{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T00:06:36Z","timestamp":1778285196928,"version":"3.51.4"},"reference-count":34,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2016,2,1]]},"published-print":{"date-parts":[[2016,2]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate the heterogeneous transmission patterns of Middle East respiratory syndrome (MERS) in the Republic of Korea, with a particular focus on epidemiological characteristics of superspreaders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective epidemiological analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Multiple healthcare facilities of secondary and tertiary care centres in an urban setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>A total of 185 laboratory-confirmed cases with partially known dates of illness onset and most likely sources of infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Primary and secondary outcome measures<\/jats:title><jats:p>Superspreaders were identified using the transmission tree. The reproduction number, that is, the average number of secondary cases produced by a single primary case, was estimated as a function of time and according to different types of hosts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of five superspreaders were identified. The reproduction number throughout the course of the outbreak was estimated at 1.0 due to reconstruction of the transmission tree, while the variance of secondary cases generated by a primary case was 52.1. All of the superspreaders involved in this outbreak appeared to have generated a substantial number of contacts in multiple healthcare facilities (association: p&lt;0.01), generating on average 4.0 (0.0\u20138.6) and 28.6 (0.0\u201363.9) secondary cases among patients who visited multiple healthcare facilities and others. The time-dependent reproduction numbers declined substantially below the value of 1 on and after 13 June 2015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Superspreaders who visited multiple facilities drove the epidemic by generating a disproportionate number of secondary cases. Our findings underscore the need to limit the contacts in healthcare settings. Contact tracing efforts could assist early laboratory testing and diagnosis of suspected cases.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2015-009936","type":"journal-article","created":{"date-parts":[[2016,2,24]],"date-time":"2016-02-24T03:01:50Z","timestamp":1456282910000},"page":"e009936","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":38,"title":["Identifying determinants of heterogeneous transmission dynamics of the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea, 2015: a retrospective epidemiological analysis"],"prefix":"10.1136","volume":"6","author":[{"given":"Hiroshi","family":"Nishiura","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akira","family":"Endo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaya","family":"Saitoh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryo","family":"Kinoshita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryo","family":"Ueno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinji","family":"Nakaoka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuichiro","family":"Miyamatsu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yueping","family":"Dong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerardo","family":"Chowell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Mizumoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,2,23]]},"reference":[{"key":"2024051515052008000_6.2.e009936.1","doi-asserted-by":"crossref","first-page":"pii: 21169","DOI":"10.2807\/1560-7917.ES2015.20.25.21169","article-title":"Epidemiological investigation of MERS-CoV spread in a single hospital in South Korea, May to June 2015","volume":"20","author":"Park","year":"2015","journal-title":"Euro Surveill"},{"key":"2024051515052008000_6.2.e009936.2","doi-asserted-by":"crossref","first-page":"pii: 21163","DOI":"10.2807\/1560-7917.ES2015.20.25.21163","article-title":"Preliminary epidemiological assessment of MERS-CoV outbreak in South Korea, May to June 2015","volume":"20","author":"Cowling","year":"2015","journal-title":"Euro Surveill"},{"key":"2024051515052008000_6.2.e009936.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60454-8"},{"key":"2024051515052008000_6.2.e009936.4","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(13)70304-9"},{"key":"2024051515052008000_6.2.e009936.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61492-0"},{"key":"2024051515052008000_6.2.e009936.6","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.epidem.2014.09.011","article-title":"Synthesizing data and models for the spread of MERS-CoV, 2013: key role of index cases and hospital transmission","volume":"9","author":"Chowell","year":"2014","journal-title":"Epidemics"},{"key":"2024051515052008000_6.2.e009936.7","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1016\/S0140-6736(13)61504-4","article-title":"Assessing the pandemic potential of MERS-CoV","volume":"382","author":"Bauch","year":"2013","journal-title":"Lancet"},{"key":"2024051515052008000_6.2.e009936.8","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-015-0450-0"},{"key":"2024051515052008000_6.2.e009936.9","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S0140-6736(13)62123-6","article-title":"Nuanced risk assessment for emerging infectious diseases","volume":"383","author":"Fisman","year":"2014","journal-title":"Lancet"},{"key":"2024051515052008000_6.2.e009936.10","doi-asserted-by":"crossref","first-page":"pii: 21181","DOI":"10.2807\/1560-7917.ES2015.20.27.21181","article-title":"Assessing the risk of observing multiple generations of Middle East respiratory syndrome (MERS) cases given an imported case","volume":"20","author":"Nishiura","year":"2015","journal-title":"Euro Surveill"},{"key":"2024051515052008000_6.2.e009936.11","doi-asserted-by":"crossref","first-page":"pii: 21167","DOI":"10.2807\/1560-7917.ES2015.20.25.21167","article-title":"The role of superspreading in Middle East respiratory syndrome coronavirus (MERS-CoV) transmission","volume":"20","author":"Kucharski","year":"2015","journal-title":"Euro Surveill"},{"key":"2024051515052008000_6.2.e009936.12","unstructured":"World Health Organization (WHO). 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