Family cluster of Middle East respiratory syndrome coronavirus infections, Tunisia, 2013

Abstract

In 2013 in Tunisia, 3 persons in 1 family were infected with Middle East respiratory syndrome coronavirus (MERS-CoV). The index case-patient's respiratory tract samples were negative for MERS-CoV by reverse transcription PCR, but diagnosis was retrospectively confirmed by PCR of serum. Sequences clustered with those from Saudi Arabia and United Arab Emirates.

Figure 1

Clinical course of disease for patients with confirmed Middle East respiratory syndrome coronavirus Infection, Tunisia, 2013. RH, regional hospital; DH, district hospital; rRT-PCR, real-time reverse transcription PCR.

Figure 2

Midpoint-rooted phylogenetic trees of the full-length nucleocapsid (N) (panel A) and spike (S) (panel B) open-reading frames (ORFs) of isolates obtained from index case-patient with Middle East respiratory syndrome coronavirus (MERS-CoV) infection, Tunisia, 2013. Serum and available nucleotide sequences from GenBank and Public Health England (http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1317136246479) and the Institut Für Virologie (http://www.virology-bonn.de/index.php?id = 46). The estimated neighbor-joining trees were constructed from nucleotide alignments by using MEGA version 6.06 (http://www.megasoftware.net). Sequence names are written as GenBank accession number|virus strain name|month-year of collection. Numbers in parentheses denote the number of additional sequences from viruses isolated from humans that are identical to the listed sequence. Solid circles indicate sequences from MERS-CoV from Tunisia, 2013. Camel icons indicate MERS-CoV sequences derived from isolates from camels. Bootstrap support values (1,000 replicates) ≥75% were plotted at the indicated internal branch nodes. Scale bars indicate number of nucleotide substitutions per site.