Monday, December 03, 2012

WHO Coronavirus Updates


Photo Credit NIAID

# 6760


While we have no indication of sustained community transmission, the emergence of a novel coronavirus in the Middle East that has infected at least 9 people (with another 9 either probable or suspected cases under investigation) since April, continues to capture the world’s public health agencies attentions.


The World Health Organization has updated two of their coronavirus documents; their coronavirus FAQ, and their interim surveillance recommendations.


Both are dated December 3rd, 2012.



First, the Frequently Asked Questions file, which has seen some minor modifications since the posting yesterday.


Frequently Asked Questions on novel coronavirus - update

3 December 2012

What is the novel coronavirus?

This is a new strain of coronavirus that has not been previously identified in humans.
Coronaviruses are a large family of viruses that are known to cause illness in humans and animals. In humans, this large family of viruses are known to cause illness ranging from the common cold to Severe Acute Respiratory Syndrome (SARS).

What are the symptoms of novel coronavirus?

In confirmed cases of illness in humans, common symptoms have been acute, serious respiratory illness with fever, cough, shortness of breath, and breathing difficulties. Based on current clinical experience, the infection generally presents as pneumonia. It has caused kidney failure and death in some cases. It is important to note that the current understanding of the illness caused by this infection is based on a limited number of cases and may change as more information becomes available.

Can it be transmitted from person to person?

This is not known with certainty at this time. The cases occurring in the same family raises the possibility of limited human-to-human transmission. Alternatively, it is possible that the infected family members were exposed to the same source of infection, for example, in a household or workplace.

How could I become infected with this virus?

To date, we do not know how humans have become infected with this virus. Investigations are underway to determine the virus source, types of exposure that lead to infection, mode of transmission and the clinical pattern and course of disease.

(Continue . . . )


The Interim surveillance recommendations have been reworded for clarity, but remain pretty much the same.


Interim surveillance recommendations for human infection with novel coronavirus

3 December 2012 

Based on additional information received since the original surveillance recommendations were published, WHO is updating its guidance for surveillance. WHO will continue to update these recommendations as more information becomes available.

This document has been revised to emphasize the recommendations, rather than to summarize current
case reports. Current numbers and descriptions of reported cases are found at

The substance of the recommendations has not changed. Some wording has been changed for the sake of clarity. 


The following should be carefully investigated and tested for novel coronavirus:

1.  Patients under investigation

A person with an acute respiratory infection, which may include history of fever or measured fever (≥ 38°C, 100.4°F) and cough


Suspicion of pulmonary parenchymal disease (e.g. pneumonia or Acute Respiratory Distress
Syndrome (ARDS)), based on clinical or radiological evidence of consolidation. 


Residence in or history of travel to the Arabian Peninsula or neighboring countries within 10 days
before onset of illness. 


Not already explained by any other infection or aetiology1 , including all clinically indicated tests
for community-acquired pneumonia according to local management guidelines. It is not necessary
to wait for all test results for other pathogens before testing for novel coronavirus.

2.  Ill contacts

Individuals with acute respiratory illness of any degree of severity who, within 10 days before onset of illness, were in close physical contact 2 with a confirmed or probable case of novel coronavirus infection, while the case was ill.

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 first 10 days after contact, the individual should be considered a “patient under investigation”, regardless of the severity of illness, and investigated accordingly.

3.  Clusters

Any cluster 3 of severe acute respiratory infection (SARI) 4  , particularly clusters of patients requiring intensive care, without regard to place of residence or a history of travel


Not already explained by any other infection or aetiology, including all clinically indicated tests
for community-acquired pneumonia according to local management guidelines.

4.  Health care workers 

Health care workers with pneumonia, who have been caring for patients with severe acute
respiratory infections, particularly patients requiring intensive care, without regard to place of
residence or history of travel. 


Not already explained by any other infection or aetiology, including all clinically indicated tests
for community-acquired pneumonia according to local management guidelines.


1 Examples of other aetiologies include Streptococcus pneumoniae, Haemophilus influenzae type B, Legionella pneumophila, other recognized primary bacterial pneumonias, influenza, and respiratory syncytial virus.

2 Close contact is defined as: 

  • Anyone who provided care for the patient, including a health care worker or family member, or who had other
    similarly close physical contact;
  • Anyone who stayed at the same place (e.g. lived with, visited) as a probable or confirmed case while the case was ill.

3  A “cluster” is defined as two or more persons with SARI, with onset of symptoms within the same two-week period and who are associated with a specific setting, such as a classroom, workplace, household, extended family, hospital, other residential institution, military barracks or recreational camp.

4  Severe Acute Respiratory Infection (SARI) is defined as:   An acute respiratory infection with:

  • history of fever or measured fever of ≥ 38 C° (100.4°F) and cough;
  • onset within the last seven days; and
  • requiring hospitalization.



With the onset of winter finding individual coronavirus infections becomes more difficult against the background noise of seasonal ILIs (influenza-like-illness).


Mild cases – if they exist – are unlikely to be detected unless purely by chance. 


We’ve seen in H5N1 endemic countries that clusters of severe influenza or pneumonia immediately become suspect – and fodder for the local press - but most of the time have turned out to be something other than bird flu.

Given the concerns over this emerging virus, we should probably expect to see that pattern repeated here. 


The price we pay for vigilance against emerging diseases is the possibility of false alarms. 


Unless and until we start seeing a lot of lab confirmed cases coming out of these reports, it is probably best to take any preliminary (and often hyperbolic) news reports with a hefty grain of salt.

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