Worldwide: 24 confirmed cases due to novel animal coronavirus - 16 fatalities - September 20, 2012 +

[alert]

http://www.who.int/csr/don/2013_02_11b/en/index.html

Novel coronavirus infection –update
11 February 2013 - The United Kingdom (UK) has informed WHO of a confirmed case with infection of the novel coronavirus (NCoV). The case is a UK resident who developed symptoms of illness on 26 January 2013. Laboratory investigations on respiratory specimens have revealed both an Influenza A(H1N1)pdm09 infection and a confirmed NCoV infection. He is hospitalized in intensive care unit.

Preliminary investigation reveals that the patient had a history of travel to Pakistan and Saudi Arabia. Further investigation into the case is ongoing.

The Health Protection Agency (HPA) has instituted stringent infection control measures around the patient and identified contacts who may have been exposed to the patient during his illness.

This is a sporadic case and does not alter the current WHO risk assessment on NCoV but the new case does indicate that the virus is persistent. As of 11 February 2013, a total of 10 confirmed cases of human infection with a novel coronavirus have been notified to WHO.

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns. Testing for the new coronavirus of patients with unexplained pneumonias, or patients with severe, progressive or complicated illness not responding to treatment, should be considered especially in persons residing in or returning from the Arabian peninsula and neighboring countries.

Any clusters of SARI or SARI in health care workers should be thoroughly investigated, regardless of where in the world they occur.

New human cases and clusters should be promptly reported both to national health authorities and to WHO.

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 are applied.

[Treyfish]

Good Catch, Alert! Co-infection sounds dangerous to me.. bet that was a helluva test result! Probably not good to find them 2 together.

[Treyfish]

A man who returned recently from the Middle East and Pakistan is under intensive care in a Manchester hospital where he has been confirmed as the first UK resident to be infected by a new form of virus.

He is only the 10th confirmed case with this type of acute respiratory illness, from which five people have died.

The latest case is the second to be identified with the coronavirus in Britain. Authorities notified the World Health Organisation on Friday. A 49-year-old Qatari man who was flown from Doha to London in September is still in hospital.The man involved in the latest case is reported to have first fallen ill on 26 January and was diagnosed with a severe illness on 31 January.http://www.guardian.co.uk/science/20...ntensive-care?

[Giuseppe Michieli]

[Source: European Centre for Disease Prevention and Control (ECDC), full page: (LINK).]

Epidemiological update: case of severe lower respiratory tract disease associated with a novel coronavirus

11 Feb 2013



On 11 February 2013, the UK Health Protection Agency (HPA) announced that an additional case of the novel coronavirus (NCoV) infection has been confirmed in a UK resident. The patient, a 60 year old male, became ill on 26 January 2013 and was admitted to hospital in England, with a severe lower respiratory tract disease on 31 January.

In the 10 days before his illness onset, the patient had visited both Pakistan (from 16 December 2012 to 20 January 2013) and Saudi Arabia (from 20 to 28 January 2013). After hospital admission, his condition deteriorated and he was transferred for extracorporeal membrane oxygenation (ECMO) treatment on 5 February. He remains severely ill in intensive care.

Laboratory investigations of respiratory specimens from 1 February have confirmed both an influenza A H1N1pdm09 infection and a NCoV infection. Because of the latter, the UK posted an alert through the EU Early Warning and Response System and the International Health Regulations.The HPA is coordinating the response to and further investigation of the potential contacts. Infection control measures have been instituted around the case. Contacts are being followed up and investigated if they develop relevant symptoms following the nationally recommended protocol.



Disease background information

As of 7 December 2012, nine laboratory-confirmed cases of severe pneumonia caused by the novel coronavirus (NCoV) had been reported to WHO. This is the 10th confirmed case.

Five of the nine cases were fatal. Onset of disease was from April to October 2012; all cases were resident in Saudi Arabia, Qatar or Jordan during the preceding days however it cannot at this stage be assumed that the viruses are only to be found in those countries.

The novel virus is distinctly different from the coronavirus which caused the SARS outbreaks in 2003 and genetically related to bat coronaviruses. No animal reservoir or mode of zoonotic transmission has yet been identified for the novel coronavirus though it is noted that similar viruses are known to be endemic in bats in many parts of the world.

The two fatal cases in Jordan were part of a cluster of 11 patients with respiratory symptoms linked to a hospital, but the limited information as yet available does not allow confirmation or refutation of their having been human-to-human transmission either in Jordan or in a family cluster in the Kingdom of Saudi Arabia.

After careful and intensive investigation of those exposed to the infections in the previous two cases in Europe, in the UK and Germany, there were no proven secondary infections.
ECDC, jointly with WHO, has mapped the capacity of virology reference laboratories in EU/EEA Member States with regard to the novel coronavirus (RT-PCR/sequencing assay). So far, approximately 250 people have been tested for the novel coronavirus in the EU since the first case was reported.

Except for the two confirmed cases, which were referred to the UK and Germany, none of the tests were positive. The results of this survey were published in Eurosurveillance on 6 December 2012.



Conclusions

An additional case of NCov was identified. The patient fell ill 6 days after entering Saudi Arabia, but the exposure could have happened while in Pakistan or in Saudi Arabia. All nine previous cases identified were reported as having some link with the Arabian Peninsula: Kingdom of Saudi Arabia (5), Qatar (2) and Jordan (2). However the virus reservoir and routes of transmission remain unknown and it should not be excluded that these novel viruses can be found in other parts of the world.

The wide geographical distribution, the long intervals between cases and clusters, and the absence of evidence for mild or asymptomatic human infections which could maintain a chain of transmission between outbreaks, point to intermittent zoonotic transmission or an environmental source. Zoonotic transmission does not exclude human-to-human transmission from an index case but there is only limited evidence to date that this has occurred.

