Epidemiology of a Novel Recombinant Middle East Respiratory Syndrome Coronavirus in Humans in Saudi Arabia
Identifieur interne : 000B77 ( Pmc/Checkpoint ); précédent : 000B76; suivant : 000B78Epidemiology of a Novel Recombinant Middle East Respiratory Syndrome Coronavirus in Humans in Saudi Arabia
Auteurs : Abdullah M. Assiri ; Claire M. Midgley [Géorgie (pays)] ; Glen R. Abedi ; Abdulaziz Bin Saeed ; Malak M. Almasri ; Xiaoyan Lu ; Hail M. Al-Abdely ; Osman Abdalla ; Mutaz Mohammed ; Homoud S. Algarni ; Raafat F. Alhakeem ; Senthilkumar K. Sakthivel ; Randa Nooh ; Zainab Alshayab ; Mohammad Alessa ; Ganesh Srinivasamoorthy ; Saeed Yahya Alqahtani ; Ali Kheyami ; Waleed Husein Hajomar ; Talib M. Banaser ; Ahmad Esmaeel ; Aron J. Hall ; Aaron T. Curns ; Azaibi Tamin ; Ali Abraheem Alsharef ; Dean Erdman ; John T. Watson ; Susan I. GerberSource :
- The Journal of Infectious Diseases [ 0022-1899 ] ; 2016.
Abstract
Url:
DOI: 10.1093/infdis/jiw236
PubMed: 27302191
PubMed Central: 5712457
Affiliations:
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PMC:5712457Le document en format XML
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<author><name sortKey="Bin Saeed, Abdulaziz" sort="Bin Saeed, Abdulaziz" uniqKey="Bin Saeed A" first="Abdulaziz" last="Bin Saeed">Abdulaziz Bin Saeed</name>
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<author><name sortKey="Almasri, Malak M" sort="Almasri, Malak M" uniqKey="Almasri M" first="Malak M." last="Almasri">Malak M. Almasri</name>
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<author><name sortKey="Al Abdely, Hail M" sort="Al Abdely, Hail M" uniqKey="Al Abdely H" first="Hail M." last="Al-Abdely">Hail M. Al-Abdely</name>
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<author><name sortKey="Abdalla, Osman" sort="Abdalla, Osman" uniqKey="Abdalla O" first="Osman" last="Abdalla">Osman Abdalla</name>
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<author><name sortKey="Mohammed, Mutaz" sort="Mohammed, Mutaz" uniqKey="Mohammed M" first="Mutaz" last="Mohammed">Mutaz Mohammed</name>
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<author><name sortKey="Algarni, Homoud S" sort="Algarni, Homoud S" uniqKey="Algarni H" first="Homoud S." last="Algarni">Homoud S. Algarni</name>
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<author><name sortKey="Alhakeem, Raafat F" sort="Alhakeem, Raafat F" uniqKey="Alhakeem R" first="Raafat F." last="Alhakeem">Raafat F. Alhakeem</name>
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<author><name sortKey="Sakthivel, Senthilkumar K" sort="Sakthivel, Senthilkumar K" uniqKey="Sakthivel S" first="Senthilkumar K." last="Sakthivel">Senthilkumar K. Sakthivel</name>
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<author><name sortKey="Nooh, Randa" sort="Nooh, Randa" uniqKey="Nooh R" first="Randa" last="Nooh">Randa Nooh</name>
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<author><name sortKey="Alshayab, Zainab" sort="Alshayab, Zainab" uniqKey="Alshayab Z" first="Zainab" last="Alshayab">Zainab Alshayab</name>
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<author><name sortKey="Alessa, Mohammad" sort="Alessa, Mohammad" uniqKey="Alessa M" first="Mohammad" last="Alessa">Mohammad Alessa</name>
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<wicri:noCountry code="nlm country">Kingdom of Saudi Arabia</wicri:noCountry>
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<author><name sortKey="Srinivasamoorthy, Ganesh" sort="Srinivasamoorthy, Ganesh" uniqKey="Srinivasamoorthy G" first="Ganesh" last="Srinivasamoorthy">Ganesh Srinivasamoorthy</name>
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<author><name sortKey="Alqahtani, Saeed Yahya" sort="Alqahtani, Saeed Yahya" uniqKey="Alqahtani S" first="Saeed Yahya" last="Alqahtani">Saeed Yahya Alqahtani</name>
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<author><name sortKey="Hajomar, Waleed Husein" sort="Hajomar, Waleed Husein" uniqKey="Hajomar W" first="Waleed Husein" last="Hajomar">Waleed Husein Hajomar</name>
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<author><name sortKey="Banaser, Talib M" sort="Banaser, Talib M" uniqKey="Banaser T" first="Talib M." last="Banaser">Talib M. Banaser</name>
