Increase in Middle East Respiratory Syndrome-Coronavirus Cases in Saudi Arabia Linked to Hospital Outbreak With Continued Circulation of Recombinant Virus, July 1–August 31, 2015

Assiri, Abdullah M.; Biggs, Holly M.; Abedi, Glen R.; Lu, Xiaoyan; Bin Saeed, Abdulaziz; Abdalla, Osman; Mohammed, Mutaz; Al-Abdely, Hail M.; Algarni, Homoud S.; Alhakeem, Raafat F.; Almasri, Malak M.; Alsharef, Ali A.; Nooh, Randa; Erdman, Dean D.; Gerber, Susan I.; Watson, John T.

Genomic sequencing of a limited number of cases demonstrated continued circulation of NRC-2015 MERS-CoV among humans through August 2015, including among cases linked and not linked to the Hospital A outbreak. This recombinant virus was first detected from a patient in SA with illness onset during January 2015 [7] and was first described after travel-associated introductions to the Republic of Korea and China [10] . Over the period of January-June 2015, NRC-2015 became predominant among human MERS cases in SA [7] . In surveillance studies of dromedary camels in SA, viruses related to NRC-2015 (designated lineage 5 by Sabir et al [4] ) were first identified in July 2014 and were predominant among surveyed camels from November 2014 through the end of the study period in April 2015 [4] .