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MERS Jeddah Export To Orlando Florida
Recombinomics Commentary 23:45
May 13, 2014

On May 1st, this patient departed Jeddah, Saudi Arabia, and traveled by airplane to London, England. And then from London to Boston, Massachusetts. The patient traveled from Boston to Atlanta, Georgia, and then from Atlanta to Orlando, Florida. The patient began feeling unwell during the flight from Jeddah to London and continued to feel unwell on subsequent flights with reported symptoms including fever, chills and a slight cough.

The above comments from the CDC telebriefing describe the second confirmed MERS case in 10 days.  However, unlike the first case, who worked in Riyadh, the latest case (44M health care worker) lived in Jeddah and represented the seventh Jeddah export in recent weeks.  Recently released sequences from six cases in Jeddah and Mecca (C7149 and C7770 from hospital A collected on April 3 and 7, respectively, as well as C7569 from hospital B collected on April 5, followed by Jeddah sequences 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) uploaded to the Drosten website formed a novel sub-clade, defined by 11 polymorphisms encoding six protein changes

Two of those changes (Spike protein Q833R and ORF8b L6Q) have not been reported in any cases outside of Jeddah and Mecca or any camel published sequence, including the recently released sequence from Qatar_2_2014).  The six prior cases were from four hospitals in two cities, signaling human to human transmission, which was further supported by partial sequences from 25 additional cases in Jeddah, which matched the six nearly complete sequences.

Today the CDC released the sequences from the first US case, Indiana/USA-1_Saudi Arabia_2014, which is more closely related two sequences from cases in Al Batin or Riyadh, although it also had a novel receptor binding domain change in the Spike gene, L411F.  This is the first recent sequence originating from Riyadh, and the CDC is to be commended for the rapid release of this important sequence.

However, the sequence from Orlando is likely to match the Jeddah / Mecca sequences described above, raising serious transmission concerns, which have increased due to symptoms in health care workers in contact with the Orlando case.

Details on the sequence and the status of the contacts would be useful.

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