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</affiliation>
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<author><name sortKey="Alsharef, Ali Abraheem" sort="Alsharef, Ali Abraheem" uniqKey="Alsharef A" first="Ali Abraheem" last="Alsharef">Ali Abraheem Alsharef</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Epidemiology of a Novel Recombinant Middle East Respiratory Syndrome Coronavirus in Humans in Saudi Arabia</title>
<author><name sortKey="Assiri, Abdullah M" sort="Assiri, Abdullah M" uniqKey="Assiri A" first="Abdullah M." last="Assiri">Abdullah M. Assiri</name>
<affiliation><nlm:aff id="af1"><institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Midgley, Claire M" sort="Midgley, Claire M" uniqKey="Midgley C" first="Claire M." last="Midgley">Claire M. Midgley</name>
<affiliation><nlm:aff id="af4"><addr-line>Division of Viral Diseases, National Center for Immunization and Respiratory Diseases</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">National Center for Immunization and Respiratory Diseases</wicri:noCountry>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="af5"><addr-line>Epidemic Intelligence Service</addr-line>
,<institution>Centers for Disease Control and Prevention</institution>
,<addr-line>Atlanta, Georgia</addr-line>
</nlm:aff>
<country xml:lang="fr">Géorgie (pays)</country>
<wicri:regionArea>Atlanta</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Abedi, Glen R" sort="Abedi, Glen R" uniqKey="Abedi G" first="Glen R." last="Abedi">Glen R. Abedi</name>
<affiliation><nlm:aff id="af4"><addr-line>Division of Viral Diseases, National Center for Immunization and Respiratory Diseases</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">National Center for Immunization and Respiratory Diseases</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Bin Saeed, Abdulaziz" sort="Bin Saeed, Abdulaziz" uniqKey="Bin Saeed A" first="Abdulaziz" last="Bin Saeed">Abdulaziz Bin Saeed</name>
<affiliation><nlm:aff id="af1"><institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="af2"><addr-line>Department of Family and Community Medicine</addr-line>
,<institution>King Saud Medical City</institution>
</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Almasri, Malak M" sort="Almasri, Malak M" uniqKey="Almasri M" first="Malak M." last="Almasri">Malak M. Almasri</name>
<affiliation><nlm:aff id="af1"><institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Lu, Xiaoyan" sort="Lu, Xiaoyan" uniqKey="Lu X" first="Xiaoyan" last="Lu">Xiaoyan Lu</name>
<affiliation><nlm:aff id="af4"><addr-line>Division of Viral Diseases, National Center for Immunization and Respiratory Diseases</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">National Center for Immunization and Respiratory Diseases</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Al Abdely, Hail M" sort="Al Abdely, Hail M" uniqKey="Al Abdely H" first="Hail M." last="Al-Abdely">Hail M. Al-Abdely</name>
<affiliation><nlm:aff id="af1"><institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Abdalla, Osman" sort="Abdalla, Osman" uniqKey="Abdalla O" first="Osman" last="Abdalla">Osman Abdalla</name>
<affiliation><nlm:aff id="af1"><institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Mohammed, Mutaz" sort="Mohammed, Mutaz" uniqKey="Mohammed M" first="Mutaz" last="Mohammed">Mutaz Mohammed</name>
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</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Algarni, Homoud S" sort="Algarni, Homoud S" uniqKey="Algarni H" first="Homoud S." last="Algarni">Homoud S. Algarni</name>
<affiliation><nlm:aff id="af1"><institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Alhakeem, Raafat F" sort="Alhakeem, Raafat F" uniqKey="Alhakeem R" first="Raafat F." last="Alhakeem">Raafat F. Alhakeem</name>
<affiliation><nlm:aff id="af1"><institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Sakthivel, Senthilkumar K" sort="Sakthivel, Senthilkumar K" uniqKey="Sakthivel S" first="Senthilkumar K." last="Sakthivel">Senthilkumar K. Sakthivel</name>
