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Revision of WHO Definition of Primary MERS Case Overdue
Recombinomics Commentary 23:15
May 8, 2014

WHO @WHO · May 7
Primary #MERS case is a person who got infected with MERS from an animal source (zoonotic)
WHO @WHO · May 7
Secondary #MERS cases are people who got infected from another MERS-infected person
The above WHO tweets on definitions assume that spontaneous or primary MERS cases are due to an animal source.  However, all six recent human sequences from cases in Jeddah and Mecca match, indicating primary infections are due to humans infecting humans.  The recent sequences from pateints in four hospitals in two cities (Jeddah and Mecca) leave little doubt that the vast majority of cases in western Saudi Arabia are due to human and not animal infections.

Three of the sequences have been public since April 26
((C7149 and C7770 from hospital A collected on April 3 and 7, respectively as well as C7569 from hospital B collected on April 5), while the other three were released today - patients in Jeddah (C8826 and C9055) collected on April 12 and April 14 from hospital A and C, respectively, as well as Mecca (C9355) collected on April 15, although they were cited in an interview yesterday.  WHO issued a report on their investigation of the spike in Jeddah cases, noting "the reasons for the increase in the number of primary community cases, as well as the infection route, remain unknown".

It would be useful if WHO would read the Jeddah and Mecca sequences.  The data defining the novel sub-clade which has emerged in Jeddah are quite clear, and WHO’s silence is deafening.

Time for WHO to redefine a primary MERS case.

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