WHO recognizes that the emergence of a new coronavirus capable of causing severe disease raises concerns because of experience with SARS. Although this novel coronavirus is distantly related to the SARS CoV, they are different. Based on current information, it does not appear to transmit easily or sustainably between people, unlike the SARS virus.

The occurrence of such sporadic cases is to be expected in the context of the enhanced surveillance for cases and clusters implemented in the Arabian Peninsula and worldwide.

ECDC notes the WHO advice encouraging Member States to maintain surveillance for severe acute respiratory infections and to carefully review any unusual patterns of infection.

Testing for the new coronavirus in patients with unexplained pneumonias, or patients with severe, progressive or complicated illness not responding to treatment, should be considered along with investigations for more likely infections.

This event does not affect the conclusions of the rapid risk assessment published by ECDC on 7 December 2012. However, ECDC will be reviewing and updating its risk assessment in the light of this additional case and other developments in the last 2 months.



Confirmed cases of novel coronavirus infection, April 2012 to 8 February 2013, in order of onset of disease.

[Onset - Age (yrs) - Sex - Probable place of infection - Date reported – Source - Outcome ]

1. April 2012 – 45 – F - Jordan** - 30/11/2012 - WHO/IHR – Dead
2. April 2012 – 25 - M - Jordan** - 30/11/2012 - WHO/IHR - Dead
3. 13/06/2012 – 60 - M - Kingdom of Saudi Arabia* - 20/09/2012 - Kingdom of Saudi Arabia/Promed - Dead
4. 03/09/2012 – 49 – M - Qatar/Kingdom of Saudi Arabia*** - 22/09/2012 - HPA/WHO – Alive
5. NK - NK - NK - Kingdom of Saudi Arabia - 04/11/2012 - Kingdom of Saudi Arabia/Promed/SMJ – Alive
6. 12/10/2012 - 45 - M - Qatar**** - 23/11/2012 - RKI/WHO - Alive
7. NK - NK - M - Kingdom of Saudi Arabia* - 19/11/2012-23/11/2012 - Kingdom of Saudi Arabia/Promed/WHO - Alive
8. 28/10/2012 - NK - M - Kingdom of Saudi Arabia* - 23/11/2012 - WHO - Dead
9. Oct 2012 - NK - M - Kingdom of Saudi Arabia* - 28/11/2012 - WHO - Dead
10. 26/1/2013 - 60 - M - Pakistan/Kingdom of Saudi Arabia - 8/11/2013 - EWRS – Alive

* Part of family cluster
** Healthcare worker and part of outbreak linked to hospital
*** Patient transferred to UK
**** Patient transferred to Germany
NK: not known



Read more

ECDC Risk Assessment Update: Severe respiratory disease associated with a novel coronavirus - 7 December 2012



More information

WHO - Coronavirus infections
Health Protection Agency UK
Robert Koch Institute (in German)

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[Treyfish]

Manchester medics are treating the UK's second ever SARS virus case
11 Feb 2013 14:25
The man, who has recently travelled to the Middle East, is in intensive care at Wytheshawe hospital


Coronavirus, which includes the Sars-like virus currently affecting patients.
A man is seriously ill in Wythenshawe Hospital after contracting a potentially fatal Sars-like virus.

The victim, who has recently travelled to the Middle East and Pakistan, is being treated in the hospital’s critical care unit.

It is only the second case of the virus to be confirmed in Britain, medics have revealed.

The MEN understands that the man, who is middle-aged and lives in the West Midlands, was transferred to Wythenshawe from another hospital last week after being admitted with flu-like symptoms and severe breathing problems.

It is thought that his illness was confirmed by doctors at Wythenshawe after blood tests and he is now being treated in an individual isolation room.

Doctors and nurses who are treating him are wearing protective gowns – and masks – to ensure they do not become infected.

He was transferred to Wythenshawe to undergo highly-specialist treatment, called Extra Corporeal Membrane Oxygenation (ECMO).

Wythenshawe is the only hospital in the north of England to offer the therapy, which is commonly used to treat swine flu patients.

The life-support technique uses a £40,000 machine which takes blood from the heart, removes carbon dioxide, and pumps oxygen into it before pushing it back around the body.

Chief nurse Mandy Bailey said: “Wythenshawe can confirm that it is treating a patient who has been diagnosed with novel coronavirus.

“We are working closely with the Health Protection Agency to ensure that anyone who has had contact with the patient is being followed up to check on their health. We are also ensuring that the patient under investigation is being treated appropriately.

“Our staff already follow strict guidelines on treating patients with unknown illnesses and have been wearing personal protective equipment at all times since their initial contact. Visitors are being limited and they too will follow strict safety guidelines.”

Officials at the Health Protection Agency said that the patient is one of 10 confirmed cases around the world. The death toll stands at five.

Five cases have been confirmed in Saudi Arabia – including three deaths; two cases were recorded in Jordan – both patients have died; one patient in Germany has recovered and last year British health experts confirmed another case.

A 49-year-old Qatari man was treated at St Thomas' hospital in London after becoming infected.

Coronaviruses range from the common cold to the Sars (Severe Acute Respiratory Syndrome) virus and are spread through sneezing and coughing.

In 2002, an outbreak of Sars killed about 800 people, mainly in Asia but it spread to more than 30 countries across the globe.

The new coronavirus was first identified in September 2012 in a patient in Saudi Arabia who has since died. Symptoms include fever, cough, shortness of breath and breathing difficulties.

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 and that healthcare staff who are looking after the patient are protected.

Contacts of the case are also being followed up to check on their health.

"Our assessment is that the risk associated with novel coronavirus to the general UK population remains extremely low and the risk to travellers to the Arabian Peninsula and surrounding countries remains very low.

