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PostPosted: Thu Jun 19, 2014 7:07 pm 
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Today Nature has come out with an editorial on MERS and calls out hoarding scientists to grow up because they are a hazard to the world's health.

http://www.nature.com/news/present-dang ... E-20140619

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PostPosted: Thu Jun 19, 2014 7:17 pm 
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NATURE | EDITORIAL

Present danger
There is much hype about predicting and preventing future pandemics, but not enough is being done about a threat sitting under our noses.

18 June 2014

If the deadly disease MERS-CoV evolves to spread easily between humans and cause a global outbreak, hard questions will be asked. Why did health authorities and scientists allow a virus with clear pandemic potential to fester for so long, and what more could have been done to nip it in the bud? Those questions need to be asked now, when there is still time to deal with the crisis.

As of 16 June, the World Health Organization (WHO) had reported 701 lab-confirmed cases of MERS-CoV (Middle East respiratory syndrome coronavirus), including 249 deaths, since the virus was first identified in September 2012. The reported cases are largely confined to the Middle East, with most in Saudi Arabia.

MERS-CoV is, in principle, eminently stoppable. It remains an animal-borne virus that sporadically infects humans: there have been large hospital outbreaks in which patients have infected health-care workers and others, but so far the virus does not spread easily between people. By tracking down its animal sources and the routes through which people contract it, authorities should be able to dam the stream of infections.

But there is a risk that MERS-CoV, like the coronavirus SARS (severe acute respiratory syndrome), might mutate to spread easily between humans and so propagate rapidly around the world. SARS was detected in late 2002 and stamped out in July 2003; in those few months, it caused more than 8,000 infections and 700 deaths. Key to the defeat of SARS was a tightly coordinated international public-health effort, led by the WHO. The organization assembled an effective in-house outbreak-response team and quickly put together an international network of scientists that for the most part set competition aside in favour of collaboration.

Partly as a result of SARS, in 2005 the WHO’s member states agreed on legally binding International Health Regulations to strengthen the international response to public-health events that occur in individual countries but potentially pose a global threat. The rules, for example, require countries to strengthen their disease surveillance and outbreak-response infrastructure, and to report all cases of possible international concern to the WHO within 24 hours.

Try harder
When it comes to MERS-CoV, the lessons of SARS success have too often been ignored. This is perhaps due in part to a mistaken perception that MERS-CoV is less urgent than was SARS, because it does not yet spread easily between people. Research groups have tended to compete rather than cooperate. From the outset, conflict and distrust over credit, patents and sharing of specimens and data have marred efforts (see Nature http://doi.org/s75; 2013).

Saudi Arabia’s response to MERS-CoV has been better than many of its critics give it credit for. Tackling the outbreak is challenging: with only a few hundred cases to go on, tracking down clues to the source of infections is not easy in a country that is almost three and a half times the size of France. But even so, response efforts have suffered from ineptitude, infighting and inadequate transparency. Saudi Arabia may be rich, but it is on a steep learning curve when it comes to international research collaboration and dealing with a complicated outbreak.

“Diplomacy and trust are key to building an effective outbreak response.”
In April, Saudi Arabia replaced its health minister as case numbers surged, and last month it created a Command and Control Center that brings together scientists and public-health officials to better coordinate control efforts, and acts as a focal point for international collaboration. This month, it removed deputy health minister Ziad Memish — the most prominent public face of Saudi MERS-CoV efforts — and announced 113 cases and 92 deaths that had occurred since 2012 but had gone unreported (these cases are not included in the WHO’s latest totals). It is too soon to say how effective the Command and Control Center will be, but domestic pressure to stop MERS-CoV is at an all-time high.

The WHO has been much less prominent and decisive on MERS-CoV than it was on SARS. Its outbreak-response division is underfunded and understaffed, and effective leadership has been lacking.

