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Netherlands MERS Cluster Via Medina Casual Contact
Recombinomics Commentary 20:30
May 29, 2014

On 29 April, while still in good health, he accompanied his son to two hospitals (Hospitals 1 and 2), both in Medina, as the son had a minor health problem unrelated to MERS CoV. He spent 45 minutes in the waiting room, reportedly among many coughing people in Hospital 1. On 1 May, he experienced diarrhoea, nausea and anorexia and felt feverish, but had no respiratory complaints.

The above comments from a Eurosurveillance paper detailing the MERS cluster in The Netherlands involving pilgrims returning from Umrah in Medina and Mecca, support the earlier WHO update suggesting the index case was infected during a visit to a hospital in Medina.  However, the above detail suggests transmission was during a 45 minute stay in the hospital waiting room while his son was being examined.

This MERS brief exposure is similar to the casual contact in Chicago, Illinois where the confirmed MERS case from Munster, Indiana had a 30-40 minute encounter with a Cook County colleague (almost certainly in Chicago) followed by a 10-20 minute contact the following day.  Serological testing was ELISA and IFA positive, which is the published definition for MERS lab confirmation, CDC after the fact redefinitions notwithstanding.

The above paper noted the virtual identity between sequences from the above index case (70M) and his sister (73M) who shared a room with the index case and his adult son during the pilgrimage and the sequence from the Munster case,
Indiana/USA-1_Saudi Arabia_2014, as noted previously.

The sequence similarity led to discussions between the US CDC and Dutch experts, that failed to find any linkage between the two confirmed cases in The Netherlands and the index case in Munster, Indiana.  The similarity between the sequences in Munster, which were exported from Riyadh, and those in The Netherlands, which were exported from Medina suggest a Medina/Riyadh sub-clade has emerged and is widespread in both cities in the Kingdom of Saudi Arabia (KSA), which has reported record numbers of confirmed MERS cases in both cities.

However, in spite of the record number of cases and associated export to the United States and the Netherlands, the sequences from both KSA cities have been withheld.

These sequences should be released immediately.

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