<affiliation><nlm:aff id="af4"><addr-line>Division of Viral Diseases, National Center for Immunization and Respiratory Diseases</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">National Center for Immunization and Respiratory Diseases</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Nooh, Randa" sort="Nooh, Randa" uniqKey="Nooh R" first="Randa" last="Nooh">Randa Nooh</name>
<affiliation><nlm:aff id="af1"><institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="af3"><addr-line>Field Epidemiology Training Program, Ministry of Health, Riyadh</addr-line>
,<country>Kingdom of Saudi Arabia</country>
</nlm:aff>
<wicri:noCountry code="nlm country">Kingdom of Saudi Arabia</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Alshayab, Zainab" sort="Alshayab, Zainab" uniqKey="Alshayab Z" first="Zainab" last="Alshayab">Zainab Alshayab</name>
<affiliation><nlm:aff id="af1"><institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="af3"><addr-line>Field Epidemiology Training Program, Ministry of Health, Riyadh</addr-line>
,<country>Kingdom of Saudi Arabia</country>
</nlm:aff>
<wicri:noCountry code="nlm country">Kingdom of Saudi Arabia</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Alessa, Mohammad" sort="Alessa, Mohammad" uniqKey="Alessa M" first="Mohammad" last="Alessa">Mohammad Alessa</name>
<affiliation><nlm:aff id="af1"><institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="af3"><addr-line>Field Epidemiology Training Program, Ministry of Health, Riyadh</addr-line>
,<country>Kingdom of Saudi Arabia</country>
</nlm:aff>
<wicri:noCountry code="nlm country">Kingdom of Saudi Arabia</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Srinivasamoorthy, Ganesh" sort="Srinivasamoorthy, Ganesh" uniqKey="Srinivasamoorthy G" first="Ganesh" last="Srinivasamoorthy">Ganesh Srinivasamoorthy</name>
<affiliation><nlm:aff id="af4"><addr-line>Division of Viral Diseases, National Center for Immunization and Respiratory Diseases</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">National Center for Immunization and Respiratory Diseases</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Alqahtani, Saeed Yahya" sort="Alqahtani, Saeed Yahya" uniqKey="Alqahtani S" first="Saeed Yahya" last="Alqahtani">Saeed Yahya Alqahtani</name>
<affiliation><nlm:aff id="af1"><institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Kheyami, Ali" sort="Kheyami, Ali" uniqKey="Kheyami A" first="Ali" last="Kheyami">Ali Kheyami</name>
<affiliation><nlm:aff id="af1"><institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Hajomar, Waleed Husein" sort="Hajomar, Waleed Husein" uniqKey="Hajomar W" first="Waleed Husein" last="Hajomar">Waleed Husein Hajomar</name>
<affiliation><nlm:aff id="af1"><institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Banaser, Talib M" sort="Banaser, Talib M" uniqKey="Banaser T" first="Talib M." last="Banaser">Talib M. Banaser</name>
<affiliation><nlm:aff id="af1"><institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Esmaeel, Ahmad" sort="Esmaeel, Ahmad" uniqKey="Esmaeel A" first="Ahmad" last="Esmaeel">Ahmad Esmaeel</name>
<affiliation><nlm:aff id="af1"><institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Hall, Aron J" sort="Hall, Aron J" uniqKey="Hall A" first="Aron J." last="Hall">Aron J. Hall</name>
<affiliation><nlm:aff id="af4"><addr-line>Division of Viral Diseases, National Center for Immunization and Respiratory Diseases</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">National Center for Immunization and Respiratory Diseases</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Curns, Aaron T" sort="Curns, Aaron T" uniqKey="Curns A" first="Aaron T." last="Curns">Aaron T. Curns</name>
<affiliation><nlm:aff id="af4"><addr-line>Division of Viral Diseases, National Center for Immunization and Respiratory Diseases</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">National Center for Immunization and Respiratory Diseases</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Tamin, Azaibi" sort="Tamin, Azaibi" uniqKey="Tamin A" first="Azaibi" last="Tamin">Azaibi Tamin</name>