On the positive side, researchers have obtained a lead, finding the virus in camels in Saudi Arabia, Egypt, Oman and Qatar. Antibodies to the pathogen — evidence of past infection — have been detected in camels in many countries in the Middle East and North Africa. Last week, researchers reported finding the virus in unpasteurized camel milk. But almost two years after MERS-CoV was first identified, no one has definitively pinned down its routes of transmission to humans. Scientists and authorities could, and should, do better.

The many cases caused by hospital outbreaks, for instance, could have been prevented by rigorous infection-control measures. Rapid identification and isolation of cases, decontamination of surfaces and use of protective clothing such as masks can all help to block infection of people in contact with patients.

Outbreak response cannot always be decreed by international rules. There is tension between the sovereign right of nations to handle the situation in their own countries and the desire of the international community to intervene and prevent the disease crossing borders. Diplomacy and trust are key to building an effective outbreak response. Saudi Arabia needs to be encouraged, not alienated.

The International Health Regulations say little about research, but a separate WHO agreement sets out clear rules for sharing samples and sequences of pandemic influenza viruses. Similar rules for all infectious diseases that have pandemic potential are needed.

What is most lacking in the fight against MERS-CoV is global leadership. The WHO, as an intergovernmental agency with a direct line to health ministries, remains best placed to bang heads together and get things done cooperatively, but its efforts must be well funded and staffed. Politicians everywhere must wake up to the fact that the world has another Middle East problem.

Nature 510, 311 (19 June 2014) doi:10.1038/510311a
Related stories and links

From nature.com
Biologists make first mouse model for MERS
30 January 2014
Progress stalled on coronavirus
18 September 2013
Scientists look to Saudi Arabia for coronavirus clues
17 May 2013
Receptor for new coronavirus found
13 March 2013
Tensions linger over discovery of coronavirus
14 January 2013
Clusters of coronavirus cases put scientists on alert
11 December 2012
SARS veterans tackle coronavirus
03 October 2012
From elsewhere
Saudi Arabia MERS-CoV Command and Control Center
WHO coronavirus site
ECDC coronavirus site

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PostPosted: Thu Jun 19, 2014 7:26 pm 
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niman wrote:
NATURE | EDITORIAL

Present danger
There is much hype about predicting and preventing future pandemics, but not enough is being done about a threat sitting under our noses.

18 June 2014

Research groups have tended to compete rather than cooperate.

This competition has led to the hoarding (by the Christian Drosten lab) of almost all 2014 MERS sequences from KSA cases including ALL from Riyadh and Medina.

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PostPosted: Thu Jun 19, 2014 7:38 pm 
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niman wrote:
niman wrote:
NATURE | EDITORIAL

Present danger
There is much hype about predicting and preventing future pandemics, but not enough is being done about a threat sitting under our noses.

18 June 2014

Research groups have tended to compete rather than cooperate.

This competition has led to the hoarding (by the Christian Drosten lab) of almost all 2014 MERS sequences from KSA cases including ALL from Riyadh and Medina.

Novel MERS Sub-Clade In Jeddah Raises Pandemic Concerns
Recombinomics Commentary 15:00
April 28, 2014

The release of three nearly full MERS sequences from Jeddah (Jeddah_C7569, Jeddah_C7149, Jeddah_C7770) at the Institute for Virology website prior to publication or release at Genbank is similar to the activity seen in the early stages of the SARS outbreak in April 2003.

Initial reports on SARS were descriptive, but a diagnostic screening tool suggested that the etiological agent was a novel coronavirus, which was subsequently names SARS (Sudden Acute Respiratory Syndrome) which was designated as beta 2b. The sequence data showed that the international spread of SARS-CoV was associated with a super-spreader event at the Metropole Hotel on February 20-21, 2013, which involved a unique sub-clade with a 29 BP deletion, and almost all human SARS sequences outside of mainland China had this deletion, signaling clonal expansion of this particularly virulent sub-clade..

