Background 

Coronaviruses are a large family of viruses, some of which may cause respiratory infections in humans and animals. Such respiratory infections may range from mild upper respiratory tract illness (common cold) to severe lower respiratory disease. The novel coronavirus, EMC 2012, was first identified in September 2012 in a 60 year old patient from Jeddah, Kingdom of Saudi Arabia who died from a severe respiratory infection in June 2012. To date there have been a total of 14 laboratory-confirmed cases of respiratory illness caused by the novel coronavirus, including eight deaths globally (http://www.who.int/csr/don/2013_03_06/en/index.html). Onset of disease was between April 2012 and February 2013.

Saudi Arabia: 7 cases, 5 deaths;
Jordan: 2 cases, 2 deaths;
UK – 4 cases, 1 patient from Qatar receiving treatment; 3 cases from UK, 1 death, 1
receiving treatment, 1 recovered;
Germany – 1 case, patient from Qatar, recovered

Clinical presentation of cases

The novel coronavirus has thus far only been identified in a small number of cases of acute, serious respiratory illness presenting with fever, cough, shortness of breath and breathing difficulties. All except one of most recently confirmed cases from the UK, presented with severe respiratory illness. Some of the severe cases also developed renal failure. Age of patients ranged between 25 and 60 years, and only two were female.

Transmission

The routes of transmission to humans have not yet been determined. In three instances, infections occurred in clusters. The first cluster of two fatal cases from Jordan, occurred in April 2012. These were part of a hospital cluster of 11 cases (2 confirmed and 9 probable), 8 of whom were health workers. The second cluster, in a family from Saudi Arabia, involved three confirmed cases and a probable case, 2 cases died in October 2012. The most recent cluster, occurred in UK in February 2013, three family members were diagnosed with novel coronavirus infection; two of these had no history of recent travel suggesting that transmission had occurred in the UK. One family member had travelled to the Middle East and Pakistan.
http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1317138148865
Recent information from the UK family cluster suggests that human to human transmission does occur. Human-to-human may also have occurred in two instances in the Middle East. Although there is evidence of human to human transmission, the risk of sustained human-to-human transmission appears to be very low.
The source of the virus, its geographic extent and the spectrum of illness are still being investigated. Genetic sequencing to date suggests that the virus is closely related to coronaviruses detected in bats. (http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1317136246479)

Testing for novel coronavirus

The WHO recommends that 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 Severe Acute Respiratory Illness (SARI) or SARI in healthcare workers should be thoroughly investigated, regardless of where in the world they occur (http://www.who.int/csr/don/2013_02_21/en/index.html).
Based on current available data, the case definitions for novel coronavirus include the following:

Patients to be investigated (referred to as “Patient Under Investigation”):

  • A person with an acute respiratory infection, which may include fever (≥ 38°C) 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 (currently Arabian Peninsula or neighbouring countries); AND
  • not already explained by any other infection or aetiology, including all clinically indicated tests for community-acquired pneumonia according to local management guidelines.

Probable Case

  • A person with an acute respiratory infection* with clinical, radiological, or histopathological evidence of pulmonary parenchymal disease (e.g. pneumonia or Acute Respiratory Distress Syndrome, (ARDS)); AND
  • no possibility of laboratory confirmation for novel coronavirus either because the patient or samples are not available for testing; AND close contact** with a laboratory-confirmed case
    * This may include but is not limited to cases with a history of fever or measured fever.
    ** Close contact includes:
  1. anyone who provided care for the patient, including a health care worker or family member, or who had other similarly close physical contact;
  2. anyone who stayed at the same place (e.g. lived with, visited) as a probable or confirmed case while the case was symptomatic.

Confirmed Case

  • A person with a laboratory confirmation of infection with the novel coronavirus.

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

Who to contact for advice on testing for novel coronavirus?

  • For further details regarding guidance for testing for novel coronavirus, clinicians can contact the Centre for Respiratory Diseases and Meningitis (CRDM) at the National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS) through the NICD Hotline: 082 883 9920. Additional information on laboratory testing can be accesses from the NICD website – (Guidelines-for-case-finding-and-laboratory-testing-novel-coronavirus).

References and additional information on novel coronavirus infection :

  1. Novel coronavirus infection – update. Availabe at http://www.who.int/csr/don/2013_03_06/en/index.html).
  2. Interim surveillance recommendations for human infection with novel coronavirus, 3 December 2012; Available at http://www.who.int/csr/disease/coronavirus_infections/InterimRevisedSurveillanceRecommendations_nCoVinfection_03Dec12.pdf
  3. Revised interim case definition for reporting to WHO – novel coronavirus. Available at http://www.who.int/csr/disease/coronavirus_infections/case_definition/en/index.html
  4. PRO/AH/EDR> Novel coronavirus – Eastern Mediterranean: bat reservoir, 22 January 2013, 20130122.1508656; available at http://www.promedmail.org/direct.php?id=20130122.1508656
  5. PRO/AH/EDR> Novel coronavirus – Eastern Med (04): UK, Person to person transmission suspected, 13 February 2013, 20130213.1541531; available at http://www.promedmail.org/direct.php?id=20130213.1541531\
  6. Risk assessment: Severe respiratory disease associate with novel coronavirus. Available at: http://www.ecdc.europa.eu/en/publications/Publications/novel-coronavirus-rapid-risk-assessment-update.pdf
  7. Novel coronavirus infection – update. Available at http://www.who.int/csr/don/2013_02_11b/en/index.html
  8. Genetic sequence information for scientists about the novel coronavirus 2012. Available at:http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1317136246479
  9. ProMED-Mail:www.promedmail.org
  10. HPAwebsite:http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1317136202755
  11. WHO website: http://www.who.int/csr/disease/coronavirus_infections/faq/en/index.html
  12. CDC website: http://www.cdc.gov/coronavirus/ncv
  13. WHO website: http://www.who.int/csr/don/2013_02_21/en/index.html
  14. HPA website:http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1317138119464

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