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Published Date: 2012-09-27 12:55:16
Subject: PRO/AH/EDR> Novel coronavirus - Saudi Arabia (06)
Archive Number: 20120927.1311743

NOVEL CORONAVIRUS - SAUDI ARABIA (06)
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Date: Wed 26 Sep 2012
Source: CIDRAP (Center for Infectious Disease Research & Policy) News [edited]
http://www.cidrap.umn.edu/cidrap/content/other/sars/news/sep2612corona.html

Some details emerge on coronavirus cases, but many gaps remain
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A European report has filled in some details about the 2 severe illnesses linked to a novel coronavirus, but most of the major questions, such as where it came from and how it spreads, remained unanswered today [26 Sep 2012].

A 49-year-old Qatari man remained in a London hospital's intensive care unit with a severe respiratory illness accompanied by renal failure. A 60-year-old Saudi Arabian man who had a similar illness and was infected with a virtually identical coronavirus died in June [2012] in his home country. No new confirmed or suspected cases were reported today.

A risk assessment released by the European Centre for Disease Prevention and Control (ECDC) offered some new details on the cases, including that the Qatari patient had returned from a trip to Saudi Arabia more than 10 days before he fell ill on [3 Sep 2012], which seems to suggest that he wasn't infected while in that country.

A case definition released by the World Health Organization (WHO) yesterday [25 Sep 2012] lists a history of travel to Saudi Arabia within 7 days before illness onset, or close contact with a probable or confirmed case-patient in that same time frame, as a possible clue to the virus in a person who is hospitalized with an acute respiratory infection accompanied by fever and cough.

A [25 Sep 2012] letter from the head of the United Kingdom Department of Health to UK health workers said the incubation period for the new virus is assumed to be 7 days, given what is known about other human coronavirus infections. The letter to UK National Health Service workers was written by Dame Sally C Davies, chief medical officer.

A then-novel coronavirus sparked the SARS (severe acute respiratory syndrome) outbreak in 2003, which involved more than 8422 cases globally and killed 916 people, according to the ECDC risk assessment. Aside from the outbreak, human coronaviruses are mainly known for causing colds. Health officials have stressed that the new coronavirus is clearly different from the SARS virus.

Both the Davies letter and the ECDC risk assessment said no suspected cases have been found among contacts of the Qatari patient or elsewhere. "Many of these contacts are already likely to be beyond the incubation period . . . when symptoms would have developed had they been infected," Davies wrote.

The ECDC said that as of yesterday [25 Sep 2012] it was not aware of "any increase in the number of patients with acute respiratory infections of unknown cause in intensive care units in Saudi Arabia or Qatar."

The ECDC statement filled in some new details on the 60-year-old Saudi Arabian who died. It said he fell ill on [6 Jun 2012], was hospitalized with severe pneumonia on [13 Jun 2012], and died on [24 Jun 2012].

The fact that the 2 cases occurred 3 months apart and that time spent in Saudi Arabia is the only known link means that "independent non-human-to-human transmission must be considered" and that an animal source can't be excluded, the ECDC said.

In addition, it is likely that the novel virus caused both cases, but more evidence is needed to prove this, the agency said. It added, "It is not clear which laboratory tests are most applicable for detection of the novel coronavirus, and there is therefore an urgent need to validate the existing tests and to develop more specific ones."

Meanwhile, the UK Health Protection Agency (HPA) said today [26 Sep 2012] that the WHO "has convened relevant European laboratories to work collaboratively to produce clinically validated assays for real-time detection of the novel coronavirus." The HPA also said that Ron Fouchier, PhD, of Erasmus Medical Center in the Netherlands, is expected to publish the full genome of the virus from the Saudi Arabian man within a day or 2.

In other developments, the Hong Kong Centre for Health Protection (CHP) published some guidance related to the new coronavirus, including advice to schools and recommendations on personal protective equipment for healthcare personnel. Hong Kong served as the launching pad for the international spread of the SARS virus in 2003, after it emerged in mainland China in late 2002.

See also:
- ECDC risk assessment [available at: http://www.ecdc.europa.eu/en/publications/Publications/RRA-Novel-coronavirus-final20120924.pdf],
- [25 Sep 2012] Davies letter to NHS staff [available at https://www.wp.dh.gov.uk/publications/files/2012/09/novel-coronavirus-25092012.pdf],
- [26 Sep 2012] UK HPA statement about development of molecular diagnostics for new virus [available at http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/RespiratoryViruses/NovelCoronavirus/respPartialgeneticsequenceofnovelcoronavirus/],
- Hong Kong CHP guidance for schools [available at http://www.chp.gov.hk/files/pdf/advice_to_school_on_prevention_of_novel_coronavirus_infection_26_9_2012_v3.pdf], and
- Recommendations for healthcare workers [available at http://www.chp.gov.hk/files/pdf/ic_matrix_for_hospitals_clinics_25_9_2012.pdf]

[Center for Infectious Disease Research & Policy
Academic Health Center
University of Minnesota
Minneapolis, MN
Regents of the University of Minnesota
USA]

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Communicated by:
ProMED-mail
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[The key new information in the reports above includes:
1. The mention that the Qatari patient had traveled to Saudi Arabia and returned to Qatar more than 10 days before the onset of illness, suggesting that the location of infection may well have occurred in Qatar and not in Saudi Arabia (if one uses the known incubation period of 7 days for coronaviruses) and
2. None of the known contacts of both patients (the Qatari patient and the Saudi Arabian patient) had developed illness after contact with the patients, suggesting a lower transmission rate than seen in the earlier SARS outbreak (2002/2003).

Other not surprising news in newswires today (26 Sep 2012) included:
1. The ruling out of coronavirus infection in the 5 "patients of interest" in Denmark (they were found to have influenza B virus (see http://medicalxpress.com/news/2012-09-patients-denmark-virus-hospital.html, communicated by ProMED-mail Rapporteur Kunihiko Iizuka)
2. The use of thermal monitoring at [Manila International Airport, Philippines] to identify potentially febrile travelers returning to their country (as was done during the SARS epidemic in 2003) has begun (see http://www.gmanetwork.com/news/photo/25752/arriving-passengers-screened-for-corona-virus).

This moderator expects that over the coming days, the media will continue to carry reports on "patients of interest" as countries begin active surveillance activities and healthcare personnel are sensitized to look for "patients of interest". - Mod.MPP]

See Also