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. 2016 Aug 3;3(3):ofw165.
doi: 10.1093/ofid/ofw165. eCollection 2016 Sep.

Increase in Middle East Respiratory Syndrome-Coronavirus Cases in Saudi Arabia Linked to Hospital Outbreak With Continued Circulation of Recombinant Virus, July 1-August 31, 2015

Abdullah M Assiri  1 , Holly M Biggs  2 , Glen R Abedi  2 , Xiaoyan Lu  2 , Abdulaziz Bin Saeed  3 , Osman Abdalla  1 , Mutaz Mohammed  1 , Hail M Al-Abdely  1 , Homoud S Algarni  1 , Raafat F Alhakeem  1 , Malak M Almasri  1 , Ali A Alsharef  1 , Randa Nooh  1 , Dean D Erdman  2 , Susan I Gerber  2 , John T Watson  2
Affiliations

Increase in Middle East Respiratory Syndrome-Coronavirus Cases in Saudi Arabia Linked to Hospital Outbreak With Continued Circulation of Recombinant Virus, July 1-August 31, 2015

Abdullah M Assiri et al. Open Forum Infect Dis. .

Abstract

During July-August 2015, the number of cases of Middle East respiratory syndrome (MERS) reported from Saudi Arabia increased dramatically. We reviewed the 143 confirmed cases from this period and classified each based upon likely transmission source. We found that the surge in cases resulted predominantly (90%) from secondary transmission largely attributable to an outbreak at a single healthcare facility in Riyadh. Genome sequencing of MERS coronavirus from 6 cases demonstrated continued circulation of the recently described recombinant virus. A single unique frameshift deletion in open reading frame 5 was detected in the viral sequence from 1 case.

Keywords: Middle East respiratory syndrome coronavirus; Saudi Arabia; coronavirus infections; disease outbreaks; infectious disease transmission.

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Figures

Figure 1.
Figure 1.
(A) Middle East respiratory syndrome coronavirus (MERS-CoV) confirmed cases reported by Saudi Arabia Ministry of Health July 1–August 31, 2015, by onset week. (B) Phylogeny of MERS-CoV full genome sequences. The phylogenetic tree was constructed from MERS-CoV genome sequences obtained from the 6 cases reported during July–August, 2015, and all near complete genome sequences available in public domain (n = 188) using the program MrBayes version 3.2.6 under a general time-reversible (GTR) model of nucleotide substitution with 4 categories of γ-distributed rate heterogeneity and a proportion of invariant sites (GTR + 4 + I). Middle East respiratory syndrome-CoV sequences belonging to the recently described novel recombinant clade (NRC-2015) [7, 10] are shown in expanded view. The 6 sequences identified in this study are marked with circles, and those colored red highlight the 4 cases linked to Hospital A. The sequence from the case with the 20-nucleotide frameshift deletion in open reading frame (ORF)5 is marked with Δ. Clade-credibility values ≥70% are indicated above the respective nodes. Numbers in brackets after some strain identifiers are the number of identical sequences with the same geographic location and sample collection year/month. The scale bar shows the genetic distance as nucleotide substitutions per site. Weeks are WHO epidemiologic weeks; week 35 is truncated at August 31, 2015.
See this image and copyright information in PMC

References

    1. Alraddadi BM, Watson JT, Almarashi A et al. . Risk factors for primary Middle East respiratory syndrome coronavirus (MERS-CoV) illness in humans. Emerg Infect Dis 2015; 22:49–55. - PMC - PubMed
    1. Oboho IK, Tomczyk SM, Al-Asmari AM et al. . 2014 MERS-CoV outbreak in Jeddah--a link to health care facilities. N Engl J Med 2015; 372:846–54. - PMC - PubMed
    1. Drosten C, Meyer B, Muller MA et al. . Transmission of MERS-coronavirus in household contacts. N Engl J Med 2014; 371:828–35. - PubMed
    1. Sabir JS, Lam TT, Ahmed MM et al. . Co-circulation of three camel coronavirus species and recombination of MERS-CoVs in Saudi Arabia. Science 2016; 351:81–4. - PubMed
    1. Balkhy HH, Alenazi TH, Alshamrani MM et al. . Notes from the field: nosocomial outbreak of Middle East respiratory syndrome in a large tertiary care hospital - Riyadh, Saudi Arabia, 2015. MMWR Morb Mortal Wkly Rep 2016; 65:163–4. - PubMed