The recent explosion of MERS cases in Jeddah and associated export has raised concerns that a novel sub-clade has emerged, with increased human transmission. This concern has led to the early release of three nearly complete MERS sequences from three early collections from patients in two hospitals.

Phylogenetic analysis showed that all three were closely related to each other and distinct from all public human MERS sequences. Although the spike protein sequence matches other human sequences, MERS antibodies and sequences have been widely detected in camels in the Middle East and northeast Africa, suggesting MERS is already well adapted to mammals, which was also seen in the first MERS outbreak (in April 2012 in Jordan), which involved human to human transmission among a large number of health care workers.

Thus, the dramatic jump in Jeddah cases may be linked to a single nucleotide change, leading to strong selection and the emergence of a novel sub-clade, which grows more efficiently in humans. This sub-clade emergence is supported by partial spike gene sequencing of 25 additional Jeddah cases, which are identical at the protein level, as indicated by Chistian Drosten.......

http://www.recombinomics.com/News/04281 ... Novel.html

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PostPosted: Thu Jun 19, 2014 7:43 pm 
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niman wrote:
niman wrote:
NATURE | EDITORIAL

Present danger
There is much hype about predicting and preventing future pandemics, but not enough is being done about a threat sitting under our noses.

18 June 2014

Research groups have tended to compete rather than cooperate.

This competition has led to the hoarding (by the Christian Drosten lab) of almost all 2014 MERS sequences from KSA cases including ALL from Riyadh and Medina.

Withheld Jeddah & Mecca MERS Sequences Raise Concerns
Recombinomics Commentary 19:30
May 7, 2014
As long as the sequences are in the draft stage, we are making them available on our homepage (http://www.virology-bonn.de) and provide them to the epidemic blog (http://epidemic.bio.ed.ac.uk).

The above comments from a letter by Christian Drosten posted April 26 on ProMed suggested that Jeddah MERS sequences would be made available almost in real time, as happened during the 2003 SARS-CoV outbreak when sequencing labs posted results on their website.

In 2003 labs in China, Hong Kong, Singapore, Canada, and Taiwan released such sequences almost in real time, and the above comments from the Drosten lab suggested sequences would be quickly posted. This pledge was important because virtually all samples from Jeddah were being sent to his lab, and it was unclear if exported cases from Jeddah to Jordan, Malaysia, Greece, United Arab Emirates, or Egypt would lead to rapid release of the exported sequences.

Shortly after the announcement was made on ProMED, the Drosten lab released three nearly complete sequences from collections in early April at his website (Jeddah_C7569, Jeddah_C7149, Jeddah_C7770), along with a phylogenetic tree that showed that all three Jeddah sequences were virtually identical. Similarly, the Rambaut lab posted a phylogenetic tree which also showed the three sequences were closely related to each other, as well as a camel sequence from Qatar (camel_2). When Recombinomics notified the Rambaut lab that a commentary was being prepared on the results, Andrew Rambaut asked that his tree not be used because the camel_2 sequence had not been made public. He also noted that he was pulling down the tree and asked that Recombinomics post a note that the tree had been made private, which was done.

The initial Recombinomics commentary used the tree posted on the Drosten website, which also showed that the three Jeddah sequences were virtually identical, raising concerns that the sequences from the Jeddah cases represented a novel sub-clade that contained 9 polymorphisms which were in all three human sequences and not reported in any prior human cases.

Another paper was subsequently published with camel sequences from Taif, KSA. Although the accession numbers were given, these sequences could not be accessed at Genbank until this week, but the Rambaut lab was able to put up a new tree with the Taif camel sequences and one of the three human sequences from Jeddah. It is unclear if this representation confused the CDC, because in their telebriefing on the MERS case in Munster, Indiana they noted that there was one sequence from Jeddah cases, when in fact there were three. The CDC cited concerns of an emerging sub-clade, but with only one sequence conclusions couldn’t be drawn.

