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MERS Travel Log Riyadh London Chicago Munster
Recombinomics Commentary 12:30
May 3, 2014

ANNE SCHUCHAT: The person traveled on April 24th from Saudi Arabia to London and then on to Chicago, Illinois. And so, they were in the kingdom before the 24th. I don't have the details of how long but I believe it was, you know, a substantial period. And so they have been in the United States since April 27th, and were admitted to a hospital on the 28th of April. So it's relatively soon since this person returned to the United States and we're closely looking at the contacts since they have returned here.
The above comments from the May 2 CDC presser on the first confirmed MERS case in the United States creates some confusion about the location of the case between April 24-27, since the patient has been in the US since “since April 27.”

However, the timing of the flights cited above suggest that time was also in the United States.  The British Airways Flight 262 is schedule to depart Riyadh (RUH) at 12:35 AM and arrive in London (LHR) at 5:25 AM.  American Airlines Flight 99 is scheduled to leave Riyadh (RUH) at 7:45A and arrive in Chicago (ORD) at 10:05 AM, suggesting he caught the connecting flight and arrived in Chicago in the morning of April 24.
Although Munster is in Indiana, it is a Chicago suburb that is about 30 mile from Ohara Airport (ORD), so the bus ride would have been relatively short and would have happened three days prior to disease onset, reducing the likelihood of transmission to fellow travelers on the two planes, at the three airports, or on the bus.

Those at the Emergency Department of Community Hospital in Munster would be more at risk, but since the patient is a health care worker from KSA, he likely warned the medical personnel of the likely etiological agent causing his MERS symptoms, and appropriate precautions were likely taken.  Moreover, the patient is receiving oxygen and in stable condition (not intubated), suggesting a lower viral load which would also limit transmission.

However, the export of MERS from KSA to the United States follows six recent MERS exports from Jeddah, raising concerns that a novel sub-clade has emerged, as was seen in 2003 for SARS.  The sequences from three Jeddah patients have been made public, and release of sequences from the Indiana patient would be useful.

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