"No travel restrictions are in place but people who develop severe respiratory symptoms, such as shortness of breath, within 10 days of returning from these countries should seek medical advice and mention which countries they have visited.”

Alice McKeegan explains why we're seeing this case now
The new virus is a type of coronavirus, which includes the common cold and Sars.

Health officials say it is similar to Sars but they do not know exactly how the new strain has developed.

SARS – or severe acute respiratory syndrome – is a highly contagious, serious and potentially life-threatening form of pneumonia.

It is caused by the Sars coronavirus – and begins with flu-like symptoms. The virus was first diagnosed in southern China in 2002 and quickly spread across the world.

A pandemic was declared and more than 8,000 people were struck down by the illness.

Statistics show that 774 victims were killed by the virus before the outbreak was brought under control in July 2003.

Symptoms include breathing difficulties, a dry cough, muscle pain, and extreme tiredness. It attacks the airways – and it is spread through coughing and sneezing.

There is currently no cure – but doctors are trying to develop a vaccine. Most patients are put on ventilators to support their breathing and given antiviral drugs. They are also kept in isolation to avoid spreading the virus.

People over the age of 65 are particularly vulnerable but experts say that people should not be too alarmed by the latest cases.http://www.manchestereveningnews.co....k-sars-1310263

[Giuseppe Michieli]

[Source: World Health Organization, Regional Office for Europe, full page: (LINK).]

Further case of novel coronavirus detected

11-02-2013



The United Kingdom has informed WHO of a confirmed case of infection with the novel coronavirus (nCoV). The new case is a United Kingdom resident who developed symptoms of illness on 26 January 2013. A preliminary investigation revealed that the patient had a travel history to Pakistan and Saudi Arabia.

Laboratory investigations on respiratory specimens have revealed infection with both Influenza A(H1N1)pdm09 and NCoV. The patient is currently hospitalized in intensive care in the United Kingdom.

The Health Protection Agency (HPA) of the United Kingdom has instituted stringent infection control measures around the patient and identified contacts who may have been exposed to him during his illness. Further investigation into the case is ongoing.



WHO recommendations

This sporadic case does not alter the current WHO risk assessment on NCoV, but the new case does indicate that the virus is persistent. As of 11 February 2013, a total of 10 confirmed cases of human infection with a novel coronavirus have been notified to WHO.

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.

For further recommendations please refer to the WHO headquarters novel coronavirus update.



Background

Coronaviruses are a large family of RNA viruses capable of infecting humans and some animal species. In humans, coronaviruses may cause a range of illnesses, from the common cold to SARS.

On 22 September 2012, the United Kingdom informed WHO of a case of acute respiratory syndrome with renal failure in a person with travel history to Saudi Arabia and Qatar. Upon further investigation, a total of 9 cases, 5 of which were fatal, were identified that had taken place since April 2012 in Saudi Arabia, Qatar and Jordan.

This particular strain of coronavirus had not been previously identified in humans and the characterization of the full genome sequence of the virus indicates that it belongs to a novel species of coronavirus in the genus Betacoronavirus that is distinct from other known coronaviruses and SARS.



WHO response

Following the first confirmation of the novel coronavirus, WHO – under the International Health Regulations – immediately alerted all its Member States about the virus and has been leading the coordination and providing guidance to health authorities and technical health agencies. WHO is also identifying a network of laboratories that can provide expertise on coronaviruses for countries.

WHO will continue monitoring the situation and working with partners to ensure a high degree of preparedness should the new virus be found to be sufficiently transmissible to cause community outbreaks.



See also

• Coronavirus infections
• Novel coronavirus infection – revised interim case definition 01-10-2012
• Novel coronavirus infection in the United Kingdom 23-09-2012

From other WHO sites

• Novel coronavirus infection –update WHO headquarters, 11 February 2013
• Background and summary of novel coronavirus infection – as of 21 December 2012
• Coronavirus infections

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[Giuseppe Michieli]

[Source: Department of Health, Hong Kong PRC SAR, full text: (LINK).]

DH closely monitors additional overseas case of Severe Respiratory Disease associated with Novel Coronavirus



The Department of Health (DH) is closely monitoring an additional case due to infection with the novel coronavirus confirmed by the Health Protection Agency of the United Kindgom (UK). The new case involved a UK resident who had recently travelled to the Middle East and Pakistan.

The patient is receiving intensive care treatment in a Manchester hospital. This latest case brings the total number of confirmed cases globally to 10, of which two have diagnosed in the UK.

A DH spokesman said, "The Centre for Health Protection (CHP) of the DH will continue its surveillance mechanism with public and private hospitals, practising doctors and the airport for any suspected cases of Novel Coronavirus associated with Severe Respiratory Disease.

"In addition, the CHP will stay vigilant and continue to work closely with the World Health Organization and other overseas health authorities to monitor the latest development of this novel infectious disease.

"No human infection with this virus has been identified so far in Hong Kong."

The spokesman advised travellers returning from novel coronavirus affected countries with respiratory symptoms should wear a facial mask and seek medical attention and reveal the travel history to the doctor.



Ends/Tuesday, February 12, 2013
Issued at HKT 15:48
NNNN

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[alert]

edit

And the second reported case in this thread (UK ex Qatar) remains critically ill, five months after infection:

http://www.mirror.co.uk/news/uk-news...e-care-1703612

[snip]

The first here was a 49-year-old man, not from the UK.

He was taken to St Thomas’ Hospital in Central London by air ambulance from Qatar in September and is still seriously ill in hospital, five months on.

[Treyfish]

UN health agency confirms 10th case of Novel Coronavirus infection



12 February 2013 – The United Nations health agency today confirmed the latest case of Novel Coronavirus, bringing to 10 the total number of cases detected globally of this rare illness.

