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Paradigm Shift Intervention Monitoring
Jeddah and Mecca MERS Sequences Match
The above comments raised concerns that all six sequences from western Kingdom of Saudi Arabia (KSA) represented clonal expansion of a novel sub-clade. Chistian Drosten has confirmed via e-mail to Recombinomics that all six sequences were closely related, confirming clonal expansion.
A similar clonal expansion was seen in 2003 for the SARS-CoV at the Metropole Hotel in Hong Kong. The sequence contained a 29 BP deletion, which was subsequently found in almost all SARS-CoV sequences from subsequent cases, including those in Singapore, Hanoi, and Toronto.
In the recent CDC telebriefing introductory remarks noted the explosive spread of SARS-CoV due to a novel sub-clade, but noted that for Jeddah only one sequence was available even though three sequences (C7149 and C7770 from hospital A on April 3 and 7, respectively as well as C7569 from hospital B on April 5) had been made public at Christian Drosten’s website on April 26, well in advance of the CDC telebriefing on May 2.
Initial comments in ProMED indirectly cited infection control issues in Jeddah, but the first three sequences were from patients in two different hospitals, and the presence of the same sub-clade in two later cases, as well as a case in Mecca, supported clonal expansion.
There have been six confirmed exports of MERS from Jeddah to five different countries (Jordan, Malaysia, Greece, United Arab Emirates, and Egypt), but onward transmission has only been cited in Amman, Jordan, where the index case (25M) infected a paramedic (28M) and his brother (28M), although media reports cited additional symptomatic contacts in Quarayat, KSA.
Christian Drosten is to be commended for the early release of the first three Jeddah sequences and the confirmation that the subsequent three sequences match.
Posting of the three more recent sequences may help convince other MERS sequencers to follow suit and promptly release sequences, which would be useful.