However, there were three nearly complete sequences, as well as 25 partial spike gene sequences from additional cases in Jeddah, all of which were said to be identical, raising additional concerns that the Jeddah cases were due to the emergence of a novel sub-clade, as happened in 2003 during the SARS CoV outbreak. However, the 25 spike gene sequences were not posted at the Drosten website and the spike positions used in the sequences were not made public. In fact there have been no updates at the Drosten website since the first three sequences were released and the Rambaut website has a phylogenetic tree with only one of the Jeddah sequences.

Recently, an interview of Drosten cited three additional sequences from more recent cases in Jeddah and Mecca, which were said to be “completely normal” which was also used to characterize thre first three Jeddah sequences, raising concerns that the three recent sequences were closely related to the first three sequencing signaling clonal expansion in Jeddah and spread to Mecca.

Attempts to clarify these relationships have failed. A e-mail to the Rambaut lab on May 5 asking about the absence of any new sequences was not answered. Similarly, e-mails to the Drosten and Rambaut labs yesterday and today seeking clarification on the three new sequences also was not answered by either lab.

Publication of the three recent sequences or a phylogenetic tree with the new sequence at the Drosten or Rambaut websites would address the clonal expansion question. The withholding of this information highlights the dangers of allowing one lab to all of the Jeddah sequencing.

These sequences should be released immediately.

The withholding of this information is hazardous to the world’s health.......

http://www.recombinomics.com/News/05071 ... hheld.html

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PostPosted: Thu Jun 19, 2014 7:48 pm 
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niman wrote:
niman wrote:
NATURE | EDITORIAL

Present danger
There is much hype about predicting and preventing future pandemics, but not enough is being done about a threat sitting under our noses.

18 June 2014

Research groups have tended to compete rather than cooperate.

This competition has led to the hoarding (by the Christian Drosten lab) of almost all 2014 MERS sequences from KSA cases including ALL from Riyadh and Medina.

Jeddah and Mecca MERS Sequences Match
Recombinomics Commentary 12:15
May 8, 2014
C.D.: There has been a lot of discussion about whether the virus has mutated to pass more easily from human to human. But we have sequenced three genomes from samples taken early in April in Jeddah, where many of the cases occurred, two more from later in the Jeddah outbreak, and another one from a patient in Mecca. They all look completely normal.

The above comments raised concerns that all six sequences from western Kingdom of Saudi Arabia (KSA) represented clonal expansion of a novel sub-clade. Chistian Drosten has confirmed via e-mail to Recombinomics that all six sequences were closely related, confirming clonal expansion.

A similar clonal expansion was seen in 2003 for the SARS-CoV at the Metropole Hotel in Hong Kong. The sequence contained a 29 BP deletion, which was subsequently found in almost all SARS-CoV sequences from subsequent cases, including those in Singapore, Hanoi, and Toronto.

In the recent CDC telebriefing introductory remarks noted the explosive spread of SARS-CoV due to a novel sub-clade, but noted that for Jeddah only one sequence was available even though three sequences (C7149 and C7770 from hospital A on April 3 and 7, respectively as well as C7569 from hospital B on April 5) had been made public at Christian Drosten’s website on April 26, well in advance of the CDC telebriefing on May 2.

Initial comments in ProMED indirectly cited infection control issues in Jeddah, but the first three sequences were from patients in two different hospitals, and the presence of the same sub-clade in two later cases, as well as a case in Mecca, supported clonal expansion.

There have been six confirmed exports of MERS from Jeddah to five different countries (Jordan, Malaysia, Greece, United Arab Emirates, and Egypt), but onward transmission has only been cited in Amman, Jordan, where the index case (25M) infected a paramedic (28M) and his brother (28M), although media reports cited additional symptomatic contacts in Quarayat, KSA.

Christian Drosten is to be commended for the early release of the first three Jeddah sequences and the confirmation that the subsequent three sequences match.

