At Epidemic - Molecular
Epidemiology and Evolution of Viral Pathogens, Andrew Rambaut has compiled a
list of 21 recently reported sequences of the Middle East Respiratory
Coronavirus (MERS-CoV) from the Kingdom of Saudi Arabia (KSA).
Lacking age and sex, and only having the collection date
makes it difficult to correlate the sequence samples with previous, individually
identified cases in the KSA. For provinces and cities in KSA that have only a
few reported MERS-CoV cases, correlation of the sequences with individual cases
is straight forward as the sample name is a clue to the geographic location.
For several of the recently released sequences, case
information is provided below.
Bisha_1_2012 is likely from the 60-year-old-male from the
town of Bisha in Asir Province. He experienced onset on June 6, 2012, was
hospitalized on June 13, 2012 and died on June 24, 2012. He is not reported as
part of any cluster of cases.
Riyadh_1_2012 is likely from a retired 70-year-old male from
Riyadh who is reported to have experienced onset on October 5, 2012, was hospitalized
on October, 13, 2012 and died on October 23, 2012. He is one of two individuals
reported as a family cluster (see Riyadh_2_2012 below).
Riyadh_2_2012 is likely from a 39-year-old male factory
worker from Riyadh who is reported to have experienced onset on October 24,
2012, was hospitalized on October 28, 2013 and died on November 2, 2012. He is possibly
the son of the individual who represents sample Riyadh_1_2012.
Riyadh_3_2013 seems to be a sample collected in February of
2013 from one of three brothers from Riyadh who were infected with MERS-CoV. All
three brothers lived in one large house with 10 other adults. The 51-year-old
male was being treated in a Riyadh hospital when he apparently experienced onset
from MERS-CoV on February 13, 2013. He
died on February 24, 2013. This cluster of 3 cases is reported in the September
issue of the International Journal of
Infectious Diseases. Apparently only two household members, two brothers of the index case, were infected, a 39-
year-old and a 40-year-old. The 39-year-old
died on March 2, and the other individual recovered.
WHO confirmed the
39-year-old in an update published on March 12, 2013. The 40-year-old was reported by WHO on March
23, 2013 as a recovered individual who had contact with a previous case (his
brother[s]). The 51-year-old male was not
reported by WHO until August 28, 2013.
WHO did not identify these three cases as a family cluster.
Buraidah_1_2013 may possibly be from a 63-year-old male from
the city of Buraydah in Al-Qassim
Province. The collection date for this
sample is May 13, 2013, however, the man is reported to have been hospitalized
on May 15, 2013 and died on May 20, 2013. He is not reported as part of a
cluster of cases and no other MERS-CoV cases have been officially reported from
Al-Qassim Province in May 2013. If
there are no reporting errors in the collection date or the dates of
hospitalization and death, then there is one additional unconfirmed,
unaccounted case from Al-Qassim Province.
Hafr Al-Batin_1_2013 is likely from a 21-year-old male from the
town of Hafar Al-Batin, in the Eastern Province. This case was reported in June
2013. He is not reported as part of a cluster of cases.
A large outbreak of MERS-CoV cases occurred in April and May
2013 in the Eastern Province of KSA.  At least 24 individuals were confirmed
cases and about half of them died. Most of infections occurred in nosocomial
settings in the city of Al-Hofuf (also referred as Al-Hasa), although some
cases were reported from a regional hospital more than 160 km away.
Without more details about the sequences it is not possible
to associate any Al-Hasa sequence with any specific individual from this
outbreak. However, the reported collection dates for the Al-Hasa samples all
fall after May 2, 2013. So it is unlikely that any of these sequences are from
the 5-6 individuals in the cluster who died before May 2, 2013.
It is not clear how representative these sequences are for
the range of MERS-CoV infections in the KSA.