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Commentary
Another Beta2c
Coronavirus UK Import From KSA?
Recombinomics
Commentary 12:00
March 25, 2013
The above comments on the nCoV infection of the UK cluster index case (60M) note that his daughter accompanied him to Mecca and was “given the all clear” indicating she was nCoV negative in testing in the UK. However, it is unclear if she was tested because she was a contact of the index case, or had been symptomatic.
In initial reports the Health Protection Agency (HPA) suggested that an additional family member may have been infected because the two cases in the UK (the son and sister of the index case) had no recent contact with each other, but both developed symptoms within one day of each other (February 6 and 5, respectively) which was well after the hospitalization and intubation of the index case. Transmission in the hospital after intubation is unlikely, and the co-morbidities found in the index case and the two UK cases differed.
The index case was initially positive for H1N1pdm09, which was not found in any of the UK contacts. In contrast, both nCoV positive contacts were co-infected with human type 2 parainfluenza virus (HPIV-2), which was also detected in two additional contacts, who were nCoV negative. It is unclear if one of these HPIV-2 positive contacts was the daughter.
However, her testing was probably well after she returned from Mecca because the index case was initially diagnosed as an H1N1pdm09 case. When he failed to respond to treatment for influenza, he was tested further and nCoV was identified.
Consequently, his son and sister were not tested until February 10 and February 13 respectively. The sister had a productive cough and the test of her low respiratory tract sample (sputum) was nCoV positive. An upper respiratory tract sample (nose and throat swab) collected on February 15 was HPIV-2 positive (but nCoV negative) suggesting she and her nephew were infected by a common source, who was not the index case. That common source may have been the index case’s daughter.
Her infection may have also happened in Saudi Arabia where genders are typically separated during religious ceremonies. Consequently the index case may have been infected by a male contact who was infected with nCoV and H1N1pdm09, while the daughter was infected by a female infected with nCoV and HPIV-2.
These possibilities can be addressed by sequencing. The sequence (England2) from the index case has already been released. Although it is more than 99.9% identical to the consensus sequence, it is easily distinguished from England1 and EMC/2012. If the source of the UK cases were the sister, who was infected in KSA, the sequences are likely different. Similarly, the HPIV-2 in the two UK cases should also be sequenced to see of the two UK cases match each other as well as the two UK contacts who were nCoV positive.
Import of nCoV into the UK by two different people would signal widespread nCoV in the Jeddah area. Although only one of the confirmed KSA cases was treated in Jeddah, the Qatari case (49M) who remains hospitalized in the UK, also developed symptoms (as did his travel companions) after practicing Uhrah in August 2012, raising concerns that nCoV is widespread in Jeddah, which was strongly suggested by widely circulating media comments in Saudi Arabia yesterday, which noted that most mild nCoV cases were in Jeddah.
The absence of IHR submissions on these mild cases raises concerns that the lack of information on mild nCoV cases in Saudi Arabia in early 2013 is similar to the lack of transparency in Guangdong, China in early 2003 regarding the spread of SARS-CoV.
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