An observational, laboratory-based study of outbreaks of middle East respiratory syndrome coronavirus in Jeddah and Riyadh, kingdom of Saudi Arabia, 2014.
Identifieur interne : 001812 ( PubMed/Curation ); précédent : 001811; suivant : 001813An observational, laboratory-based study of outbreaks of middle East respiratory syndrome coronavirus in Jeddah and Riyadh, kingdom of Saudi Arabia, 2014.
Auteurs : Christian Drosten [Allemagne] ; Doreen Muth ; Victor M. Corman [Allemagne] ; Raheela Hussain ; Malaki Al Masri ; Waleed Hajomar ; Olfert Landt [Allemagne] ; Abdullah Assiri ; Isabella Eckerle ; Ali Al Shangiti ; Jaffar A. Al-Tawfiq ; Ali Albarrak ; Alimuddin Zumla ; Andrew Rambaut [États-Unis] ; Ziad A. MemishSource :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [ 1537-6591 ] ; 2015.
Descripteurs français
- KwdFr :
- MESH :
- Wicri :
- geographic : Arabie saoudite.
English descriptors
- KwdEn :
- MESH :
- geographic : Saudi Arabia.
- epidemiology : Coronavirus Infections.
- genetics : Middle East Respiratory Syndrome Coronavirus.
- Base Sequence, Cross Infection, Disease Outbreaks, Humans, Molecular Sequence Data, Polymorphism, Single Nucleotide.
Abstract
In spring 2014, a sudden rise in the number of notified Middle East respiratory syndrome coronavirus (MERS-CoV) infections occurred across Saudi Arabia with a focus in Jeddah. Hypotheses to explain the outbreak pattern include increased surveillance, increased zoonotic transmission, nosocomial transmission, and changes in viral transmissibility, as well as diagnostic laboratory artifacts.
DOI: 10.1093/cid/ciu812
PubMed: 25323704
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Doreen Muth<affiliation><nlm:affiliation>Institute of Virology, University of Bonn Medical Centre.</nlm:affiliation><wicri:noCountry code="subField">University of Bonn Medical Centre</wicri:noCountry></affiliation><affiliation><nlm:affiliation>Jeddah Regional Laboratory.</nlm:affiliation><wicri:noCountry code="no comma">Jeddah Regional Laboratory.</wicri:noCountry></affiliation><affiliation><nlm:affiliation>Global Centre for Mass Gatherings Medicine.</nlm:affiliation><wicri:noCountry code="no comma">Global Centre for Mass Gatherings Medicine.</wicri:noCountry></affiliation><affiliation><nlm:affiliation>Regional Laboratory, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.</nlm:affiliation><wicri:noCountry code="subField">Kingdom of Saudi Arabia</wicri:noCountry></affiliation><affiliation><nlm:affiliation>Global Centre for Mass Gatherings Medicine.</nlm:affiliation><wicri:noCountry code="no comma">Global Centre for Mass Gatherings Medicine.</wicri:noCountry></affiliation><affiliation><nlm:affiliation>Institute of Virology, University of Bonn Medical Centre.</nlm:affiliation><wicri:noCountry code="subField">University of Bonn Medical Centre</wicri:noCountry></affiliation><affiliation><nlm:affiliation>Regional Laboratory, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.</nlm:affiliation><wicri:noCountry code="subField">Kingdom of Saudi Arabia</wicri:noCountry></affiliation><affiliation><nlm:affiliation>Johns Hopkins Aramco Healthcare, Saudi Aramco, Dhahran, Kingdom of Saudi Arabia Indiana University School of Medicine, Indianapolis.</nlm:affiliation><wicri:noCountry code="subField">Indianapolis</wicri:noCountry></affiliation><affiliation><nlm:affiliation>Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.</nlm:affiliation><wicri:noCountry code="subField">Kingdom of Saudi Arabia</wicri:noCountry></affiliation><affiliation><nlm:affiliation>Global Centre for Mass Gatherings Medicine Division of Infection and Immunity, University College London National Institute for Health Research Biomedical Research Centre, University College London Hospitals National Health Service Foundation Trust.</nlm:affiliation><wicri:noCountry code="subField">University College London Hospitals National Health Service Foundation Trust</wicri:noCountry></affiliation><affiliation><nlm:affiliation>Global Centre for Mass Gatherings Medicine Alfaisal University, Riyadh, Kingdom of Saudi Arabia.</nlm:affiliation><wicri:noCountry code="subField">Kingdom of Saudi Arabia</wicri:noCountry></affiliation>Le document en format XML