The latest case is a resident from the United Kingdom who developed symptoms at the end of last month. He has been hospitalized and is currently receiving intensive care. Investigations revealed that the man had recently travelled to Pakistan and Saudi Arabia.

The World Health Organization (WHO) said this is “a sporadic case” that does not alter its risk assessment. However, it added that the new case “does indicate that the virus is persistent.”

Coronaviruses are a large family of viruses which cause illness in humans and animals. In humans, these illnesses range from the common cold to infection with Severe Acute Respiratory Syndrome (SARS).

“Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns,” the agency said in an update.

“Testing for the new coronavirus of patients with unexplained pneumonias, or patients with severe, progressive or complicated illness not responding to treatment, should be considered especially in persons residing in or returning from the Arabian peninsula and neighbouring countries.”

Of the 10 cases confirmed so far, two have been reported in Qatar, five in Saudi Arabia and two in Jordan. All patients were severely ill, and five have died.

WHO did not advise special screening at points of entry nor did it recommend that any travel or trade restrictions are applied. The agency added that it will continue to work with its partners to monitor the situation closely and investigate any reports of SARI cases in health care workers.http://www.un.org/apps/news/story.as...=#.URqB_qXpe5I

[alert]

Published Date: 2013-02-12 16:43:16
Subject: PRO/AH> Novel coronavirus - Eastern Med. (03): Saudi comment
Archive Number: 20130212.1540011

NOVEL CORONAVIRUS - EASTERN MEDITERRANEAN (03): SAUDI COMMENT
************************************************** ***********
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Tue 12 Feb 2013
From: Ziad A Memish [edited]


The most recent WHO report of severe respiratory illness in a 60 year old British national warrants comment about limitations of the current novel coronavirus case definition [e.g., see ProMED post: Novel coronavirus - Eastern Med. (02): UK ex Saudi Arabia, Pakistan 20130212.1539086. - Mod.CP] Press releases following the UK Health Protection Agency's announcement again emphasize the fact that this individual has had contact with the Middle East though the incubation period and appearance of symptoms are ambiguous enough that a more cautious statement is needed, that is, that it remains unknown where and when this patient became infected. As well, a finding of dual novel coronavirus and 2009 H1N1 [influenza A(H1N1)pdm09] influenza genes by molecular test methods should be interpreted with caution until confirmation is available from an independent source. We have made a thorough search for dual infections (both viral and bacterial) on our SARI [severe acute respiratory infection] cases, and have yet to find any. Meanwhile the incidence and severity of influenza infections have made headlines this winter [e.g., see the ProMED post: Influenza (17): Czech Republic, severity 20130208.1535245, - Mod.CP] Alerts for severe 2009 H1N1 infections are prominent on south Asian websites following reports of flu deaths in India last week [e.g., see ProMED-mail post Influenza (15): India (RJ) mortality 20130204.1528727. - Mod.CP] To put the matter in context, morbidity and mortality from influenza this winter will dwarf the 9 [now 10] cases of novel coronavirus infections reported so far.

Saudi Arabia continues to conduct surveillance for novel coronavirus in patients who meet the current SARI definition. It is one of several agents being investigated at our laboratories and by our colleagues at outside referral labs. During the last Hajj season [2012], we were able to test more than 300 sick pilgrims and found no evidence of novel coronavirus infection. Neither was this virus detected by our French (1) and Egyptian colleagues (personal communication) who reported surveillance findings on returned pilgrims. Our efforts to identify cases are ongoing, but now that validated detection tests are commercially available (2), we recommend that an expanded search for this virus is undertaken. Thus far it is less associated with focused or even regional outbreaks than it is with sporadic disease in widely separated locales. Unless and until SARI investigations are expanded, our understanding of its epidemiology and disease spectrum will remain limited. An urgent discussion of the current case definition is needed.

References
----------
1. Gautret P, Charrel R, Belhouchat K, et al: Lack of nasal carriage (hCoV) in French Hajj pilgrims returning from the Hajj 2012, despite high rate of respiratory symptoms. DOI: 10.1111/1469-0691.12.166. 11 Feb 2013 [abstract available at http://onlinelibrary.wiley.com/doi/1...2174/abstract].

2. Corman VM, Muller MA, Drosten C, et al: Assays for laboratory confirmation of novel human coronavirus infections. Euro Surveill. 2012; 17(49): pii=20334; available at http://www.eurosurveillance.org/View...rticleid=20334.

--
Ziad A Memish, MD,FRCPC,FRCPE,FRCPL,FACP
Deputy Minister for Public Health
Ministry of Health
Professor, College of Medicine
AlFaisal University
Riyadh
Kingdom of Saudi Arabia


[ProMED-mail in general supports Dr Memish's reservation that the existing data regarding the epidemic potential of the recently characterised novel coronavirus are sparse and should not be over-interpreted. The increasing availability of accurate diagnostic reagents and methodologies should help achieve a better understanding of the epidemiology of the disease. It is unfortunate that results of field studies aimed at identifying possible transmission exposure risks are not available as yet to try to address epidemiologic issues in a scientific manner. - Mod.CP

[sharon sanders]

Also please see:

UK - Possible Human-to-Human transmission of novel coronavirus HCoV - 11th worldwide case

http://www.flutrackers.com/forum/sho...d.php?t=200153

[Giuseppe Michieli]

[Source: Department of Health, Hong Kong PRC SAR, full text: (LINK).]

DH closely monitors additional overseas case of Severe Respiratory Disease associated with Novel Coronavirus



The Department of Health (DH) is closely monitoring another additional case due to infection with the novel coronavirus confirmed by the Health Protection Agency (HPA) of the United Kingdom (UK). The latest case is the family member and is in close personal contact with the 10th case announced by HPA earlier.

The patient, who is a UK resident, does not have any recent travel history and is currently receiving intensive care treatment in a hospital in Birmingham. This latest case brings the total number of confirmed cases globally to 11, of which three have been diagnosed in the UK.