<affiliation><nlm:aff id="af4"><addr-line>Division of Viral Diseases, National Center for Immunization and Respiratory Diseases</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">National Center for Immunization and Respiratory Diseases</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Alsharef, Ali Abraheem" sort="Alsharef, Ali Abraheem" uniqKey="Alsharef A" first="Ali Abraheem" last="Alsharef">Ali Abraheem Alsharef</name>
<affiliation><nlm:aff id="af1"><institution>Ministry of Health</institution>
</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Erdman, Dean" sort="Erdman, Dean" uniqKey="Erdman D" first="Dean" last="Erdman">Dean Erdman</name>
<affiliation><nlm:aff id="af4"><addr-line>Division of Viral Diseases, National Center for Immunization and Respiratory Diseases</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">National Center for Immunization and Respiratory Diseases</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Watson, John T" sort="Watson, John T" uniqKey="Watson J" first="John T." last="Watson">John T. Watson</name>
<affiliation><nlm:aff id="af4"><addr-line>Division of Viral Diseases, National Center for Immunization and Respiratory Diseases</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">National Center for Immunization and Respiratory Diseases</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Gerber, Susan I" sort="Gerber, Susan I" uniqKey="Gerber S" first="Susan I." last="Gerber">Susan I. Gerber</name>
<affiliation><nlm:aff id="af4"><addr-line>Division of Viral Diseases, National Center for Immunization and Respiratory Diseases</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">National Center for Immunization and Respiratory Diseases</wicri:noCountry>
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</author>
</analytic>
<series><title level="j">The Journal of Infectious Diseases</title>
<idno type="ISSN">0022-1899</idno>
<idno type="eISSN">1537-6613</idno>
<imprint><date when="2016">2016</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><title>Abstract</title>
<p><bold><italic>Background.</italic>
</bold>
Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe respiratory illness in humans. Fundamental questions about circulating viruses and transmission routes remain.</p>
<p><bold><italic>Methods.</italic>
</bold>
We assessed routinely collected epidemiologic data for MERS-CoV cases reported in Saudi Arabia during 1 January–30 June 2015 and conducted a more detailed investigation of cases reported during February 2015. Available respiratory specimens were obtained for sequencing.</p>
<p><bold><italic>Results.</italic>
</bold>
During the study period, 216 MERS-CoV cases were reported. Full genome (n = 17) or spike gene sequences (n = 82) were obtained from 99 individuals. Most sequences (72 of 99 [73%]) formed a discrete, novel recombinant subclade (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.</p>
<p><bold><italic>Discussions.</italic>
</bold>
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 indicates the need for better understanding of risk factors for MERS-CoV transmission.</p>
</div>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Infect Dis</journal-id>
<journal-id journal-id-type="iso-abbrev">J. Infect. Dis</journal-id>
<journal-id journal-id-type="publisher-id">jid</journal-id>
<journal-id journal-id-type="hwp">jinfdis</journal-id>
<journal-title-group><journal-title>The Journal of Infectious Diseases</journal-title>
</journal-title-group>
<issn pub-type="ppub">0022-1899</issn>
<issn pub-type="epub">1537-6613</issn>
<publisher><publisher-name>Oxford University Press</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">27302191</article-id>
<article-id pub-id-type="pmc">5712457</article-id>
<article-id pub-id-type="doi">10.1093/infdis/jiw236</article-id>
<article-id pub-id-type="publisher-id">jiw236</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Major Articles and Brief Reports</subject>
<subj-group subj-group-type="category-toc-heading"><subject>Viruses</subject>
</subj-group>
</subj-group>
<subj-group subj-group-type="category-oup-series"><subject>Editor's Choice</subject>
</subj-group>
</article-categories>
