The first case of Middle East Respiratory Syndrome (MERS) in the United States was confirmed in a traveler to Indiana from Saudi Arabia in early May 2014. On May 1, 2014, the Indiana State Department of Health obtained an initial positive laboratory result for MERS Coronavirus (MERS-CoV) from a serum specimen from the patient. CDC confirmed the positive result on May 2, within hours of receiving the specimen.
On May 3, CDC received an additional sputum specimen from the patient. In less than 48 hours, CDC used Advanced Molecular Detection (AMD) methods to sequence the complete virus genome.
Just before this first case of MERS surfaced in the United States, the number of cases reported from Saudi Arabia had more than doubled from the previous year. Public health investigators were concerned that changes in the virus could be spurring the increase. Major changes in the virus might allow MERS-CoV to spread more easily from person to person. Combining disease tracking information with sequencing technology helps public health investigators understand more about the virus and how it spreads, leading to stronger safeguards.
AMD methods showed that this sequence was similar to other known MERS-CoV sequences. The rapid pace with which this new sequence information was available and parallel work reported from Germany allowed CDC to sooth concerns about significant changes in the virus. Work has already started on ways to improve the efficiency and timeliness of this type of result. These methods are also applicable to unknown agents and other emergent threats.
The critical need for increased AMD capacity at CDC was outlined in an internal report from a 2011 expert panel convened to review the status of CDC’s bioinformatics activities, identify gaps, and provide input on strategies for moving forward: Future Strategies for Bioinformatics in CDC’s Infectious Disease Laboratories (pdf).
Funded AMD initiatives in 2014 represent a significant leap forward for CDC’s advanced sequencing and bioinformatics capabilities. CDC will be able to build critical molecular sequencing and bioinformatics capacities at national and state levels, leading to reduced diagnostic costs in the future. For example, states would no longer need to submit lab cultures to CDC to identify outbreak pathogens. With AMD, CDC could rapidly look for a microbe’s match among the thousands of reference samples in its world-class microbe library.
In FY 2015, the CDC has requested $30 million in funding allocations for Advanced Molecular Detection and Response to Infectious Disease Outbreaks, continuing the initial investment of $30 million in FY 2014. This funding will enable CDC to continue building critical capacities at the national and state levels.
Source: Centers for Disease Control, adapted.