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Al-Tawfiq</name><affiliation><nlm:affiliation>Johns Hopkins Aramco Healthcare, Saudi Aramco, Dhahran, Kingdom of Saudi Arabia Indiana University School of Medicine, Indianapolis.</nlm:affiliation><wicri:noCountry code="subField">Indianapolis</wicri:noCountry></affiliation></author><author><name sortKey="Albarrak, Ali" sort="Albarrak, Ali" uniqKey="Albarrak A" first="Ali" last="Albarrak">Ali Albarrak</name><affiliation><nlm:affiliation>Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.</nlm:affiliation><wicri:noCountry code="subField">Kingdom of Saudi Arabia</wicri:noCountry></affiliation></author><author><name sortKey="Zumla, Alimuddin" sort="Zumla, Alimuddin" uniqKey="Zumla A" first="Alimuddin" last="Zumla">Alimuddin Zumla</name><affiliation><nlm:affiliation>Global Centre for Mass Gatherings Medicine Division of Infection and Immunity, University College London National Institute for Health Research Biomedical Research Centre, University College London Hospitals National Health Service Foundation Trust.</nlm:affiliation><wicri:noCountry code="subField">University College London Hospitals National Health Service Foundation Trust</wicri:noCountry></affiliation></author><author><name sortKey="Rambaut, Andrew" sort="Rambaut, Andrew" uniqKey="Rambaut A" first="Andrew" last="Rambaut">Andrew Rambaut</name><affiliation wicri:level="2"><nlm:affiliation>Institute of Evolutionary Biology, University of Edinburgh, Centre for Infection, Immunity and Evolution, University of Edinburgh, United Kingdom Fogarty International Center, National Institutes of Health, Bethesda, Maryland.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Maryland</region></placeName><wicri:cityArea>Institute of Evolutionary Biology, University of Edinburgh, Centre for Infection, Immunity and Evolution, University of Edinburgh, United Kingdom Fogarty International Center, National Institutes of Health, Bethesda</wicri:cityArea></affiliation></author><author><name sortKey="Memish, Ziad A" sort="Memish, Ziad A" uniqKey="Memish Z" first="Ziad A" last="Memish">Ziad A. Memish</name><affiliation><nlm:affiliation>Global Centre for Mass Gatherings Medicine Alfaisal University, Riyadh, Kingdom of Saudi Arabia.</nlm:affiliation><wicri:noCountry code="subField">Kingdom of Saudi Arabia</wicri:noCountry></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2015">2015</date><idno type="RBID">pubmed:25323704</idno><idno type="pmid">25323704</idno><idno type="doi">10.1093/cid/ciu812</idno><idno type="wicri:Area/PubMed/Corpus">001812</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">001812</idno><idno type="wicri:Area/PubMed/Curation">001812</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">001812</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">An observational, laboratory-based study of outbreaks of middle East respiratory syndrome coronavirus in Jeddah and Riyadh, kingdom of Saudi Arabia, 2014.</title><author><name sortKey="Drosten, Christian" sort="Drosten, Christian" uniqKey="Drosten C" first="Christian" last="Drosten">Christian Drosten</name><affiliation wicri:level="1"><nlm:affiliation>Institute of Virology, University of Bonn Medical Centre German Centre for Infection Research, Hannover, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute of Virology, University of Bonn Medical Centre German Centre for Infection Research, Hannover</wicri:regionArea></affiliation></author><author><name sortKey="Muth, Doreen" sort="Muth, Doreen" uniqKey="Muth D" first="Doreen" last="Muth">Doreen Muth</name><affiliation><nlm:affiliation>Institute of Virology, University of Bonn Medical Centre.</nlm:affiliation><wicri:noCountry code="subField">University of Bonn Medical Centre</wicri:noCountry></affiliation></author><author><name sortKey="Corman, Victor M" sort="Corman, Victor M" uniqKey="Corman V" first="Victor M" last="Corman">Victor M. Corman</name><affiliation wicri:level="1"><nlm:affiliation>Institute of Virology, University of Bonn Medical Centre German Centre for Infection Research, Hannover, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute of Virology, University of Bonn Medical Centre German Centre for Infection Research, Hannover</wicri:regionArea></affiliation></author><author><name sortKey="Hussain, Raheela" sort="Hussain, Raheela" uniqKey="Hussain R" first="Raheela" last="Hussain">Raheela Hussain</name><affiliation><nlm:affiliation>Jeddah Regional Laboratory.</nlm:affiliation><wicri:noCountry code="no comma">Jeddah Regional Laboratory.