<title-group><article-title>Epidemiology of a Novel Recombinant Middle East Respiratory Syndrome Coronavirus in Humans in Saudi Arabia</article-title>
</title-group>
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</contrib>
<contrib contrib-type="author"><name><surname>Alsharef</surname>
<given-names>Ali Abraheem</given-names>
</name>
<xref ref-type="aff" rid="af1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Erdman</surname>
<given-names>Dean</given-names>
</name>
<xref ref-type="aff" rid="af4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Watson</surname>
<given-names>John T.</given-names>
</name>
<xref ref-type="aff" rid="af4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gerber</surname>
<given-names>Susan I.</given-names>
</name>
<xref ref-type="aff" rid="af4">4</xref>
</contrib>
</contrib-group>
<aff id="af1"><label>1</label>
<institution>Ministry of Health</institution>
</aff>
<aff id="af2"><label>2</label>
<addr-line>Department of Family and Community Medicine</addr-line>
,<institution>King Saud Medical City</institution>
</aff>
<aff id="af3"><label>3</label>
<addr-line>Field Epidemiology Training Program, Ministry of Health, Riyadh</addr-line>
,<country>Kingdom of Saudi Arabia</country>
</aff>
<aff id="af4"><label>4</label>
<addr-line>Division of Viral Diseases, National Center for Immunization and Respiratory Diseases</addr-line>
</aff>
<aff id="af5"><label>5</label>
<addr-line>Epidemic Intelligence Service</addr-line>
,<institution>Centers for Disease Control and Prevention</institution>
,<addr-line>Atlanta, Georgia</addr-line>
</aff>
<author-notes><corresp id="d829e311">Correspondence: C. M. Midgley, Centers for Disease Control and Prevention, Atlanta, GA (<email>ydk5@cdc.gov</email>
).</corresp>
</author-notes>
<pub-date pub-type="ppub"><day>01</day>
<month>9</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="epub" iso-8601-date="2016-06-14"><day>14</day>
<month>6</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>14</day>
<month>6</month>
<year>2016</year>
</pub-date>
<pmc-comment> PMC Release delay is 0 months and 0 days and was based on the . </pmc-comment>
<volume>214</volume>
<issue>5</issue>
<fpage>712</fpage>
<lpage>721</lpage>
<history><date date-type="received"><day>9</day>
<month>2</month>
<year>2016</year>
</date>
<date date-type="accepted"><day>25</day>
<month>4</month>
<year>2016</year>
</date>
</history>
<permissions><copyright-statement>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.</copyright-statement>
<copyright-year>2016</copyright-year>
<license><license-p>This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.</license-p>
</license>
</permissions>
<self-uri xlink:href="jiw236.pdf"></self-uri>
<abstract><title>Abstract</title>
<p><bold><italic>Background.</italic>
</bold>
Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe respiratory illness in humans. Fundamental questions about circulating viruses and transmission routes remain.</p>
<p><bold><italic>Methods.</italic>
</bold>
We assessed routinely collected epidemiologic data for MERS-CoV cases reported in Saudi Arabia during 1 January–30 June 2015 and conducted a more detailed investigation of cases reported during February 2015. Available respiratory specimens were obtained for sequencing.</p>
<p><bold><italic>Results.</italic>
</bold>
During the study period, 216 MERS-CoV cases were reported. Full genome (n = 17) or spike gene sequences (n = 82) were obtained from 99 individuals. Most sequences (72 of 99 [73%]) formed a discrete, novel recombinant subclade (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.</p>
<p><bold><italic>Discussions.</italic>
</bold>
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 indicates the need for better understanding of risk factors for MERS-CoV transmission.</p>
</abstract>
<kwd-group><kwd>Middle East respiratory syndrome</kwd>
<kwd>MERS</kwd>
<kwd>coronavirus</kwd>
<kwd>MERS epidemiology</kwd>
<kwd>MERS transmission</kwd>
<kwd>MERS phylogeny</kwd>
<kwd>recombinant</kwd>
<kwd>Saudi Arabia</kwd>
</kwd-group>
<funding-group><award-group><funding-source><named-content content-type="funder-name">Saudi Arabia Ministry of Health</named-content>
</funding-source>
</award-group>
