Monday, December 10, 2012

ECDC: Updated Novel Coronavirus Risk Assessment

Coronavirus

Photo Credit NIAID

 

# 6770

 


Although we’ve no fresh reports of infection by the novel coronavirus which appeared in the Middle East last April, and has been confirmed in 9 patients (see WHO: Background & Summary Of Coronavirus Cases), health officials around the globe continue to assess the situation and make provisions to detect and contain the virus.

 

A week ago the World Health Organization  released new Interim surveillance recommendations and an updated Coronavirus FAQ (see WHO Coronavirus Updates).

 

Today, in the wake of the announcement of two cases from Jordan last spring, the ECDC updates their Coronavirus Risk Assessment, previously updated on November 26th.

 

Novel coronavirus: ECDC updates its risk assessment

10 Dec 2012

ECDC updates its risk assessment on novel coronavirus

 

ECDC has published another update of its risk assessment on the novel coronavirus. Two cases in Jordan have retrospectively been confirmed. These additional cases have increased the geographical area in which transmission of the virus has occurred. The two fatal cases were part of a cluster of 11 patients with respiratory symptoms linked to a hospital. The limited information available about this outbreak does not allow for an assessment of whether human-to-human transmission has occurred or indeed whether the cases in this cluster had the same cause.

 

The ECDC risk assessment highlights that healthcare workers should be alerted to the possibility of attending to patients who meet specific characteristics which would require an investigation according to the WHO case definition. The new WHO recommendations favour the investigation of patients returning from the Arabian Peninsula or its neighbouring countries, but do not exclude the testing of patients with unexplained pneumonia in the absence of such travel.

 

A specific serological test and seroepidemiological studies are needed to investigate the occurrence of mild and asymptomatic infections. The diagnostic capacity for novel coronavirus is adequate in the EU. This is confirmed by a newly published article in Eurosurveillance on the results of a survey undertaken by ECDC and WHO. The virus genome is in the public domain and mechanisms for sharing samples and diagnostic methods between countries and laboratories are in place.

 

As of 4 December 2012, a total of nine laboratory-confirmed cases of severe pneumonia caused by the novel coronavirus have been reported to WHO. Five of the nine cases were fatal. Onset of disease was from April to October 2012 and all cases were resident in Saudi Arabia, Qatar or Jordan during the presumed 10 days incubation period.

 

ECDC endorses the WHO travel advice and does not advise any travel or trade restrictions for Saudi Arabia or Qatar.

 

The entire Risk Assessment may be downloaded here.

 

This document’s main conclusions and recommendations reads:

 

  • As of 4 December 2012, nine laboratory-confirmed cases of severe pneumonia caused by the novel coronavirus have been reported to WHO. 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 presumed 10 days incubation period.
  • Two retrospectively tested and confirmed cases in Jordan in April 2012 have increased the geographical area in which transmission has occurred. The two fatal cases were part of a cluster of 11 patients with respiratory symptoms linked to a hospital, but the limited information available about this outbreak does not allow for an assessment of whether any human-to-human transmission occurred or whether the cases in this cluster had the same cause.
  • Healthcare workers should be alerted to the possibility of attending to patients who meet the WHO case definition. Such cases should be investigated rapidly and managed according to WHO recommendations or national guidance documents.
  • The new WHO recommendations for the investigation of patients favour the investigation of patients returning from the Arabian Peninsula or its neighbouring countries, but do not exclude the testing of patients with unexplained pneumonia in the absence such travel.
  • Healthcare workers caring for patients under investigation should exercise stringent infection control measures as indicated by national or international guidance. Similarly, health professionals engaged in the medical evacuation of patients presenting with acute respiratory distress syndrome (ARDS) should be particularly vigilant, especially if patients originate from the Arabian Peninsula or its neighbouring countries.
  • Testing for the novel coronaviruses should be considered in patients undergoing medical evacuation for ARDS prior to their transfer out of the Arabian Peninsula or its neighbouring countries. All public and private hospitals and private healthcare facilities should test patients on admission for the novel coronaviruses if they present with ARDS and have been medically evacuated from the Arabian Peninsula or its neighbouring countries. Referring providers should inform the recipient hospital if testing for novel coronavirus has been performed.
  • Healthcare workers caring for confirmed cases should be monitored for early symptoms of infection. This includes healthcare workers who provided direct clinical or personal care, or performed examination of the cases while they were symptomatic. Close contacts of confirmed cases must be monitored for symptoms as well.
  • Any probable or confirmed case diagnosed in the EU/EEA should be reported to national authorities through the Early Warning and Response System (EWRS) and to WHO under the International Health Regulations (2005). Reporting through EWRS allows for an automatic IHR notification and avoids double reporting.
  • Patients still under investigation do not need to be reported internationally before confirmation. However, notification at state and national levels needs to follow national legislation or guidance to allow the implementation of infection control measures, initiation of outbreak investigation, and epidemiological monitoring.
  • A specific serological test and seroepidemiological studies are needed to investigate the occurrence of mild and asymptomatic infections.
  • ECDC endorses WHO's travel advice and does not advise any travel or trade restrictions for Saudi Arabia or Qatar.
  • WHO and ECDC re-emphasise the importance of timely and thorough investigations; this includes the reporting of any clusters of severe acute respiratory infections in the community or in healthcare workers, regardless of where in the world they occur.

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