results indicate that a dileucine motif in the endodomain tail (218LL219) is required for efficient N packaging into VLPs. Results from cross-linking VLP analyses suggest that the cysteine residues 63, 85 and 158 are not in close proximity to the M dimer interface. We noted a significant reduction in M secretion due to serine replacement for C158, but not for C63 or C85. Further analysis suggests that C158 is involved in M-N interaction. In addition to mutations of the highly conserved 107-SWWSFNPE-114 motif, substitutions at codons W19, W57, P58, W91, Y94 or F95 all resulted in significantly reduced VLP yields, largely due to defective M secretion. VLP production was not significantly affected by a tryptophan replacement of Y94 or F95 or a phenylalanine replacement of W19, W57 or W91. Combined, these results indicate the involvement of specific M amino acids during SARS-CoV virus assembly, and suggest that aromatic residue retention at specific positions is critical for M function in terms of directing virus assembly.</text>
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                <text>DOI: 10.1371/journal.pone.0064013</text>
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                <text>PLoS ONE</text>
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