A DH spokesman said, "The Centre for Health Protection (CHP) of the DH will seek more information on these two recent cases from the World Health Organization (WHO) and HPA.

''The CHP will stay vigilant and continue to work closely with the WHO and other overseas health authorities to monitor the latest development of this novel infectious disease."

"Locally, the CHP will continue its surveillance mechanism with public and private hospitals, practising doctors and the airport for any suspected cases of Novel Coronavirus associated with Severe Respiratory Disease."

"No human infection with this virus has been identified so far in Hong Kong," the spokesman stressed.

The spokesman advised travellers returning from novel coronavirus affected countries with respiratory symptoms should wear a facial mask and seek medical attention and reveal the travel history to the doctor.

Ends/Wednesday, February 13, 2013
Issued at HKT 21:46
NNNN

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[Treyfish]

Epidemiological update: Case of severe lower respiratory tract disease associated with a novel coronavirus
13 Feb 2013

ECDC
On 13 February 2013, the HPA announced that one family contact of the previously-confirmed case reported on 11 February was laboratory-confirmed to be infected with the novel coronavirus (NCoV). This second case from the same family was hospitalised on 9 February with a short history of respiratory symptoms. The patient has an existing medical condition that may make him more susceptible to respiratory infections. He does not have a recent travel history, and is currently receiving intensive care treatment.
The cases have been notified through the EU alerting system for communicable diseases.
This brings the total of laboratory-confirmed cases of severe pneumonia caused by the NCoV to eleven globally (see table below).
The information available suggests human-to-human transmission of the NCoV in this family cluster.
The HPA reports that surveillance of family, close contacts of the two patients and healthcare workers treating the two patients is ongoing, as per the UK National Guidelines. None are currently presenting with symptoms consistent with nCoV.
The HPA is also following-up regarding passengers who may have been exposed while flying with the case announced on 11 February 2013 and are in contact with the airline concerned.
In light of this human-to-human transmission of the NCoV within the family cluster, ECDC is now updating its risk assessment, previously published on 7 December 2012.

Case No.	Date of Onset	Age (years)	Sex	Probable place of infection	Date reported	Source	Outcome
1	April 2012	45	F	Jordan**	30/11/12	WHO/IHR	Dead
2	April 2012	25	M	Jordan**	30/11/12	WHO/IHR	Dead
3	13/06/12	60	M	Kingdom of Saudi Arabia*	20/09/12	Kingdom of Saudi Arabia/ProMed	Dead
4	03/09/12	49	M	Qatar/ Kingdom of Saudi Arabia***	22/09/12	HPA/WHO	Alive
5	NK	NK	NK	Kingdom of Saudi Arabia*	04/11/12	Kingdom of Saudi Arabia/ProMed / SMJ	Alive
6	12/10/12	45	M	Qatar****	23/11/12	RKI / WHO	Alive
7	NK	NK	M	Kingdom of Saudi Arabia*	19/11/12- 23/11/12	Kingdom of Saudi Arabia/ProMed/ WHO	Alive
8	28/10/12	NK	M	Kingdom of Saudi Arabia*	23/11/12	WHO	Dead
9	October 2012	NK	M	Kingdom of Saudi Arabia*	28/11/12	WHO	Dead
10	24 /1/2013	60	M	Pakistan/ Kingdom of Saudi Arabia*	8/1/13	EWRS	Alive/Hospitalised
11	6/2/2013	NK	M	United Kingdom*	12/02/13	HPA	Alive/Hospitalised

* Part of family cluster
** Healthcare worker and part of outbreak linked to hospital
*** Patient transferred to UK
**** Patient transferred to Germany
NK: not known





http://www.ecdc.europa.eu/en/press/n...2FLists%2FNews

[Treyfish]

Novel coronavirus infection – update

13 FEBRUARY 2013 - The United Kingdom (UK) has informed WHO of another confirmed case of infection with the novel coronavirus (NCoV). The patient is a UK resident and a relative of the case announced on 11 February 2013.

The latest confirmed case does not have any recent travel history outside the UK and is currently hospitalized in an intensive care unit. It is understood that this patient has pre-existing medical conditions that may have increased susceptibility to respiratory infections.

Confirmed NCoV in a person without recent travel history indicates that infection was acquired in the UK. To date, evidence of person-to-person transmission has been limited. Although this case is suggestive of person-to-person transmission, on the basis of current evidence, the risk of sustained person-to-person transmission appears to be very low.

The Health Protection Agency (HPA) is following up on all close contacts (family and healthcare workers) who may have been exposed to either of these two new confirmed cases.

As of 13 February 2013, a total of 11 confirmed cases of human infection with NCoV have been notified to WHO, with no change in the number of fatalities i.e., five deaths since April 2012.

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns. Testing for the new coronavirus should be considered in patients with unexplained pneumonias, or in patients with unexplained severe, progressive or complicated respiratory illness not responding to treatment.

Any clusters of SARI or SARI in healthcare workers should be thoroughly investigated, regardless of where in the world they occur.

New cases and clusters of the NCoV should be reported promptly both to national health authorities and to WHO.

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 monitor closely the situation.http://www.who.int/csr/don/2013_02_13/en/index.html

[alert]

A sixth fatality has been reported, likely the 11th reported case:

http://www.reuters.com/article/2013/...91I0SK20130219
http://www.flutrackers.com/forum/sho...d.php?t=200529

And a 12th case, a mild one, has also been confirmed in a third family member:

http://www.flutrackers.com/forum/sho...d.php?t=200274

[alert]

Saudi Arabia has reported an additional fatal case, the 13th case and 7th death worldwide:

http://www.flutrackers.com/forum/sho...d.php?t=200678

[Treyfish]

Saudi Arabia reports new coronavirus case; UK wonders about 4th case in cluster
By: Helen Branswell, The Canadian Press
TORONTO - Saudi Arabia has discovered another infection with the novel coronavirus, the World Health Organization announced Thursday.
The infected person was hospitalized in late January and died on Feb. 10, but confirmation of the infection was only made Feb. 18, the WHO said in a statement. Further investigation of the new case is underway.

