Community case clusters of Middle East respiratory syndrome coronavirus in Hafr Al-Batin, Kingdom of Saudi Arabia: a descriptive genomic study.
The Middle East respiratory syndrome coronavirus (MERS-CoV) was first described in September 2012 and to date 86 deaths from a total of 206 cases of MERS-CoV infection have been reported to the WHO. Camels have been implicated as the reservoir of MERS-CoV, but the exact source and mode of transmission for most patients remain unknown. During a 3 month period, June to August 2013, there were 12 positive MERS-CoV cases reported from the Hafr Al-Batin region district in the north east region of the Kingdom of Saudi Arabia. In addition to the different regional camel festivals in neighboring countries, Hafr Al-Batin has the biggest camel market in the entire Kingdom and hosts an annual camel festival. Thus, we conducted a detailed epidemiological, clinical and genomic study to ascertain common exposure and transmission patterns of all cases of MERS-CoV reported from Hafr Al-Batin. Analysis of previously reported genetic data indicated that at least two of the infected contacts could not have been directly infected from the index patient and alternate source should be considered. While camels appear as the likely source, other sources have not been ruled out. More detailed case control studies with detailed case histories, epidemiological information and genomic analysis are being conducted to delineate the missing pieces in the transmission dynamics of MERS-CoV outbreak.
Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia (KSA); College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia. Electronic address: zmemish@yahoo.com.
Ziad A
ZA
Memish
Wellcome Trust Sanger Institute, Hinxton, United Kingdom.
Matthew
M
Cotten
Wellcome Trust Sanger Institute, Hinxton, United Kingdom.
Simon J
SJ
Watson
Wellcome Trust Sanger Institute, Hinxton, United Kingdom; Division of Infection and Immunity, University College London, and UCL Hospitals NHS Foundation Trust, London, United Kingdom.
Paul
P
Kellam
Division of Infection and Immunity, University College London, and UCL Hospitals NHS Foundation Trust, London, United Kingdom.
Alimuddin
A
Zumla
Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia (KSA).
Rafat F
RF
Alhakeem
Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia (KSA).
Abdullah
A
Assiri
Global Centre for Mass Gatherings Medicine (GCMGM), Ministry of Health, Riyadh, Kingdom of Saudi Arabia (KSA).
Abdullah A Al
AA
Rabeeah
Saudi Aramco Medical Services Organization, Saudi Aramco, Dhahran, Kingdom of Saudi Arabia and Indiana University School of Medicine, Indianapolis, IN (USA).
Jaffar A
JA
Al-Tawfiq
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002162:Camelus / Q000821:virology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D016358:Contact Tracing; D018352:Coronavirus Infections / Q000453:epidemiology* / Q000635:transmission; D005260:Female; D016679:Genome, Viral; D006801:Humans; D008297:Male; D008875:Middle Aged; D065207:Middle East Respiratory Syndrome Coronavirus / Q000235:genetics* / Q000302:isolation & purification*; D010802:Phylogeny; D012529:Saudi Arabia / Q000453:epidemiology; D055815:Young Adult
Clusters; Community; Coronavirus; Genome; MERS-CoV; Middle East; Phylogeny; Virus transmission