Send to

Choose Destination
Clin Infect Dis. 2015 Feb 1;60(3):369-77. doi: 10.1093/cid/ciu812. Epub 2014 Oct 16.

An observational, laboratory-based study of outbreaks of middle East respiratory syndrome coronavirus in Jeddah and Riyadh, kingdom of Saudi Arabia, 2014.

Author information

Institute of Virology, University of Bonn Medical Centre German Centre for Infection Research, Hannover, Germany.
Institute of Virology, University of Bonn Medical Centre.
Jeddah Regional Laboratory.
Global Centre for Mass Gatherings Medicine.
Regional Laboratory, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
Tib-Molbiol, Berlin, Germany.
Johns Hopkins Aramco Healthcare, Saudi Aramco, Dhahran, Kingdom of Saudi Arabia Indiana University School of Medicine, Indianapolis.
Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
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.
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.
Global Centre for Mass Gatherings Medicine Alfaisal University, Riyadh, Kingdom of Saudi Arabia.



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.


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.


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.


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.


MERS-coronavirus; nosocomial transmission; outbreak; transmission infection control; virus isolation

[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center