# 7286
The ECDC has updated their rapid risk assessment on the novel coronavirus (formerly nCoV) dubbed MERS-CoV, based on information received since their last update on May 7th.
As we saw earlier in the day from the World Health Organization, the ECDC is warning that nasopharyngeal swabs are not an optimal sample collection method, and that deeper respiratory sampling may be required.
Below you’ll find their press summary, links to the update, and some excerpts from the actual update.
ECDC updates Rapid Risk Assessment on Middle East respiratory syndrome coronavirus (novel coronavirus)
17 May 2013
ECDC
ECDC has published an update of its rapid risk assessment on Middle East respiratory syndrome coronavirus (MERS-CoV), previously referred to as the novel coronavirus. It focuses on developments since the previous ECDC risk assessment, and provides updated threat assessment and recommendations for Europe.
As of 14 May 2013, 38 cases of MERS-CoV have been reported worldwide, including 20 deaths. All cases remain associated with transmission in the Arabian Peninsula and Jordan. This includes indirect association following secondary person-to-person transmission in the UK and France.
The report of 19 new infections in Saudi Arabia in the past two weeks – including one infection with the novel coronavirus acquired in the United Arab Emirates and later imported to Europe – indicate that there is an ongoing source of infection and risk of transmission to humans in the Arabian Peninsula and Jordan.
The confirmed infection in France of a patient who shared a hospital room with a patient returning from the United Arab Emirates indicates the risk of nosocomial transmission. This is the second nosocomial transmission in Europe. The first one took place when an imported case in the UK visited a relative in the hospital in February 2013.
Resources:
- Updated ECDC rapid risk assessment on MERS-CoV
- ECDC epidemiological update, 7 May 2013, on additional confirmed cases of novel coronavirus in Kingdom of Saudi Arabia
- More information on novel coronavirus (Middle East respiratory syndrome coronavirus) on ECDC website
Severe respiratory disease associated with Middle East respiratory syndrome coronavirus (MERS-CoV)
(Excerpts)
Summary
• As of 14 May 2013, 38 cases of Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported worldwide, including 20 deaths. All cases remain associated (including indirect association following secondary person-to-person transmission in the UK and France) with transmission in the Arabian Peninsula and Jordan. The age of cases ranges from 24 to 94 years (N=34 cases), with a mean of 55.5 years and a male/female ratio of 1:0.2.
• The report of 19 new infections in Saudi Arabia in the past two weeks – including one infection with the novel coronavirus acquired in the United Arab Emirates and later imported to Europe – indicate that there is an ongoing source of infection and risk of transmission to humans in the Arabian Peninsula and Jordan.
• The most recent imported case, which resulted in a nosocomial transmission, originated in the United Arab Emirates and then moved to France. Both patients had underlying conditions and a degree of immunosuppression. One of the transmissions in the UK also affected an immunosuppressed person. These underlying conditions may be increasing vulnerability and the risk of transmission.
• The first French case raises the possibility that presentations may not include respiratory symptoms initially, especially in those with immunosuppression or underlying chronic conditions. This needs also to be taken into account when revising case-finding strategies.
• The confirmed infection in France of a patient who shared a hospital room with a patient returning from the United Arab Emirates indicates the risk of nosocomial transmission. This is the second nosocomial transmission in Europe. The first one took place when an imported case in the UK visited a relative in the hospital in February 2013.
• These conclusions should be seen in the light of the many uncertainties that still continue with the investigation of cases in the Arabian
Recommendations
• Healthcare workers in the EU should be vigilant in identifying patients that may require further investigation; they should also follow ECDC and national guidance for case finding. Patients developing severe respiratory infections and who have been in the Arabian Peninsula or neighbouring countries in the preceding 10 days should be investigated rapidly. Special attention should be given to medical evacuated patients from the Arabian Peninsula and neighbouring countries.
• Patients with chronic underlying conditions who develop severe infections (not just respiratory infections) should also be investigated rapidly for novel coronavirus if they have been in the Arabian Peninsula or neighbouring countries in the preceding 10 days.
• Since routine microbiological sampling (nasopharyngeal swabs) may give misleading negative results in persons later shown to be infected with the coronavirus, tests should be repeated with deeper respiratory sampling if a person fits into a category that requires investigation, especially if their condition is worsening.
• As demonstrated by a case with dual influenza and novel coronavirus infections, there is a possibility of co-infection and this should be considered by healthcare personnel. Identification of one causative agent should not exclude testing for novel coronavirus where indicated.
• Mapping of international routes of medical evacuation or emergency medical care from the Arabian Peninsula and neighbouring countries to the EU could be considered in order to determine the most vulnerable centres in the EU where these cases might arrive.
• Companies undertaking medical evacuations from affected areas should be reminded of the risk of transferring infections across borders and of their obligations to protect staff engaged in the transfer; the same holds true for the staff of institutions which receive patients.
• Healthcare workers caring for patients under investigation for MERS-CoV should exercise standard infection control measures following national or international guidance.
• Close contacts of confirmed cases must be monitored for symptoms for 10 days after the last exposure, and should be tested, and should be informed what to do should they become ill. This should be carried out according to guidance, such as that developed by Public Health England UK (See ‘Sources of additional information’ below).
• Healthcare workers caring for confirmed cases should be monitored for early symptoms of infection and advised to seek testing and thereafter self-isolate if they become unwell.
• Clusters of severe acute respiratory infections in the community or in healthcare settings, either among patients or healthcare workers, should always be reported rapidly and investigated for a range of pathogens, regardless of where in the world these infections occur.
• ECDC does not currently consider a need for testing individual patients with unexplained pneumonias or other respiratory symptoms unless they fall under one of the above categories.
• Any probable or confirmed case being 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 qualifies as IHR notification and avoids double reporting. Patients still under investigation do not need to be reported internationally before confirmation, but information on outcome of such testing exercises should be shared with ECDC.
• ECDC supports the WHO travel advice which imposes no travel or trade restrictions in relation to novel coronaviruses. However, EU citizens travelling to the Arabian Peninsula and neighbouring countries need to be aware of the presence of MERS-CoV in this geographical area and of the small risk of infection. Member States may consider active information efforts for travellers to areas most at risk.
• Although the reservoir of infection in the Middle East is unknown, other novel coronaviruses are zoonoses and have come from animal sources. Travellers should therefore follow standard good hygiene practise and avoid contact with animals or their waste products.