The Geneva-based agency urged countries to consider testing for the new virus when patients present for care with unexplained pneumonias or when patients with severe, progressive or complicated respiratory illnesses don't respond to treatment — especially if those patients have recently travelled to or come from parts of the world where infections have occurred.
To date, cases have been linked to three countries in the Middle East — Saudi Arabia, Qatar and Jordan.

The new case is the 13th confirmed infection and seventh death caused by the new coronavirus, which the WHO is calling NCoV.
In addition, there are nearly a dozen cases the WHO considers "probable" infections — people who were exposed to cases and who later became sick but who were not tested or weren't tested in time. If an infected person had recovered from the illness, current tests — which look for virus DNA in mucus — would not find evidence of infection.
Some laboratories are working to develop a blood test that will detect antibodies to the virus. Once blood tests are available it should be possible to figure out whether some of the probable cases were actually infected.
One instance where such a tool would be useful involves the current cluster of NCoV cases in Britain.

A man who had recently travelled to Pakistan and Saudi Arabia became severely ill after his return. He tested positive for the virus, as did two other members of his family who had not travelled abroad. But a fourth infection may have also occurred in that family....http://www.winnipegfreepress.com/wor...192256741.html

[alert]

This is a report of the Qatari man hospitalized in Germany (case #5). The entire article is worth reading.

Note the following text. This might be indicative of a large number of missed milder cases. It brings to my mind the initial report at the start of the H1N1 pandemic from the Diario Desperatar de Oaxaca mentioning mild respiratory symptoms in 16 HCW contacts of a fatal confirmed case. This seems like a LOT of people to coincidentally have respiratory symptoms.

http://www.eurosurveillance.org/View...rticleId=20406

[snip]

Contact investigation
We identified 120 hospital and three out-of-hospital contacts, including the interpreter of the patient. Protective measures were largely limited to HCW wearing gloves and gowns when providing intimate care and use of surgical face masks during suctioning. From 31 October until 4 November (illness weeks five and six), the patient was isolated using barrier nursing due to a concurrent Pseudomonas aeruginosa infection. This included use of surgical masks only. Among the 120 hospital contacts the largest group were nurses (n=59; 49%), followed by physicians (n=26; 22%) and laboratory technicians (n=15; 13%) (Table 1). Median time from first contact to venipuncture was 39 days (range: 13–50 days).

Eighty-five (69%) of all respondents reported contact at a distance of less than or equal to 2 m, 14 (11%) of more than 2 m, and 24 (20%) of unknown distance to the patient. Frequency of ARI by week of first contact differed significantly among the groups (Table 1). However, there was no trend in the ARI proportion over time: eight of 33 contacts with first exposure during illness weeks three or four experienced ARI within 10 days of last contact; five of nine contacts with first exposure during the patient’s fifth week of illness; and none of 14 with first contact during week six of illness developed ARI.

Among 81 contacts reporting exposure within 2 m, 21 had ARI compared to none of 14 with contact of more than 2 m (p value; 0.04) (Table 1). Among those with first exposure in week three or four of illness of the patient, the proportion of contacts with ARI was not significantly different between those considered to be at high risk and the remaining contacts (p value, 0.87) (Table 1). Thirteen HCW had contact to the patient in weeks three or four of illness, had contact within 2 m to the patient and had worn surgical face masks rarely or never. Among these, nine were high-risk contacts, including one nurse who assisted in a bronchoscopy on 25 October. All nine provided a blood sample. The median time after last contact with the patient for these nine HCW was 32 days (range: 13–46 days). No sample was reactive by IFA.

[snip]

During two interviews that the patient kindly agreed to, we explored a wide spectrum of factors that he might have been exposed to. Even though NCoV is genetically similar to bat coronaviruses [1,13,14], other animals may serve as (intermediate) host as well. While our patient denied contact to bats, he remembered ill goats among the animals on his farm. Albarrak et al. reported that the first Saudi case was exposed to farm animals, but the first Qatari patient and the second Saudi patient were not [15]. Although our patient reported no direct contact with his animals, one animal caretaker working for him was ill with cough and might have been an intermediate link in the chain of infection.

Coronaviruses do infect ruminants such as goats [16] and thus goats could be considered as a possible source of origin for the novel virus, particularly in the geographical and cultural context of our patient. Recent experimental studies have found that NCoV can infect and replicate in cells of various species including humans, swine, monkeys and bats, suggesting a more promiscuous host specificity compared to other human coronaviruses such as SARS CoV [17]. Susceptibility of goat cells was not tested, but it cannot be excluded that NCoV might infect this species as well.

[snip]

[Giuseppe Michieli]

NONE among the HCWs entered in contact with German patient had demonstrated infection with NCoV through sequential serology.

Despite the study limitations, this is an evidence that the patient was not infectious at the time HCWs provided care.

Of concern, instead, the fact that so many HCWs entered in contact with a severely ill patient - presenting an acute respiratory infection - without complete PPE.

A lot of pneumonia cases remains unexplained and treated as community associated pneumonia empirically every day in our countries hospitals.

Are we sure that health care workers are protecting themselves and all other patients from infections?

