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Published Date: 2012-09-23 17:29:14
Subject: PRO/AH/EDR> Novel coronavirus - Saudi Arabia (03): UK HPA, WHO, Qatar
Archive Number: 20120923.1305982

NOVEL CORONAVIRUS - SAUDI ARABIA (03): UNITED KINGDOM HEALTH PROTECTION AGENCY, WHO, QATAR
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In this report:
[1] HPA press release
[2] HPA notice for professionals
[3] WHO GAR

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[1] HPA press release
Date: 23 Sep 2012
Source: Health Protection Agency UK press release [edited]
http://www.hpa.org.uk/NewsCentre/NationalPressReleases/2012PressReleases/120923acuterespiratoryillnessidentified/

The Health Protection Agency (HPA) can confirm the diagnosis of one laboratory confirmed case of severe respiratory illness associated with a new type of coronavirus. The patient, who is from the Middle East and recently arrived in the UK, is receiving intensive care treatment in a London hospital.

In recent months, this new human coronavirus was also identified in a patient with acute respiratory illness in Saudi Arabia, who subsequently died.

Coronaviruses are causes of the common cold but can also include more severe illness, such as the virus responsible for SARS (Severe Acute Respiratory Syndrome). This new virus, however, is different from any that have previously been identified in humans. Preliminary enquiries have revealed no evidence of illness in contacts of these 2 cases, including healthcare workers. Based on what we know about other coronaviruses, many of these contacts will already have passed the period when they could have caught the virus from the infected person.

We are also aware of a small number of other cases of serious respiratory illness in the Middle East in the past 3 months, one of whom was treated in the UK but has since died. This person's illness is also being investigated although there is no evidence at present to suggest that it is caused by the same virus or linked to the other 2 cases. No other confirmed cases have been identified to date in the UK.

Professor John Watson, head of the respiratory diseases department at the HPA, said: "The HPA is providing advice to healthcare workers to ensure the patient under investigation is being treated appropriately.

"In the light of the severity of the illness that has been identified in the 2 confirmed cases, immediate steps have been taken to ensure that people who have been in contact with the UK case have not been infected, and there is no evidence to suggest that they have.

"Further information about these cases is being developed for healthcare workers in the UK, as well as advice to help maintain increased vigilance for this virus. This information is also being shared with national and international authorities including the World Health Organization and the European Centre for Disease Control.

"As we are aware of only 2 cases worldwide and there is no specific evidence of ongoing transmission, at present there is no specific advice for the public or returning travellers to take but we will share any further advice with the public as soon as more information becomes available."

Notes for editors:

Laboratory confirmed cases to date
Saudi Arabia:1
UK: 1

For further information, see the Q&A that has been developed on this topic. [see http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1317136202755]
Further information has also been produced for health professionals. [see [2] below]

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[2] HPA notice for professionals
Date: 23 Sep 2012
Source: Health Protection Agency UK (HPA) release for Health Professionals [edited]
http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1317136202801

Information for professionals: novel corona virus
On [21 Sep 2012] a novel corona virus was identified in lower respiratory tract specimens of a Qatari national who was receiving treatment for a severe respiratory illness in London. The virus is the same as a novel corona virus recently identifed by Dutch researchers in lung tissue from a national from Saudi Arabia who was ill previously with pneumonia. These are currently the only 2 known cases where this virus has been isolated.

There are a variety of corona viruses and these include viruses causing common cold symptoms and other types causing the much more serious illness of SARS. In light of the seriousness of the illness in these 2 patients and the unknown nature of the novel coronavirus, the current patient is being managed in strict respiratory isolation and any staff caring for them must wear full personal protective equipment - FFP3 respirator (staff should be fit tested), goggles, gown and gloves. Anyone who was in close contact with the patient while the patient was ill is being followed up - this includes healthcare workers who provided direct clinical or personal care or examination of the case while they were symptomatic.

The incubation period is currently considered to be up to 7 days and therefore any respiratory illness occuring in the 7 days following last contact with this case is considered relevant and staff should alert their manager / occupational health service as soon as possible. Symptoms would include fever, cough, or other respiratory symptoms.

At the current time any person recently returning from Saudi Arabia or Qatar with a serious respiratory illness should be managed in strict respiratory isolation (ideally a negative pressure room) and all staff should wear PPE as described above.

Clinicians who think they may have a patient meeting the above criteria should call the fever service on 0844 7788990.

Individuals with health concerns or queries should contact their occupational health department.

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[3] WHO GAR
Date: 23 Sep 2012
Source: WHO Global Alert and Response [edited]
http://www.who.int/csr/don/2012_09_23/en/index.html

On [22 Sep 2012], the United Kingdom (UK) informed WHO of a case of acute respiratory syndrome with renal failure with travel history to the Kingdom of Saudi Arabia (KSA) and Qatar.

The case is a previously healthy, 49-year-old male Qatari national that presented with symptoms on [3 Sep 2012] with travel history to the KSA prior to onset of illness. On [7 Sep 2012], he was admitted to an intensive care unit (ICU) in Doha, Qatar. On [11 Sep 2012], he was transferred to the UK by air ambulance from Qatar. The Health Protection Agency of the UK (HPA) conducted laboratory testing and has confirmed the presence of a novel coronavirus.

The HPA has compared the sequencing of the virus isolate from the 49-year-old Qatari national with that of a virus sequenced previously by the Erasmus University Medical Centre, Netherlands. This latter isolate was obtained from lung tissue of a fatal case earlier this year [2012] in a 60-year-old Saudi national. This comparison indicated 99.5 percent identity, with one nucleotide mismatch over the regions compared.

Coronaviruses are a large family of viruses which includes viruses that cause the common cold and SARS. Given that this is a novel coronavirus, WHO is currently in the process of obtaining further information to determine the public health implications of these 2 confirmed cases.

With respect to these findings, WHO does not recommend any travel restrictions. Information regarding requirements and recommendations for the Hajj season in 2012 can be found at http://www.who.int/ith/updates/20120730/en/index.html.

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[The above reports from the Health Protection Agency (HPA) of the UK and WHO provide a bit more information on the background of the tested cases reported in the previous post (see Novel coronavirus - Saudi Arabia (02): additional cases, RFI 20120923.1305931) and addresses the question raised by Mod.CP concerning the viral identifications. According to the HPA report, there have been only 2 confirmed cases with severe disease associated with this novel coronavirus, the 1st from a Saudi Arabian national (see Novel coronavirus - Saudi Arabia: human isolate 20120920.1302733) and the 2nd from a Qatari national treated in the UK. Apparently, the 3rd case mentioned in the previous ProMED-mail report today [23 Sep 2012] is a suspected case under investigation but not as yet confirmed to have been infected with this coronavirus. Information from the WHO report includes information that the 2nd case (the Qatari national) was a previously healthy 49-year-old male with a history of travel to Saudi Arabia prior to onset of illness, raising the possibility that infection may have taken place in Saudi Arabia.

From the information provided above it is clear there is a heightened level of awareness on the international level for the need for a rapid investigation on the possible implications of a novel coronavirus associated with severe disease. Concerns regarding the upcoming mass gathering in a region where this virus has been identified are clearly present, and the approach of implementing "active surveillance" (actively searching for cases) is highly appropriate to better define the epidemiology of this newly identified novel coronavirus.

For the HealthMap/ProMED map of the middle east region showing Saudi Arabia and Qatar, see http://healthmap.org/r/1HAJ. - Mod.MPP]

See Also