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Betacornavirus Cluster Raises Pandemic Concerns
Recombinomics Commentary 18:30
November 23, 2012

So far, only the two most recently confirmed cases in Saudi Arabia are epidemiologically linked - they are from the same family, living in the same household. Preliminary investigations indicate that these 2 cases presented with similar symptoms of illness. One died and the other recovered.

Additionally, 2 other members of this family presented with similar symptoms of illness, where one died and the other is recovering. Laboratory results of the fatal case is pending, while the case that is recovering tested negative for the novel coronavirus.

The above comments are from the WHO update announcing 4 additional confirmed novel betacoronavirus cases (in addition to the two confirmed cases in Saudi Arabia and Qatar).  Three of these cases have been noted in earlier media reports.  The first case was reported earlier this month.  Little information was provided, but the case was identified at a Riyadh hospital, had been on a ventilator, and recovered.  The description of the second case was limited, but similar.  That case was recently announced by the Saudi Arabia Ministry of Health, was also hospitalized in Riyadh, and also recovered. The third recent case was described at the Robert Koch Institute website.  That case was from Qatar, was hospitalized last month, and recovered.

Thus, the recent fatal confirmed case would be a case epidemiologically linked to the recent case in Riyadh, and the linkage would support human transmission, which is further supported by the description of the two additional family members described above.  Thus, this cluster would involve four family members, including two who were confirmed and two who died.  Although one of the symptomatic cases tested negative, this result is likely a false negative linked to sample collection or test sensitivity.  A new PCR test has been developed, which is based on two regions of the novel coronavirus, which should have greater sensitivity than the pan-coronaviris PCR test, which alos yielded negative results for symptomatic contacts of the first Qatar case.  Testing of contacts should use the new PCR test as well as culturing and/or direct sequencing of relevant samples.

The above cluster is not a surprise.  Full sequences from the first two confirmed cases have been made public, and these sequences are 99.5% identical, but have more than 10% mismatching with all other coronvirus sequences.  These first two cases had renal failure, which was also seen in about 5% of SARS-CoV cases, suggesting that the first two cases represent a subset of cases which were severe (and likely had a high level of viral RNA).

The latest cluster suggests that testing is now more sensitive or the novel betacornavirus is spreading more efficiently in humans.  More detail on this cluster, including release of sequences from these cases would be useful.

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