Posting of the three more recent sequences may help convince other MERS sequencers to follow suit and promptly release sequences, which would be useful......

http://www.recombinomics.com/News/05081 ... Match.html

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PostPosted: Thu Jun 19, 2014 7:51 pm 
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niman wrote:
niman wrote:
NATURE | EDITORIAL

Present danger
There is much hype about predicting and preventing future pandemics, but not enough is being done about a threat sitting under our noses.

18 June 2014

Research groups have tended to compete rather than cooperate.

This competition has led to the hoarding (by the Christian Drosten lab) of almost all 2014 MERS sequences from KSA cases including ALL from Riyadh and Medina.

MERS Clonal Expansion In Jeddah and Mecca
Recombinomics Commentary 16:00
May 8, 2014
Christian Drosten at the Virology Institute in Bonn has uploaded the 3 recent MERS sequences from patients in Jeddah (C8826 and C9055) collected on April 12 and April 14 from hospital A and C, respectively, as well as Mecca (C9355) collected on April 15. The three earlier sequences were from two hospitals ((C7149 and C7770 from hospital A collected on April 3 and 7, respectively as well as C7569 from hospital B collected on April 5)). The release of these nearly full sequences from patients in Jeddah and Mecca are to be commended and will hopefully encourage other sequencing labs to make sequences available on lab websites as soon as possible.

The first three sequences had nine polymorphisms that were in all three Jeddah patients, but not in any published sequence. Subsequently, sequences from camels in Taif were described in an mBio paper and four were closely related (see list below). However, none of the camel sequences had all 8 polymorphisms. Two camel sequences (378 and 505) had 5 of the 8 polymorphisms and none of the camel sequences had A23953G, which encoded Q833R in the spike protein, or T28778A, which encoded L6Q in ORF8b.

The three newly released human sequences had all none of the polymorphisms. Thus, all six humans sequences from three hospitals in Jeddah as well as a hospital in Mecca uniquely matched each other signaling clonal expansion in western Saudi Arabia.

The emergence of this novel sub-clade and spread throughout Jeddah and Mecca raises serious pandemic concerns.......

http://www.recombinomics.com/News/05081 ... lonal.html

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PostPosted: Thu Jun 19, 2014 7:57 pm 
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niman wrote:
niman wrote:
NATURE | EDITORIAL

Present danger
There is much hype about predicting and preventing future pandemics, but not enough is being done about a threat sitting under our noses.

18 June 2014

Research groups have tended to compete rather than cooperate.

This competition has led to the hoarding (by the Christian Drosten lab) of almost all 2014 MERS sequences from KSA cases including ALL from Riyadh and Medina.

Evolving Novel MERS Jeddah Sub-Clade Confirmed In Greece
Recombinomics Commentary 22:00
May 14, 2014
Recently, a novel MERS Jeddah/Mecca sub-clade was reported in six of six cases from four hospitals in Jeddah or Mecca. Moreover, the partial spike gene sequence 25 additional Jeddah cases exactly match the 6 nearly complete sequences. In recent weeks there have been seven Jeddah exports to six countries (Jordan, Malaysia, Greece, United Arab Emirates, Egypt, United States). Another export from the Kingdom of Saudi Arabia (KSA) was announced today (Netherlands – location in KSA not cited).

The United States CDC, in collaboration with the Hellenic Institute, released the Spike and N gene sequences, Greece-Saudi Arabia_2014, from an April 18 oropharyngeal swab from the Jeddah export to Greece (69M), who is in critical condition. The 11 polymorphisms that define the sub-clade include 2 in the spike gene and 3 in ORF8b (which is fully overlapped by the N gene). One of the Spike polymorphisms, Q833R, and one of the ORF8b polymorphisms, have not been reported in any MERS sequences, other than those in the sub-clade described above. The sequences from the exported case had both unique polymorphisms, as well as the other three polymorphisms, which are in these two genes, and partially define the sub-clade, confirming the spread of the Jeddah sub-clade to Greece via commercial airline.........

http://www.recombinomics.com/News/05141 ... volve.html

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PostPosted: Thu Jun 19, 2014 8:01 pm 
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Posts: 56044
Location: Pittsburgh, PA USA
niman wrote:
niman wrote:
NATURE | EDITORIAL

Present danger
There is much hype about predicting and preventing future pandemics, but not enough is being done about a threat sitting under our noses.

