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Mystery MERS Meeting Raises Vectoring Concerns
Recombinomics Commentary 21:45
May 20, 2014

DAVID SWERDLOW: Nothing has changed about our initial evaluation of where the Indiana patient had been.  All the original information about the airplanes and the bus are all still correct.  This gentleman did -- the Indiana gentleman, the Indiana patient, traveled in a car to have a business meeting with this gentleman in Illinois from Indiana.  So it doesn't change anything about the conveyances or the buses or the airplanes, and he did have a business meeting with the business associate and had face-to-face contact, enough that we were concerned and included this person in our circle of people that we were monitoring, testing, and also considering for avoiding contact with other people. 
MIKE STOBBE: How long was the meeting? 
DAVID SWERDLOW: It was about 40 minutes. 
MIKE STOBBE: Was it in Chicago or where in Illinois? 
DAVID SWERDLOW: I can't really divulge that kind of confidential information for confidentiality reasons. 
MIKE STOBBE: Can you say the nature of the meeting? 
DAVID SWERDLOW: It was a business meeting. 

The above comments reflect the CDC’s concern about revealing details on activities of American Health Care Worker (HCW) ex-Riyadh between his arrival in Munster, Indiana in the early afternoon of April 24, (on a bus from O’Hare Airport) and April 27, when he “went” to the family in Munster after his symptoms became more severe.

Prior to the May 17 presser, the CDC had not admitted that he was not in Indiana, and the above comments suggest that he went to Illinois by a car trip (and not by two car trips, one for each meeting).  The description of the “business meeting” is consistent with attendance at a scientific meeting in Chicago, less than 30 miles from Munster.  The first full day of the meeting (which discussed medical research and business) was April 25, the day of the 30-40 minute face to face interaction between the index case, a health care worker, and a “business associate” who was likely also an attendee of the meeting.  The second “meeting” was 10-20 minutes in length and was on April 26, the second full day of the meeting.

The detection of MERS antibodies in the Illinois colleague from contact on April 25 and/or 26 suggests that the index case was more contagious on April 27 when he “went” to Munster when symptoms became more severe.  The conference ended April 27, raising concerns that attendees who had contact with the index case had significant exposures.

The conference, which was the 10th Annual Meeting of the American Physician’s Scientist Association (APSA) was held jointly with the American Society for Clinical Investigation and the Association of American Physicians (ASCI/AAP) and in conjunction with the meeting of the Central Society for Clinical and Translational Research and the Midwestern Section of the American Federation for Medical Research (CSCTR/MWAFMR) which had approximately 300 registered attendees who were physicians and medical researchers from institutions throughout the United States. 

The leaders of the infectious disease session were from Children’s Hospital of Philadelphia, Duke University Medical Center, and Yale University.  The Emergency Medicine session was led by physicians from Harbor UCLA Medical Center and Northwestern University.  The panel on Global Health included physicians from Northwestern and the University of Chicago.  Additional attendees represented medical centers throughout the United States, which would represent an opportunity for serious vectoring of MERS.

The CDC is aggressively following up airplane and HCW contacts, as well as family members in Munster.  However, the lack of information on the activities of the index case between April 25 and April 27, which coincides with the dates of the meeting (which did conduct business), raises concerns that the MERS confirmed case with face to face contact on April 25 & 26 may not fully reflect recent MERS transmission in Illinois.

The CDC should provide detail on activities of the index case in this timeframe and if the index case traveled to Illinois, and the two “business meetings” were linked to the Chicago conference, attendees should be notified, since at least two attendees have been MERS lab confirmed.

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