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The apartment complex outbreak has led World Health Organization officials to focus more attention on the possibility that the illness, known as SARS, for severe acute respiratory syndrome, could be spread in a way other than face-to-face contact.
WHO director-general Dr Margaret Chan appealed for help for the countries hit by the "most complex outbreak in the four decades of this disease".
It was noted that without the drug resistance marker only prospective typing of all isolates would have detected this large, complex outbreak.
We investigated this large, complex outbreak by combining epidemiological analysis with whole-genome sequencing.
In response to such events, federal public health and food safety laboratories are exploring next-generation sequencing (NGS) to define complex outbreak scenarios.
This outbreak in West Africa (mostly affecting Guinea, Sierra Leone and Liberia) has been the largest and most complex outbreak since the virus was discovered.
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The hierarchy of causation has been translated into causal models and complex outbreaks are now considered as multi-factorial, comprised of an often-unknown range of component causes [32], which need to be explored both independently and in conjunction with other causes.
One challenge in responding to complex outbreaks is coordination among partners.
M. abscessus complex outbreaks associated with cosmetic procedures and nosocomial transmissions are not uncommon.
SNP trees have, with much success, been used previously to describe complex outbreaks in detail [ 4, 37].
In contrast, MLST typing often lacks the discriminatory power to describe complex outbreaks [ 4], but can indicate some phylogenetic relationships, since it is based on the sequencing of genes, although some of these relationships might be questionable [ 5].
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