18 June 2014

Research groups have tended to compete rather than cooperate.

This competition has led to the hoarding (by the Christian Drosten lab) of almost all 2014 MERS sequences from KSA cases including ALL from Riyadh and Medina.

Evolving Novel MERS Jeddah Sub-Clade Confirmed In Florida
Recombinomics Commentary 23:30
May 14, 2014

The recently described novel Jeddah MERS sub-clade has raised concerns. It was found in 6/6 sequences from Jeddah and Mecca (from 4 hospitals) and matched 25 spike sequences from 25 more cases in Jeddah. Moreover, recent exports (7 to 6 countries) have also been from Jeddah, including the case in Orlando, Florida.

The CDC recently released the Spike and N gene sequences, Greece-Saudi Arabia_2014, from the case in Greece, which confirmed the presence of an evolving sub-clade, which had the expected markers as well as additional changes in the S gene (R511P) and the ORF8b gene (T31I) signaling rapid evolution.

The CDC has released the full sequences from the case (44M) in Orlando, Florida, Florida/USA-2_Saudi Arabia_2014, and are to be commended for the rapid release of these important sequences.

Like the sequences from Greece, Orlando is also an evolving Jeddah sub-clade. It also had the expected markers in the Spike and ORF8b genes, as well as a novel change in the Spike gene, S684F.

The confirmation of the same Jeddah sub-clade in Greece and Orlando, Florida as found in Jeddah and Mecca raises serious pandemic concerns......

http://www.recombinomics.com/News/05141 ... volve.html

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PostPosted: Thu Jun 19, 2014 8:30 pm 
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Joined: Wed Aug 19, 2009 10:42 am
Posts: 56044
Location: Pittsburgh, PA USA
niman wrote:
niman wrote:
NATURE | EDITORIAL

Present danger
There is much hype about predicting and preventing future pandemics, but not enough is being done about a threat sitting under our noses.

18 June 2014

Research groups have tended to compete rather than cooperate.

This competition has led to the hoarding (by the Christian Drosten lab) of almost all 2014 MERS sequences from KSA cases including ALL from Riyadh and Medina.

........We have sequenced near full genomes of 3 viruses from the early phase of the Jeddah outbreak. The samples were submitted to Jeddah regional laboratory on [3, 5 and 7 Apr 2014], and sent to Germany for external confirmatory testing on [14 Apr 2014] by KSA MOH in Riyadh. Two of the sequenced viruses were from patients treated in the major public hospital in which most cases of the Jeddah outbreak seem to have occurred. A 3rd sequence was from another health care facility in the city. Genome sequences of all 3 viruses are highly similar to each other but not identical, and are highly similar to a large number of known MERS-CoV sequences (consult http://www.virology-bonn.de for a phylogeny; genome overview in Cotten 2014). There are no genome insertions or deletions suggestive of sudden major changes. The receptor-binding domain in the spike protein thought to influence the virus's ability to be transmitted or spread is 100 percent identical to the binding site in a large number of known MERS-CoV genome sequences. Based on genome comparison with other MERS-CoV strains there is no reason to assume that the sequenced viruses from Jeddah have acquired changes increasing their pandemic potential.

As long as the sequences are in the draft stage, we are making them available on our homepage (http://www.virology-bonn.de) and provide them to the epidemic blog (http://epidemic.bio.ed.ac.uk). They will be submitted to GenBank after some curating.

We have sequenced partial spike protein genes from another 25 viruses, showing 100 percent sequence identity with above-mentioned genomes.......

http://www.promedmail.org/direct.php?id=2432140

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