</wicri:noCountry></affiliation></author><author><name sortKey="Al Masri, Malaki" sort="Al Masri, Malaki" uniqKey="Al Masri M" first="Malaki" last="Al Masri">Malaki Al Masri</name><affiliation><nlm:affiliation>Global Centre for Mass Gatherings Medicine.</nlm:affiliation><wicri:noCountry code="no comma">Global Centre for Mass Gatherings Medicine.</wicri:noCountry></affiliation></author><author><name sortKey="Hajomar, Waleed" sort="Hajomar, Waleed" uniqKey="Hajomar W" first="Waleed" last="Hajomar">Waleed Hajomar</name><affiliation><nlm:affiliation>Regional Laboratory, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.</nlm:affiliation><wicri:noCountry code="subField">Kingdom of Saudi Arabia</wicri:noCountry></affiliation></author><author><name sortKey="Landt, Olfert" sort="Landt, Olfert" uniqKey="Landt O" first="Olfert" last="Landt">Olfert Landt</name><affiliation wicri:level="1"><nlm:affiliation>Tib-Molbiol, Berlin, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Tib-Molbiol, Berlin</wicri:regionArea></affiliation></author><author><name sortKey="Assiri, Abdullah" sort="Assiri, Abdullah" uniqKey="Assiri A" first="Abdullah" last="Assiri">Abdullah Assiri</name><affiliation><nlm:affiliation>Global Centre for Mass Gatherings Medicine.</nlm:affiliation><wicri:noCountry code="no comma">Global Centre for Mass Gatherings Medicine.</wicri:noCountry></affiliation></author><author><name sortKey="Eckerle, Isabella" sort="Eckerle, Isabella" uniqKey="Eckerle I" first="Isabella" last="Eckerle">Isabella Eckerle</name><affiliation><nlm:affiliation>Institute of Virology, University of Bonn Medical Centre.</nlm:affiliation><wicri:noCountry code="subField">University of Bonn Medical Centre</wicri:noCountry></affiliation></author><author><name sortKey="Al Shangiti, Ali" sort="Al Shangiti, Ali" uniqKey="Al Shangiti A" first="Ali" last="Al Shangiti">Ali Al Shangiti</name><affiliation><nlm:affiliation>Regional Laboratory, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.</nlm:affiliation><wicri:noCountry code="subField">Kingdom of Saudi Arabia</wicri:noCountry></affiliation></author><author><name sortKey="Al Tawfiq, Jaffar A" sort="Al Tawfiq, Jaffar A" uniqKey="Al Tawfiq J" first="Jaffar A" last="Al-Tawfiq">Jaffar A. Al-Tawfiq</name><affiliation><nlm:affiliation>Johns Hopkins Aramco Healthcare, Saudi Aramco, Dhahran, Kingdom of Saudi Arabia Indiana University School of Medicine, Indianapolis.</nlm:affiliation><wicri:noCountry code="subField">Indianapolis</wicri:noCountry></affiliation></author><author><name sortKey="Albarrak, Ali" sort="Albarrak, Ali" uniqKey="Albarrak A" first="Ali" last="Albarrak">Ali Albarrak</name><affiliation><nlm:affiliation>Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.</nlm:affiliation><wicri:noCountry code="subField">Kingdom of Saudi Arabia</wicri:noCountry></affiliation></author><author><name sortKey="Zumla, Alimuddin" sort="Zumla, Alimuddin" uniqKey="Zumla A" first="Alimuddin" last="Zumla">Alimuddin Zumla</name><affiliation><nlm:affiliation>Global Centre for Mass Gatherings Medicine Division of Infection and Immunity, University College London National Institute for Health Research Biomedical Research Centre, University College London Hospitals National Health Service Foundation Trust.</nlm:affiliation><wicri:noCountry code="subField">University College London Hospitals National Health Service Foundation Trust</wicri:noCountry></affiliation></author><author><name sortKey="Rambaut, Andrew" sort="Rambaut, Andrew" uniqKey="Rambaut A" first="Andrew" last="Rambaut">Andrew Rambaut</name><affiliation wicri:level="2"><nlm:affiliation>Institute of Evolutionary Biology, University of Edinburgh, Centre for Infection, Immunity and Evolution, University of Edinburgh, United Kingdom Fogarty International Center, National Institutes of Health, Bethesda, Maryland.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Maryland</region></placeName><wicri:cityArea>Institute of Evolutionary Biology, University of Edinburgh, Centre for Infection, Immunity and Evolution, University of Edinburgh, United Kingdom Fogarty International Center, National Institutes of Health, Bethesda</wicri:cityArea></affiliation></author><author><name sortKey="Memish, Ziad A" sort="Memish, Ziad A" uniqKey="Memish Z" first="Ziad A" last="Memish">Ziad A. Memish</name><affiliation><nlm:affiliation>Global Centre for Mass Gatherings Medicine Alfaisal University, Riyadh, Kingdom of Saudi Arabia.