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8 May 2013

Novel coronavirus 2012: update on cases in Saudi Arabia

This updates the previous Clinical Update of 27 March 2013

Since the beginning of May 2013, the Ministry of Health in Saudi Arabia has informed the World Health Organization (WHO) of 13 new laboratory confirmed cases of novel coronavirus (nCoV) infection, including seven deaths [1-2].

As of 6 May 2013, 30 cases of human infection with novel coronavirus (nCoV) have been reported to WHO (two from Jordan, two from Qatar, 23 from Saudi Arabia, one from the United Arab Emirates and two, associated with transmission from imported cases, in the United Kingdom (UK);18 of these 30 cases have died [1-3].

Sustained community transmission of the virus has not been observed; human-to-human transmission has occurred in at least one of four clusters of cases [3].  Although some cases have had animal exposures, information on zoonotic transmission remains limited, and a specific animal reservoir has not been identified. Investigations are on-going [4].

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.

Advice for travellers

There continue to be no travel restrictions to the Middle East and the risk to travellers remains very low. Travellers returning from the Middle East and surrounding countries, with mild respiratory symptoms are most likely to have a common respiratory illness such as a cold.  However, if severe respiratory symptoms develop, such as shortness of breath, within ten days of returning from these countries, medical advice should be sought from their GP or NHS 111. Returning travellers should mention which countries they have visited.

The risk of UK residents contracting infection in the UK is very low.

Advice for health professionals

Health professionals should, as always, take a detailed travel history when evaluating an ill returned traveller. The level of risk in those who come to the UK from, or return from, the Middle East and meet the case definition for a “case under investigation” is very low but warrants testing for novel coronavirus infection. The probability that a cluster of cases of severe acute respiratory infection of unexplained aetiology requiring intensive care admission is due to novel coronavirus remains very low, but warrants testing.

Public Health England (PHE) has developed advice for health professionals in relation to novel coronavirus 2012, including a case definition for investigation and management of patients, and infection control advice. Where patients meet the possible case definition, clinicians should inform their local PHE Centres which will be able to assist in the risk assessment and advise on what samples should be taken. These risk assessments will continue to be reviewed frequently in response to any further cases of novel coronavirus.

Standard transmission based precautions for respiratory tract infections should be instituted if a possible case is suspected.

Clinical queries about the management of potential cases of severe respiratory infections in people who have recently visited Saudi Arabia, Qatar or Jordan, or the neighbouring countries of Bahrain, Iraq, Israel, Kuwait, Lebanon, Oman, Syria, UAE and Yemen, should be directed in the first instance to the local infectious disease physician or microbiologists.  The national Imported Fever Service is available to local infectious disease physicians or microbiologists should specialist advice be needed (0844 7788990).

References

1. World Health Organization. Novel coronavirus infection – update. 6 May 2013. [Accessed 8 May 2013]. Available at: http://www.who.int/csr/don/2013_05_06_ncov/en/index.html

2. World Health Organization. Novel coronavirus infection – update.3 May 2013. [Accessed 8 May 2013]. Available at: http://www.who.int/csr/don/2013_05_03_ncov/en/index.html

3. World Health Organization. Global Alert and Response (GAR): Novel coronavirus summary and literature update – as of 25 April 2013. [Accessed 8 May 2013]. Available at: http://www.who.int/csr/disease/coronavirus_infections/update

_20130425/en/index.html

4. Health Protection Agency. Update on family cluster of novel coronavirus infection in the UK. 19 February 2013. [Accessed 8 May 2013]. Available at:  http://www.hpa.org.uk/NewsCentre/NationalPressReleases/

2013PressReleases/120319Updateoffamilyclusterofnovel

coronavirus/

Links 

Public Health England – Novel corona virus

WHO Novel coronavirus summary and literature update

CDC Novel Coronavirus Update