Middle East Respiratory Syndrome Coronavirus Recombination and the Evolution of Science and Public Health in China.

Abstract

Since the discovery of Middle East respiratory syndrome coronavirus (MERS-CoV) in late 2012, more than 1,400 people have received a laboratory diagnosis of MERS and over 450 people have died. Most of the cases have been documented on the Arabian Peninsula; however, sporadic cases have also been reported in Europe and Asia in travelers returning from the Middle East. Except in South Korea, the imported MERS-CoV has not established a substantive chain of infection beyond the index traveler case. The spread within South Korea to 186 people, resulting in 36 deaths, has been attributed to a delay in diagnosis and isolation of the index case, lapses in infection control, and care of patients by family members rather than trained medical staff. This interpretation was supported by a preliminary report from a World Health Organization panel wherein no mutations linked to transmissibility or pathogenesis were found in sequences obtained in South Korea and China. However, in a recent mBio article, Wang and colleagues report detailed genomic analysis of the virus implicated in the first known case of MERS in China (1). They describe 11 amino acid substitutions, 8 of them shared with the South Korean strain and MERS-CoV strains recently circulating in Saudi Arabia, and define a recombination event that they speculate may have contributed to enhanced human-to-human transmission of MERS-CoV and the rapid spread of the virus in South Korea.