</nlm:affiliation><wicri:noCountry code="subField">Kingdom of Saudi Arabia</wicri:noCountry></affiliation></author></analytic><series><title level="j">Clinical infectious diseases : an official publication of the Infectious Diseases Society of America</title><idno type="eISSN">1537-6591</idno><imprint><date when="2015" type="published">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Base Sequence</term><term>Coronavirus Infections (epidemiology)</term><term>Cross Infection</term><term>Disease Outbreaks</term><term>Humans</term><term>Middle East Respiratory Syndrome Coronavirus (genetics)</term><term>Molecular Sequence Data</term><term>Polymorphism, Single Nucleotide</term><term>Saudi Arabia</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Arabie saoudite</term><term>Coronavirus du syndrome respiratoire du Moyen-Orient (génétique)</term><term>Données de séquences moléculaires</term><term>Flambées de maladies</term><term>Humains</term><term>Infection croisée</term><term>Infections à coronavirus (épidémiologie)</term><term>Polymorphisme de nucléotide simple</term><term>Séquence nucléotidique</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>Saudi Arabia</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Coronavirus Infections</term></keywords><keywords scheme="MESH" qualifier="genetics" xml:lang="en"><term>Middle East Respiratory Syndrome Coronavirus</term></keywords><keywords scheme="MESH" qualifier="génétique" xml:lang="fr"><term>Coronavirus du syndrome respiratoire du Moyen-Orient</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Infections à coronavirus</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Base Sequence</term><term>Cross Infection</term><term>Disease Outbreaks</term><term>Humans</term><term>Molecular Sequence Data</term><term>Polymorphism, Single Nucleotide</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Arabie saoudite</term><term>Données de séquences moléculaires</term><term>Flambées de maladies</term><term>Humains</term><term>Infection croisée</term><term>Polymorphisme de nucléotide simple</term><term>Séquence nucléotidique</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Arabie saoudite</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">In spring 2014, a sudden rise in the number of notified Middle East respiratory syndrome coronavirus (MERS-CoV) infections occurred across Saudi Arabia with a focus in Jeddah. Hypotheses to explain the outbreak pattern include increased surveillance, increased zoonotic transmission, nosocomial transmission, and changes in viral transmissibility, as well as diagnostic laboratory artifacts.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">25323704</PMID><DateCompleted><Year>2015</Year><Month>09</Month><Day>11</Day></DateCompleted><DateRevised><Year>2018</Year><Month>11</Month><Day>13</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1537-6591</ISSN><JournalIssue CitedMedium="Internet"><Volume>60</Volume><Issue>3</Issue><PubDate><Year>2015</Year><Month>Feb</Month><Day>01</Day></PubDate></JournalIssue><Title>Clinical infectious diseases : an official publication of the Infectious Diseases Society of America</Title><ISOAbbreviation>Clin. Infect. Dis.</ISOAbbreviation></Journal><ArticleTitle>An observational, laboratory-based study of outbreaks of middle East respiratory syndrome coronavirus in Jeddah and Riyadh, kingdom of Saudi Arabia, 2014.</ArticleTitle><Pagination><MedlinePgn>369-77</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1093/cid/ciu812</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">In spring 2014, a sudden rise in the number of notified Middle East respiratory syndrome coronavirus (MERS-CoV) infections occurred across Saudi Arabia with a focus in Jeddah. Hypotheses to explain the outbreak pattern include increased surveillance, increased zoonotic transmission, nosocomial transmission, and changes in viral transmissibility, as well as diagnostic laboratory artifacts.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">Diagnostic results from Jeddah Regional Laboratory were analyzed. Viruses from the Jeddah outbreak and viruses occurring during the same time in Riyadh, Al-Kharj, and Madinah were fully or partially sequenced. A set of 4 single-nucleotide polymorphisms distinctive to the Jeddah outbreak were determined from additional viruses. Viruses from Riyadh and Jeddah were isolated and studied in cell culture.