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Published Date: 2012-09-30 11:44:31
Subject: PRO/AH/EDR> Novel coronavirus - Saudi Arabia (10): WHO, revised case def.
Archive Number: 20120930.1315960

NOVEL CORONAVIRUS - SAUDI ARABIA (10): WHO, REVISED CASE DEFINITIONS
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In this update:
[1] WHO update 29 Sep 2012
[2] WHO revised interim case definitions 29 Sep 2012

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[1] WHO update 29 Sep 2012
Date: 29 Sep 2012
Source: WHO GAR [edited]
http://www.who.int/csr/don/2012_09_29/en/index.html

Novel coronavirus infection - update - revised interim case definition
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WHO has continued to monitor the situation. No additional confirmed cases have been reported, and there is no evidence so far of person-to-person transmission of the novel coronavirus.

In order to ensure an appropriate and effective identification and investigation of patients who may be infected with the virus, without overburdening health care systems with unnecessary testing, a revised interim case definition has been issued by WHO (see related links to right of source page). It should be noted that this case definition was developed based on data from 2 confirmed cases, and as such some degree of clinical judgment is required where individual cases are concerned.

WHO has been cooperating closely with the laboratories which were responsible for the confirmation of the presence of the novel coronavirus in the 2 confirmed cases. These laboratories have been working on the development of diagnostic reagents and protocols which can be provided to laboratories that are not in a position to develop their own, and these are now available. WHO is now seeking to broaden the number of laboratories that will be able to assist Member States with the detection or confirmation of this novel virus.

WHO has received offers of support from a number of major public health institutions around the world to assist with testing, should the need arise. The complete nucleic acid sequence of the virus has been uploaded to Genbank, and the testing protocol, utilizing real-time PCR, has been published.

WHO does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions be applied.

WHO continues to inform its Member States through the designated National Focal Points under the International Health Regulations (2005).

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Communicated by:
ProMED-mail Rapporteur Marianne Hopp

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[2] WHO revised interim case definitions 29 Sep 2012
Date: 29 Sep 2012
Source: WHO GAR [edited]
http://www.who.int/csr/disease/coronavirus_infections/case_definition/en/index.html

Revised interim case definition - novel coronavirus
Interim case definition as of [29 Sep 2012]
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Case finding and classification scheme for Severe Acute Respiratory Infections associated with novel coronavirus infection:
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The following scheme is recommended for identifying cases that should be tested for infection with the novel coronavirus recently described. The goals of this scheme are to ensure a systematic approach to appropriate identification and investigation of patients who may be infected with the virus without overburdening health care systems with unnecessary testing. It should be noted that this information was developed based on data from 2 confirmed cases, and as such some degree of clinical judgment is required where individual cases are concerned.

Patients to be investigated (referred to as "Patient Under Investigation"):
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A person with an acute respiratory infection, which may include fever (greater than or equal to 38 C, 100.4 F) and cough;
AND
suspicion of pulmonary parenchymal disease (e.g. pneumonia or acute respiratory distress syndrome (ARDS)) based on clinical or radiological evidence of consolidation;
AND
travel to or residence in an area where infection with novel coronavirus has recently been reported or where transmission could have occurred;*
AND
is not already explained by any other infection or aetiology, including all clinically indicated tests for community-acquired pneumonia according to local management guidelines.

Management of Patients Under Investigation:
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Patients falling into this category should undergo routinely available laboratory tests as clinically indicated according to local management guidelines for community-acquired pneumonia to determine the presence of other potential primary aetiologies of pneumonia. Examples of other aetiologies might include _Streptococcus pneumoniae_, haemophilus influenza type B, _Legionella pneumophila_, other recognized primary bacterial pneumonias, influenza, and respiratory syncytial virus. It is not necessary to wait for all test results for other pathogens to be available before testing for novel coronavirus. In addition, patients with a clear history and clinical presentation consistent with chemical pneumonitis or smoke inhalation should not be considered as patients under investigation.

If the respiratory disease is unexplained, appropriate clinical specimens should be sent for laboratory investigation. Rapid progress has been made in the characterization of the novel coronavirus and in the development of sensitive and specific diagnostic assays. WHO is collaborating with partner laboratories to make these available as quickly as possible. It is anticipated that the 1st batch of reagents, together with information and testing algorithms, will be available for urgent testing within the coming days.

Until then, WHO is able to provide contact information of laboratories willing and able to test for the presence of the novel coronavirus. For further details, national authorities should contact their respective International Health Regulations Contact Point at their WHO Regional Office.

Appropriate infection control measures should be instituted while the patient is under investigation. Should Member States require further guidance on infection prevention and control, please refer to the WHO interim guidelines on infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care (WHO/CDS/EPR/2007.6):

Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care [available in English at http://www.who.int/csr/resources/publications/WHO_CDS_EPR_2007_6c.pdf.

Management of case contacts
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Any person who has had close contact** with a probable or confirmed case while the probable or confirmed case was ill should be carefully monitored for the appearance of respiratory symptoms. If symptoms develop within the 1st 10 days following the contact, the individual should be considered a "Patient Under Investigation" regardless of the severity of illness and investigated accordingly.

If laboratory data, including histopathological examination of fatal cases, cannot be obtained because the patient has died before specimens are taken, clinical specimens cannot otherwise be obtained, or appropriate laboratory testing for other pathogens is not available, then the patient may meet the criteria for being a "Probable Case" as defined below.

Case definitions for reporting
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Probable Case
A person fitting the definition above of a "Patient Under Investigation" with clinical, radiological, or histopathological evidence of pulmonary parenchyma disease (e.g. pneumonia or ARDS) but no possibility of laboratory confirmation either because the patient or samples are not available or there is no testing available for other respiratory infections,
AND
close contact** with a laboratory confirmed case,
AND
is not already explained by any other infection or aetiology, including all clinically indicated tests for community-acquired pneumonia according to local management guidelines.

Confirmed Case
A person with laboratory confirmation of infection with the novel coronavirus.

Reporting:
WHO requests that probable and confirmed cases be reported within 24 hours of being classified as such through the regional focal point for International Health Regulations at the appropriate WHO Regional Office.

* Currently, these areas would include only Qatar and Saudi Arabia (as of 29 Sep 2012).

** Close contact includes:
- anyone who provided care for the patient including a health care worker or family member or had other similarly close physical contact;
- anyone who stayed at the same place as (e.g. lived with, visited) a probable or confirmed case while the case was symptomatic.

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Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[As more information becomes available, one expects to see additional revisions in the case definitions. As a reminder, at present there have been only 2 confirmed cases of severe respiratory illness associated with this novel coronavirus. The fact that there haven't been additional cases in close contacts of these 2 patients (including healthcare personnel caring for them) is highly suggestive that the virus involved has not acquired easy human-to-human transmissibility. That being said, there is still the possibility that serosurveys might demonstrate a significant number of individuals with evidence of prior infection with this novel coronavirus, suggesting the virus is in fact more readily transmitted person-to-person but in the majority of infections there is either a mild disease or no clinical disease is noted. - Mod.MPP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1HAJ.]

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