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Paradigm Shift Intervention Monitoring
Iran MERS Cluster Linked To Umrah Pilgrim
Apparently added every four sisters are now isolated in hospital under observation , but one of them is extremely serious and was admitted in the ICU
The above translation provides more information on the cluster in Kerman, Iran. As expected, the cases are linked to a Kingdom of Saudi Arabia (KSA) pilgrim. Although it is unclear if contact was in KSA or Iran, the linkage signals yet another example of export and likely onward transmission, as was recently described for two pilgrims from The Netherlands.
In that cluster the index case (70M) developed symptoms after a visit to a hospital in Medina. His travel companion (73F) developed symptoms after they arrived in Mecca. Sequences from both cases matched each other as well as the health care worked (HCW) from Riyadh who exported MERS to Munster, Indiana, with onward transmission to Chicago. Illinois via casual contact.
The presence of the same sub-clade in the cluster in The Netherlands and the United States increases concerns that this sub-clade is common in Riyadh and Medina, where explosions of cases have been reported. The spike in MERS cases in these two cities is similar to reports on cases in Mecca and Jeddah.
However, sequences from Mecca and Jeddah form a second sub-clade which matches exports to Athens, Greece and Orlando, Florida. In contrast to the Jeddah/Mecca sub-clade, no sequences have been released from the almost 140 Riyadh cases or the 30 Medina cases. Instead the CDC in the United States and EMC in The Netherlands released sequences from these exports.
The Indiana sequence was complete and included a stop codon at position 78 in ORF 8b, generating a truncated protein. This disruption is similar to the 29 nt deletion in SARS-CoV, which also affected ORF 8b and was linked to the worldwide spread of SARS and the presence of the 29 nt deletion in virtually all human cases reported in early 2003, post the Metropole Hotel incident on February 20-21, 2003 (see 9th floor layout).
The clustering of the cases in the United States and the Netherlands raises concerns that the same sub-clade has caused the cluster in Iran, and poses a serious threat to pilgrims planning travel to KSA for Ramadan, which begins in a month.
The failure to release any MERS sequences from Riyadh or Medina is hazardous to the world’s health.