[Treyfish]

MoH confirms death of woman from rare form of coronavirus


Saturday 23 February 2013

Last Update 22 February 2013 9:15 pm
A Riyadh resident has died from a rare form of a coronavirus, according to the Saudi Ministry of Health (MoH).
Undersecretary to the Ministry of Health for Public Health, Dr. Ziad Al-Memish, told Arab News yesterday that the victim was a 61-year-old Saudi woman. The cause of death was confirmed by a laboratory test.
It is the third such fatality in the Kingdom and the constitutes the 13th confirmed case of a coronavirus infection. It is the seventh death blamed on the virus worldwide.
The Saudi patient was hospitalized on Jan. 29 in a hospital in Riyadh and died there on Feb. 10.
The woman had recently returned from abroad with symptoms of severe acute respiratory syndrome (SARS), the official said. She did not respond to treatment.
In September last year, the ministry reported three cases of the virus, two of whom were Saudis while one was from Qatar. Two of the patients died in Saudi Arabia.http://arabnews.com/moh-confirms-dea...m-coronavirus?

[alert]

Here's some more details about cases #10 and #11:

http://www.healthaim.com/deadly-viru...ems-worldwide/

Deadly Virus Could Cause Problems Worldwide
Posted by David Arnold on Mar 2nd, 2013 // No Comments

Khalid Hussain was the first person from Britain who died from the new SARS-type virus in late February. Hussain was just 38 and died at a hospital in Birmingham, England after his father infected him. His father had just returned from a trip to Mecca, when Hussain become sick.

The symptoms of the SARS-like coronavirus are shortness of breath, a strong cough and a fever. Those symptoms are similar to a common cold. Shortly afterwards, breathing becomes difficult and the lips on the person start to turn blue.

[snip]

[alert]

Saudi Arabia has confirmed an additional fatal case, the 14th case worldwide and the 8th fatality:

http://www.flutrackers.com/forum/sho...d.php?t=201542

[alert]

Let us not also forget that 2 of the 6 non-fatal cases (#2 and #10) are still ill, so if one were to calculate the CFR based only on cases that have reached a final outcome, the apparently CFR would be 66.7%, 8 deaths in 12 cases.

Published Date: 2013-03-06 19:06:11
Subject: PRO/AH/EDR> Novel coronavirus - Eastern Mediterranean (07): Saudi Arabia, WHO
Archive Number: 20130306.1574423

NOVEL CORONAVIRUS - EASTERN MEDITERRANEAN (07): SAUDI ARABIA, WHO
************************************************** ***************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: 6 Mar 2013
Source: WHO GAR (Global Alert and Response) [edited]
http://www.who.int/csr/don/2013_03_06/en/index.html


Novel coronavirus infection - update 6 Mar 2013
-------------------
The Ministry of Health in Saudi Arabia has informed WHO of a new confirmed case of infection with the novel coronavirus (NCoV).

The patient, a 69-year-old male, was hospitalized on [10 Feb 2013] and died on [19 Feb 2013]. Preliminary investigation indicated that the patient had no contact with previously reported cases of NCoV infection and did not have recent history of travel.

To date, WHO has been informed of a global total of 14 confirmed cases of human infection with NCoV, including 8 deaths. Of the total number, 7 cases, including 5 deaths, have been reported from Saudi Arabia.

Based on the current situation and available information, WHO encourages all Member States (MS) to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns. WHO is currently working with international experts and countries where cases have been reported to assess the situation and review recommendations for surveillance and monitoring.

All MS are reminded to promptly assess and notify WHO of any new case of infection with NCoV along with information about potential exposures that may have resulted in infection and a description of the clinical course.

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 closely monitor the situation.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[As stated above, the current total number of confirmed cases of illness associated with infection with the novel coronavirus (nCoV) is now 14, of which 8 had a fatal outcome, a case fatality rate (CFR) of 57 percent. As the total number of confirmed cases to date is small (14), the observed CFR of 57 may be a reflection of non-confirmation of milder illness associated with infection with this nCoV.

The breakdown of cases (and deaths) by country of report is:
- Saudi Arabia: 7 (5 deaths)
- Jordan: 2 (2 deaths)
- UK: 4 (1 patient from Qatar - under treatment, 3 patients from UK - one with history of travel to Saudi Arabia and Pakistan prior to illness; 1 under treatment, 1 recovered, 1 death)
- Germany: 1 (patient from Qatar - discharged).

More information on the epidemiologic investigation surrounding this case's potential exposures, such as animals, including bats, would be greatly appreciated.

[alert]

Saudi Arabia has confirmed an additional fatal case:

http://www.flutrackers.com/forum/sho...d.php?t=201891

bringing the worldwide total to 15 cases, 9 deaths.

[alert]

Originally Posted by alert

Saudi Arabia has confirmed an additional fatal case:

http://www.flutrackers.com/forum/sho...d.php?t=201891

bringing the worldwide total to 15 cases, 9 deaths.

And a contact of that case who had a mild illness has been confirmed to be case #16:

http://www.flutrackers.com/forum/sho...d.php?t=202423

[alert]

Hat-tip Treyfish. Case #10 has died:

http://www.birminghammail.co.uk/life...in-uks-1877516

Birmingham grandad is UK's second Coronavirus victim
23 Mar 2013 09:00
Abid Hussain, of Winson Green, lost battle against Sars-like bug in hospital on Tuesday

Birmingham grandad Abid Hussain has become the UK’s second victim to the new Sars-like bug Coronavirus.

The tragedy comes as Mr Hussain’s wife and daughter were in Pakistan after burying his son Khalid, 38, who had also fallen victim to the killer disease.

The dad-of-two, in his 60s, of Winson Green, was being treated at Wythenshawe Hospital, in Manchester, and seemed to be improving.

But he took a turn for the worse and lost his battle on Tuesday.