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">Up to 481 samples were received per day for reverse transcription polymerase chain reaction (RT-PCR) testing. A laboratory proficiency assessment suggested positive and negative results to be reliable. Forty-nine percent of 168 positive-testing samples during the Jeddah outbreak stemmed from King Fahd Hospital. All viruses from Jeddah were monophyletic and similar, whereas viruses from Riyadh were paraphyletic and diverse. A hospital-associated transmission cluster, to which cases in Indiana (United States) and the Netherlands belonged, was discovered in Riyadh. One Jeddah-type virus was found in Riyadh, with matching travel history to Jeddah. Virus isolates representing outbreaks in Jeddah and Riyadh were not different from MERS-CoV EMC/2012 in replication, escape of interferon response, or serum neutralization.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Virus shedding and virus functions did not change significantly during the outbreak in Jeddah. These results suggest the outbreaks to have been caused by biologically unchanged viruses in connection with nosocomial transmission.</AbstractText><CopyrightInformation>© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Drosten</LastName><ForeName>Christian</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Institute of Virology, University of Bonn Medical Centre German Centre for Infection Research, Hannover, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Muth</LastName><ForeName>Doreen</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Institute of Virology, University of Bonn Medical Centre.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Corman</LastName><ForeName>Victor M</ForeName><Initials>VM</Initials><AffiliationInfo><Affiliation>Institute of Virology, University of Bonn Medical Centre German Centre for Infection Research, Hannover, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hussain</LastName><ForeName>Raheela</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Jeddah Regional Laboratory.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Al Masri</LastName><ForeName>Malaki</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Global Centre for Mass Gatherings Medicine.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>HajOmar</LastName><ForeName>Waleed</ForeName><Initials>W</Initials><AffiliationInfo><Affiliation>Regional Laboratory, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Landt</LastName><ForeName>Olfert</ForeName><Initials>O</Initials><AffiliationInfo><Affiliation>Tib-Molbiol, Berlin, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Assiri</LastName><ForeName>Abdullah</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Global Centre for Mass Gatherings Medicine.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Eckerle</LastName><ForeName>Isabella</ForeName><Initials>I</Initials><AffiliationInfo><Affiliation>Institute of Virology, University of Bonn Medical Centre.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Al Shangiti</LastName><ForeName>Ali</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Regional Laboratory, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Al-Tawfiq</LastName><ForeName>Jaffar A</ForeName><Initials>JA</Initials><AffiliationInfo><Affiliation>Johns Hopkins Aramco Healthcare, Saudi Aramco, Dhahran, Kingdom of Saudi Arabia Indiana University School of Medicine, Indianapolis.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Albarrak</LastName><ForeName>Ali</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zumla</LastName><ForeName>Alimuddin</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Global Centre for Mass Gatherings Medicine Division of Infection and Immunity, University College London National Institute for Health Research Biomedical Research Centre, University College London Hospitals National Health Service Foundation Trust.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Rambaut</LastName><ForeName>Andrew</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Institute of Evolutionary Biology, University of Edinburgh, Centre for Infection, Immunity and Evolution, University of Edinburgh, United Kingdom Fogarty International Center, National Institutes of Health, Bethesda, Maryland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Memish</LastName><ForeName>Ziad 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