UpdateCDC continues to work closely with the World Health Organization (WHO) and other partners to better understand the public health risk presented by recently reported cases of infection with a novel coronavirus. As of March 6, 2013, 14 laboratory-confirmed cases have been reported to WHO - seven from Saudi Arabia, two from Qatar, two from Jordan, and three from the United Kingdom. The onset of illness was between April 2012 and February 2013 (1). Among the 14 cases, eight were fatal. Severe acute respiratory infections occurred in 13 of the 14 cases, while one case experienced a mild respiratory illness and fully recovered. Clusters of cases in Saudi Arabia, Jordan and the United Kingdom are being investigated. The first cluster of two cases, both fatal, occurred near Amman, Jordan, in April 2012. Stored samples from these two cases tested positive retrospectively for the novel coronavirus. This cluster was temporally associated with cases of illness among workers in a hospital (2). A second cluster occurred in October 2012, in Saudi Arabia. Of the four individuals in the household, three were laboratory-confirmed cases, two of them died. In February 2013, a third cluster of three family members was identified in the United Kingdom. All three people tested positive for novel coronavirus. Among them, one family member is receiving treatment, one died, and one recovered after experiencing a mild respiratory illness. This cluster provides evidence of person-to-person transmission of novel coronavirus. It also provides the first example of mild illness being associated with novel coronavirus infection. The efficiency of person-to-person transmission of novel coronavirus is not well characterized but appears to be low, given the small number of confirmed cases since the discovery of the virus.
The reservoir and route of transmission of the novel coronavirus are still being investigated. Genetic sequencing to date has determined the virus is most closely related to coronaviruses detected in bats. CDC is continuing to collaborate with WHO and affected countries to better characterize the epidemiology of novel coronavirus infection in humans.
Patient Under Investigation (PUI)CDC requests that state and local health departments report PUIs for novel coronavirus to CDC.
- A person with an acute respiratory infection, which may include fever (≥ 38°C , 100.4°F) and cough; AND
- suspicion of pulmonary parenchymal disease (e.g., pneumonia or acute respiratory distress syndrome based on clinical or radiological evidence of consolidation); AND
- history of travel from the Arabian Peninsula or neighboring countries* within 10 days; AND
- not already explained by any other infection or etiology, including all clinically indicated tests for community-acquired pneumonia** according to local management guidelines.
- Persons who develop severe acute lower respiratory illness of known etiology within 10 days after travel from the Arabian Peninsula or neighboring countries* but do not respond to appropriate therapy; OR
- Persons who develop severe acute lower respiratory illness who are close contacts of a symptomatic traveler who developed fever and acute respiratory illness within 10 days after travel from the Arabian Peninsula or neighboring countries*. Close contact is defined as providing care for the ill traveler (e.g., a healthcare worker or family member), or having similar close physical contact; or stayed at the same place (e.g. lived with, visited) as the traveler while the traveler was ill.
* Countries considered in the Arabian Peninsula and neighboring include: Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen.
** Examples of respiratory pathogens causing community-acquired pneumonia include influenza A and B, respiratory syncytial virus, Streptococcus pneumoniae, and Legionella pneumophila.
- A person fitting the definition above of a “Patient Under Investigation” with clinical, radiological, or histopathological evidence of pulmonary parenchyma disease (e.g. pneumonia or ARDS) but no possibility of laboratory confirmation either because the patient or samples are not available or there is no testing available for other respiratory infections, AND
- close contact with a laboratory confirmed case, AND
- not already explained by any other infection or etiology, including all clinically indicated tests for community-acquired pneumonia according to local management guidelines.
- A person with laboratory confirmation of infection with the novel coronavirus.
Clusters of Severe Acute Respiratory IllnessIn addition, any clusters of Severe Acute Respiratory Illness (SARI) in healthcare workers in the United States should be thoroughly investigated (3,4). Occurrence of a SARI cluster of unknown etiology should prompt immediate notification of local public health for further notification and testing.
Also see WHO case definitions in the WHO interim surveillance recommendations for human infection with novel coronavirus [85 KB, 3 pages].
For Healthcare Providers
- Infection control recommendations for healthcare settings
Until the transmission characteristics of the novel coronavirus are better understood, patients under investigation and probable and confirmed cases should be managed according to CDC’s infection control recommendations for the coronavirus that caused SARS. See Appendix A: Type and duration of precautions needed for selected infections and conditions in the 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings [3.8 MB, 225 pages].
Infection prevention recommendations may be updated as information about transmission and the severity of clinical illness caused by this novel coronavirus becomes available.
- Respirator Trusted-Source Information
- Respirator Fact Sheet
For Health Departments
- Interim Local Health Departments Novel Coronavirus (NCV) Investigation Form [169 KB, 1 page] Reviewed Mar 2013
- Interim Guidance for State and Local Health Departments
- Interim Guidelines for Collection, Processing and Transport of Clinical Specimens from Potential Novel Coronavirus Patients [169 KB, 3 pages] Updated Feb 2013
- Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with Novel Coronavirus [100 KB, 2 pages] Reviewed Feb 2013
- Background and summary of novel coronavirus infection - as of 21 December 2012. Global Alert and Response (GAR) 2012 [cited December 22, 2012].
- Interim surveillance recommendations for human infection with novel coronavirus - update [85 KB, 3 pages]. 2012 December 3, 2012 [cited December 4, 2012].
- Technical Guidelines for Integrated Disease Surveillance and Response in the African Region October 2010 [3.1 MB, 416 pages]. 2010 [cited December 2, 2012].
- CDC. How to Investigate Unexplained Respiratory Disease Outbreaks (URDO) [cited December 7, 2012].