<award-group><funding-source><named-content content-type="funder-name">CDC as part of an emergency response</named-content>
</funding-source>
</award-group>
</funding-group>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Géorgie (pays)</li>
</country>
</list>
<tree><noCountry><name sortKey="Abdalla, Osman" sort="Abdalla, Osman" uniqKey="Abdalla O" first="Osman" last="Abdalla">Osman Abdalla</name>
<name sortKey="Abedi, Glen R" sort="Abedi, Glen R" uniqKey="Abedi G" first="Glen R." last="Abedi">Glen R. Abedi</name>
<name sortKey="Al Abdely, Hail M" sort="Al Abdely, Hail M" uniqKey="Al Abdely H" first="Hail M." last="Al-Abdely">Hail M. Al-Abdely</name>
<name sortKey="Alessa, Mohammad" sort="Alessa, Mohammad" uniqKey="Alessa M" first="Mohammad" last="Alessa">Mohammad Alessa</name>
<name sortKey="Algarni, Homoud S" sort="Algarni, Homoud S" uniqKey="Algarni H" first="Homoud S." last="Algarni">Homoud S. Algarni</name>
<name sortKey="Alhakeem, Raafat F" sort="Alhakeem, Raafat F" uniqKey="Alhakeem R" first="Raafat F." last="Alhakeem">Raafat F. Alhakeem</name>
<name sortKey="Almasri, Malak M" sort="Almasri, Malak M" uniqKey="Almasri M" first="Malak M." last="Almasri">Malak M. Almasri</name>
<name sortKey="Alqahtani, Saeed Yahya" sort="Alqahtani, Saeed Yahya" uniqKey="Alqahtani S" first="Saeed Yahya" last="Alqahtani">Saeed Yahya Alqahtani</name>
<name sortKey="Alsharef, Ali Abraheem" sort="Alsharef, Ali Abraheem" uniqKey="Alsharef A" first="Ali Abraheem" last="Alsharef">Ali Abraheem Alsharef</name>
<name sortKey="Alshayab, Zainab" sort="Alshayab, Zainab" uniqKey="Alshayab Z" first="Zainab" last="Alshayab">Zainab Alshayab</name>
<name sortKey="Assiri, Abdullah M" sort="Assiri, Abdullah M" uniqKey="Assiri A" first="Abdullah M." last="Assiri">Abdullah M. Assiri</name>
<name sortKey="Banaser, Talib M" sort="Banaser, Talib M" uniqKey="Banaser T" first="Talib M." last="Banaser">Talib M. Banaser</name>
<name sortKey="Bin Saeed, Abdulaziz" sort="Bin Saeed, Abdulaziz" uniqKey="Bin Saeed A" first="Abdulaziz" last="Bin Saeed">Abdulaziz Bin Saeed</name>
<name sortKey="Curns, Aaron T" sort="Curns, Aaron T" uniqKey="Curns A" first="Aaron T." last="Curns">Aaron T. Curns</name>
<name sortKey="Erdman, Dean" sort="Erdman, Dean" uniqKey="Erdman D" first="Dean" last="Erdman">Dean Erdman</name>
<name sortKey="Esmaeel, Ahmad" sort="Esmaeel, Ahmad" uniqKey="Esmaeel A" first="Ahmad" last="Esmaeel">Ahmad Esmaeel</name>
<name sortKey="Gerber, Susan I" sort="Gerber, Susan I" uniqKey="Gerber S" first="Susan I." last="Gerber">Susan I. Gerber</name>
<name sortKey="Hajomar, Waleed Husein" sort="Hajomar, Waleed Husein" uniqKey="Hajomar W" first="Waleed Husein" last="Hajomar">Waleed Husein Hajomar</name>
<name sortKey="Hall, Aron J" sort="Hall, Aron J" uniqKey="Hall A" first="Aron J." last="Hall">Aron J. Hall</name>
<name sortKey="Kheyami, Ali" sort="Kheyami, Ali" uniqKey="Kheyami A" first="Ali" last="Kheyami">Ali Kheyami</name>
<name sortKey="Lu, Xiaoyan" sort="Lu, Xiaoyan" uniqKey="Lu X" first="Xiaoyan" last="Lu">Xiaoyan Lu</name>
<name sortKey="Mohammed, Mutaz" sort="Mohammed, Mutaz" uniqKey="Mohammed M" first="Mutaz" last="Mohammed">Mutaz Mohammed</name>
<name sortKey="Nooh, Randa" sort="Nooh, Randa" uniqKey="Nooh R" first="Randa" last="Nooh">Randa Nooh</name>
<name sortKey="Sakthivel, Senthilkumar K" sort="Sakthivel, Senthilkumar K" uniqKey="Sakthivel S" first="Senthilkumar K." last="Sakthivel">Senthilkumar K. Sakthivel</name>
<name sortKey="Srinivasamoorthy, Ganesh" sort="Srinivasamoorthy, Ganesh" uniqKey="Srinivasamoorthy G" first="Ganesh" last="Srinivasamoorthy">Ganesh Srinivasamoorthy</name>
<name sortKey="Tamin, Azaibi" sort="Tamin, Azaibi" uniqKey="Tamin A" first="Azaibi" last="Tamin">Azaibi Tamin</name>
<name sortKey="Watson, John T" sort="Watson, John T" uniqKey="Watson J" first="John T." last="Watson">John T. Watson</name>
</noCountry>
<country name="Géorgie (pays)"><noRegion><name sortKey="Midgley, Claire M" sort="Midgley, Claire M" uniqKey="Midgley C" first="Claire M." last="Midgley">Claire M. Midgley</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>
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