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Illinois MERS Transmission By Casual Contact
Recombinomics Commentary 21:00
May 17, 2014

The CDC held a press conference to announce the lab confirmation of another MERS case (in Illinois).  The latest case was PCR negative, but confirmed with a MERS antibody test.  The contact between the latest case and the MERS case in Munster, Indiana was considered “close contact” because of 2 short business meetings (40 min and 20 min) involving the case and contact being within six feet of each other.  The only reported physical contact was via handshake(s).

There are additional suspect cases in Indiana, who have also tested negative by PCR (twice), but are being tested for MERS antibodies.  It is likely that one or more will be positive.

The transmission at a business meeting is much more like casual contact, CDC and WHO definitions notwithstanding.  The transmission further supports sustained transmission which was suggested by MERS cases in Jeddah and Mecca, as well as exports to Athens and Orlando. 

All 33 sequences from these cases match each other signaling clonal expansion and sustained transmission (samples were from patients linked to at least four hospitals in two cities (Jeddah and Mecca) on samples collected between April 3 and May 10.  The Jeddah sub-clade includes 3 non-synonymous changes (L6Q, L40P, and K60N) in ORF8b, the same gene disrupted (by 29 nt deletion) in the SARS outbreak in 2003.

The sequence from the Munster case,
Indiana/USA-1_Saudi Arabia_2014, however is most closely related to prior MERS sequences in Riyadh, where the Munster case was employed as a health care worker (HCW).  However, that ORF8b sequence had a termination codon at position 78, shortening the 112 amino acid protein to 77 amino acids.

The targeting of ORF8b in the Jeddah sub-clade, as well as the sequence in Indiana / Illinois, raises serious pandemic concerns.

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