Epidemiology of a Novel Recombinant MERS-CoV in Humans in Saudi Arabia.

Assiri AM1, Midgley CM2, Abedi GR3, Bin Saeed A4, Almasri MM1, Lu X3, Al-Abdely HM1, Abdalla O1, Mohammed M1, Algarni HS1, Alhakeem RF1,Sakthivel SK3, Nooh R5, Alshayab Z5, Alessa M5, Srinivasamoorthy G3, AlQahtani SY1, Kheyami A1, HajOmar WH1, Banaser TM1, Esmaeel A1, Hall AJ3,Curns AT3, Tamin A3, Alsharef AA1, Erdman D3, Watson JT3, Gerber SI3.

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Abstract

BACKGROUND:

The Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe respiratory illness in humans. Fundamental questions about circulating viruses and transmission routes remain.

METHODS:

We assessed routinely collected epidemiologic data for MERS-CoV cases reported in Saudi Arabia during January 01 - June 30, 2015, and conducted a more detailed investigation of cases reported during February 2015. Available respiratory specimens were obtained for sequencing.

RESULTS:

During the study period, 216 MERS-CoV cases were reported. Spike gene or full genome sequences (n=17) were obtained from 99 individuals. Most (72 of 99, 73%) sequences formed a discrete, novel recombinant clade (NRC-2015), which was detected in 6 regions and became predominant by June, 2015. No clinical differences were noted between clades. Among 87 cases reported during February 2015, 13 had no recognized risks for secondary acquisition; 12 of these 13 also denied camel contact. Most viruses (8 of 9) from these 13 individuals belonged to NRC-2015.

DISCUSSION:

Our findings document the spread and eventual predominance of NRC-2015 in humans in Saudi Arabia during the first half of 2015. Our identification of cases without recognized risk factors but with similar virus sequences suggests that additional study is needed to better understand risk factors for MERS-CoV infection.

Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.