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Qatari MERS-CoV Case Raises Ramadan Concerns
Recombinomics Commentary 08:15
August 21, 2013

The Supreme Council of Health in Qatar Tuesday for the registration of new cases of Corona virus that causes respiratory syndrome Middle East, a patient diagonal at the age of 59 years. The council said in a press statement Tuesday that "the patient was out of the country and felt symptoms before coming to the state, and upon arrival it was detected and diagnosed with the disease in the National Influenza Laboratory." And, the statement said, "that the patient receives appropriate treatment currently is in stable condition."

The above translation describes the first MERS-CoV case (59M) identified in Qatar. 

However, the above case is the third Qatari to be MERS-CoV confirmed.  The first case (49M) developed mild symptoms while performing Umrah in the Kingdom of Saudi Arabia (KSA) during Ramadan, almost exactly one year ago.  He and companions developed mild symptoms while in KSA and his symptoms resolved after returning to Qatar.  However, symptoms returned 2 weeks after resolution and worsening symptoms led to transport to England via air ambulance.  The sequences from this case (England1) were 99.5% identical to the first confirmed (60M), EMC/12, confirmed a novel human coronavirus which was evolutionarily distinct from beta 2c coronavirus identified in prior and subsequent bat sequences

The second confirmed Qatari (45M) was also confirmed in 2012 and also was diagnosed in Europe.  He had not traveled outside of Qatar in the days prior to symptoms and the sequences (Essen, Germany) were most closely related to England1, suggesting both cases were infected in Qatar.

However, the above 2013 cases was diagnosed in Qatar, but developed symptoms while outside of the country, raising the possibility that his infection was linked to Ramadan pilgrims who would have been exiting KSA. 

Detail on the travel history of the above case and disease onset dates would be useful.

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