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Sustained MERS Transmission From Saudi Arabia To Jordan
Recombinomics Commentary 18:00
June 04, 2014

The case is 26-year-old male health-care worker. He presented with fever on 23 May 2014. His condition deteriorated as he developed pneumonia and gastrointestinal symptoms and he was admitted to the hospital on 30 May 2014. A specimen was collected and tested positive for MERS-CoV on 31 May 2014. He is currently in a stable condition. He has no known comorbidities, but does have a history of contact with a laboratory confirmed MERS-CoV health-care worker case reported to WHO on 11 May 2014.

The above comments from today’s WHO MERS update describe the PCR confirmed quaternary transmission of MERS with disease onset dates extending from April 9 to May 23, raising serious sustained transmission from Jeddah, Kingdom of Saudi Arabia (KSA) to Amman, Jordan.  The index case (25M) developed symptoms in Al Grayat (Al Quarayyat in Al Jawf province) on April 9, shortly after travel through Jeddah and Mecca.  He was locally hospitalized between April 10-14, where he was diagnosed with pneumonia.  He then traveled to Amman, Jordan where he was MERS PCR confirmed.  His asymptomatic brother (28M) and a paramedic contact (28M) were then PCR confirmed on a sample collected on May 22 from the brother, and a sample collected after the paramedic developed symptoms on May 22.  A tertiary case (50M HCW) who was a contact of both secondary cases, developed symptoms on May 7 and was also PCR confirmed.  The quaternary case, 26M HCW, developed symptoms on May 23 and was also PCR confirmed, raising sustained transmission concerns.

Since all symptomatic cases in the transmission chain were HCWs in Amman, Jordan, one or more cases may have been infected by an unknown/unreported case.  However, each WHO update notes the linkage to the prior confirmed case, suggesting the prior case was the source of the infection.  Since the index case was likely infected in Jeddah or Mecca, and 8 of 8 sequences linked to those two city are the same sub-clade, sequence data should determine the source of the MERS in the index case, and matches with the index case would support the transmission chain described above.

The lack of any sequence data from the explosion of MERS KSA cases in Jeddah, Mecca, Medina, and Riyadh, which have collection dates after April 15, is scandalous and a hazard to the world’s health.

These sequences should be released immediately.

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