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WHO - Cause of Jeddah MERS Primary Case Spike Unknown
Recombinomics Commentary 16:00
May 7, 2014

The reasons for the increase in the number of primary community cases, as well as the infection route, remain unknown.

The above comments from the WHO EMRO investigation of MERS cases in Jeddah continue to raise concerns that a novel sub-clade has emerged in Jeddah.  The WHO report did note spread in hospitals and the need for more infection control, but the cases in western KSA have not been limited to Jeddah.  The most recent MoH MERS update has cited cases in Jeddah, Mecca, Medina, and Taif.

The spike in Jeddah cases beginning in mid-March has raised concerns about a novel sub-clade.  Sequences from three cases in two hospitals collected in early April
(Jeddah_C7569, Jeddah_C7149, Jeddah_C7770)has increased concerns because all three sequences are virtually identical and include 9 polymorphisms not reported in any prior human cases.  These sequences were released at the Drosten website and 25 partial sequences from the spike gene from additional Jeddah cases were said to be identical.  However, these sequences, or location within the spike gene, have not been made public.
Similarly, recent remarks have cited sequences from two more recent cases in Jeddah and one case in Mecca.  All six sequences were said to “look completely normal” raising concerns that all six sequences formed the same novel sub-clade containing all or most of the 9 polymorphisms that defined the sub-clade.

 If sequences match, concerns would be increased with regard to a novel sub-clade similar to the emergence of a novel SARS-CoV sub-clade in Hong Kong in 2003, which then spread to Singapore, Hanoi, and Toronto lead to significant nosocomial outbreaks.

The sequences from the three recent cases have been withheld.  E-mails to the Drosten lab today and yesterday have not been answered, which is also true for e-mails to Andrew Rambaut on May 5, 6, and 7.  The sequences or a phylogenetic tree would address the relationship between the first three cases, and the three more recent cases.
These sequences should be released immediately.

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