[snip]

------------

[Now 2/3 of the confirmed cases that have reached a final outcome (10 of 15) have died, with case #2 possibly still hospitalized since September 2012. - alert]

[Treyfish]

Patient released after coronavirus treatment


Last Update 24 March 2013 2:29 am
There was another case of coronavirus infection in the Kingdom, according to the World Health Organization (WHO).
Ziad Al-Memish, undersecretary to the Ministry of Health for Public Health, confirmed the new case. “It was a mild infection in a person from Riyadh and the patient is already discharged from the hospital after complete recovery,” Al-Memish said.
The undersecretary said that there was no cause for alarm about the infection as the ministry had already taken all preventive measures to keep the disease under control.
The official also pointed out that people need not worry about the virus as it is believed that it cannot be transmitted from person to person. Still, he cautioned people to take measures to avoid the virus.
“We are also monitoring the virus in all parts of the Kingdom through the regional directorates of the MoH,” he said.
Al-Memish, who is also the chairman of the National Scientific Committee for Infectious Diseases, said that only a few people had been found positive in the world.
Symptoms of the virus include runny nose, general feeling of illness, mild sore throat, cough, headache, low fever and chills. It can also cause respiratory, intestinal and neurological illness.
The official said most of those infected recover completely with no complications after receiving the required supportive therapy.
To date four countries have recorded infections: Saudi Arabia with nine cases and six deaths; Qatar with two cases; Britain with three cases and one death; and Jordan with two fatal cases. http://arabnews.com/news/445886?

[alert]

Germany has imported a case from the UAE, who has since died:

http://www.flutrackers.com/forum/sho...d.php?t=202496

becoming the 17th case and 11th fatality.

In addition to updating the counts in this thread, I am changing the location listed to "Worldwide" (as ProMED did for SARS on March 15, 2003) rather than trying to expand the list of countries or to differentiate between countries that experienced local transmission and those that only reported imported cases. Besides, WHO guildlines currently do suggest that clusters of unexplained SARI should be tested for NCoV, no matter where in the world they occur.

[alert]

From the comments on:

http://www.promedmail.org/direct.php...130326.1604564

[snip]

[The above mentioned cases were reported in earlier ProMED-mail posts, including a media report announcing the death of the case in the UK (see Novel coronavirus - Eastern Mediterranean (13): Germany ex UAE 20130326.1603038 and Novel coronavirus - Eastern Mediterranean (12): KSA, UK fatality, RFI 20130323.1600113).

As of today, 26 Mar 2013, the breakdown of cases (and deaths) by country of report is:
- Saudi Arabia: 9 (6 deaths)
- Jordan: 2 (2 deaths)
- UK: 4 (one patient from Qatar -- under treatment, 3 patients from UK -- one with history of travel to Saudi Arabia and Pakistan prior to illness; one recovered, 2 deaths)
- Germany: 2 (one patient from Qatar -- discharged, one patient from the UAE - one death).

As mentioned in the above WHO release, the total number of confirmed nCoV cases is now 17 with 11 deaths, bringing the case fatality ratio to 64.7 percent. Caution in interpretation of this figure as the numbers of cases is still very low and the ability to detect prior mild infections with this specific coronavirus is presently absent. Given the histories of other respiratory illnesses in contacts of cases that were relatively mild and associated with full recovery, but tested negative for infection with the nCoV, the possibility that there are more infections associated with milder disease is there.

In the report of the Jordanian cluster, there were a total of 11 individuals reported to have had respiratory illnesses, with confirmation of nCoV infection in specimens from the 2 fatal cases only (see prior ProMED-mail reports: Novel coronavirus - Eastern Mediterranean: WHO, Jordan, conf., RFI 20121130.1432498 and Novel coronavirus - Saudi Arabia (04): RFI, Jordan, April 2012 20120925.1308001).

More information on the epidemiologic investigations of this newest case would be greatly appreciated.

[alert]

We only have 11 deaths in our count. Might this mean the hospitalized case from September 2012 has died?

http://www.who.int/csr/disease/coron.../en/index.html

Novel coronavirus summary and literature update – as of 24 April 2013
As of 24 April 2013, 17 cases of human infection with novel coronavirus (nCoV) have been reported to WHO: two from Jordan, two from Qatar, 10 cases from Saudi Arabia, two from the United Kingdom (UK), and one from the United Arab Emirates. Most patients are male (81.3%; 13 of 16 cases with gender reported) and range in age from 25 to 73 years old (median 45 years old). The first cases had onset of illness in late March or early April 2012, the most recent case reported had onset on 8 March 2013. Most patients presented with severe acute respiratory disease requiring hospitalization, and at least 11 have required mechanical ventilation or other advanced respiratory support. Only 2 of the 17 presented with mild disease. Twelve patients have died. One was co-infected with influenza A virus.

Four clusters of cases have been identified. The first occurred in April 2012 in a health care setting in Jordan, with 2 confirmed cases, and 11 probable cases. Both of the confirmed cases died. Ten of the 13 persons in this cluster were health care workers. Two additional clusters occurred among family contacts of cases in Saudi Arabia and one among family members of a resident of the United Kingdom who had recently visited Saudi Arabia. Human-to-human transmission can be confirmed only in the latter as none of the family members who were infected had recently been outside of the United Kingdom and their only known exposure was to the first case (see UKHPA reference below). No sustained community transmission was observed in any of the clusters.

Although some of the cases may have become infected from animal exposures and zoonotic transmission, information on animal exposures is limited. An animal reservoir has not been identified. Investigations into animal sources are on-going.

Four viruses from the United Kingdom (n=2), Saudi Arabia (n=1) and Jordan (n=1) have been cultured and complete genome sequences have been posted to GenBank, a public database. All four of the viruses have a high degree of genetic similarity. Analyses show that the viruses are similar to a bat virus. It should be noted, however, that the similarity of the human virus to the bat virus does not necessarily imply that bats are the reservoir for the human virus. Given the living environment of most of the patients, direct exposure to bats appears unlikely.