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Netherlands Pilgrims Match Munster Cook County MERS
Recombinomics Commentary 20:45
May 22, 2014

The Department of Viroscience at the Erasmus Medical Center (EMC) has released partial MERS sequences from two pilgrims infected while performing Umrah in the Kingdom of Saudi Arabia (KSA).  The index case, 70M, developed symptoms in Medina, while the second case, 73F, developed symptoms in Mecca and are designated Netherlands_1_2014 and Netherlands_2_2014.  EMC is to commended for the rapid release (at Genbank) of these important sequences.  The partial sequences indicate the two cases were infected by the same sub-clade, which had a number of polymorphisms matching the recent export from Riyadh, KSA to Munster, Indiana, with onward transmission to Cook County, Illinois.

Although the 5 sets of sequences from the two cases were limited in size, the matches with each other as well as Indiana/USA-1_Saudi Arabia_2014, clearly signals clonal expansion of this novel sub-clade.  The ORF1a sequence from Netherlands_1 and Netherlands_2 had T1976A which was also uniquely found in Indiana/USA-1_Saudi Arabia_2014. Netherlands_2 also had A11699G, which was present in Indiana/USA-1_Saudi Arabia_2014 and Riyadh_9_2013. The S gene of Netherlands_2 had C22687T, which was also uniquely found in Indiana/USA-1_Saudi Arabia_2014..  Netherlands_1 had S gene T22551C, which encoded F366L and was also uniquely found in Indiana/USA-1_Saudi Arabia_2014.  Netherlands_1 also had G29749A in the N gene, also uniquely found in Indiana/USA-1_Saudi Arabia_2014.

However, the largest number of matches between Netherlands_1 and Indiana/USA-1_Saudi Arabia_2014 were in ORF4b.  There were 4 polymorphisms, and 3 were non-synonymous.  Changes in these four positions were not found in any published MERS sequence.  Both isolates had changes at position 26127.  Netherlands_1 had C26127A (S12Y), while Indiana/USA-1_Saudi Arabia_2014 had a mixture C26127Y (S12F).  The changes in the other three positions, C26232T (L47F), A26346T (Y85F) and C26449A further supported clonal expansion and airline exports combined with onward transmission moved this sub-clade from Medina to two cities in the Netherlands (The Hague and Zwolle), as well as from Riyadh to Munster, Indiana and Cook County aka Chicago, Illinois.

The matches with Indiana/USA-1_Saudi Arabia_2014, including a polymorphism in the N gene also suggests that ORF8b is truncated in both exports to The Netherlands, raising concern that the human to human transmission between the two exports to the Netherlands as well as the two cases in the United States is common.

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