As of May 8, 2013, 30 laboratory-confirmed cases of human infection with novel coronavirus (nCoV) have been reported to the World Health Organization (WHO): two from Jordan, two from Qatar, 23 cases from Saudi Arabia, two from the United Kingdom (UK), and one from the United Arab Emirates. Most patients are male (79.3%; 23 of 29 cases with sex reported) and range in age from 24 to 94 years (median 56 years). The first cases had onset of illness in late March or early April 2012; the most recent cases reported had onset on May 1, 2013 (13 cases with onset April 14 to May 1, 2013). Most patients presented with severe acute respiratory disease requiring hospitalization and eventually required mechanical ventilation or other advanced respiratory support. Eighteen patients have died.
Several cases have occurred in clusters, including in a healthcare setting in Jordan in April 2012 (of 2 confirmed and 11 probable cases, 10 were healthcare workers) and in the UK among family members of an infected patient who had recently arrived from Saudi Arabia. The Jordanian outbreak illustrated the potential of this virus to spread through health care facilities and the UK outbreak confirmed the potential of the virus to transmit between humans with close contact. In neither instance did transmission appear to go beyond the immediate outbreak into the community.
Since April 14, 2013, 13 new cases of infection have been confirmed and reported in Saudi Arabia (10 males and three females, median age 58 years). Seven of these have died, four remain critically ill in intensive care and two are hospitalized but clinically improved. All patients were reported to have at least one comorbid medical condition and most had more than one. Most of the cases were patients at a single healthcare facility. Two were family members of two patients from that facility; no healthcare workers have been affected. Although investigations are still ongoing into the source of this outbreak, early information indicated that only a small minority of these cases had contact with animals in the time leading up to their illness.
Five viruses from the United Kingdom (n=2), Saudi Arabia (n=1), Jordan (n=1), and Germany (n=1) have been cultured and genome sequences have been made publicly available. No sequence data are yet available from the latest cluster. All five of the sequenced viruses have a high degree of genetic similarity. Preliminary analyses show that the viruses are genetically somewhat similar to bat viruses. It should be noted, however, that the similarity does not necessarily imply that bats are the reservoir for the human virus or that direct exposure to bats or bat excreta were responsible for infection. The nCoV itself has not yet been found in an animal.
An international network of clinical experts has been convened to discuss therapeutic options. It concluded that in the absence of clinical evidence for disease-specific interventions, convalescent plasma is the most promising therapy. A memo containing advice for setting up international or regional serum centers, to obtain and share convalescent plasma, has been circulated by WHO to ministries of health in affected countries. WHO and the International Severe Acute Respiratory and Emerging Infection Consortium have developed and shared a set of research protocols and case report forms to help clinical investigators establish studies of pathogenesis and pharmacology. These are available at http://www.prognosis.org/isaric/.
WHO has developed interim guidance document Infection prevention and control during health care for probable or confirmed cases of nCoV infection. The recommendations have been reviewed by members of the WHO Global Infection Prevention and Control Network (GIPCN) and other international experts. The interim guidance document is available at: http://www.who.int/csr/disease/coronavirus_infections/IPCnCoVguidance_06May13.pdf.
WHO has released a statement regarding the currrent novel coronavirus situation in the Middle East:
"The emergence of this new coronavirus is globally recognized as an important and major challenge for all of the countries which have been affected as well as the rest of the world. The Ministry of Health of the Kingdom of Saudi Arabia has recognized this and invited the World Health Organization (WHO) to help them assess the situation and to provide guidance and recommendations. WHO is pleased to be here to work together with the Kingdom of Saudi Arabia.
"At this time there are some things about this new disease we understand. However we would like to remind everyone that this is a new infection and there are also many gaps in our knowledge that will inevitably take time to fill in.
"We know that the disease is caused by a virus from a group called coronaviruses. One member of the coronavirus family is the SARs virus. This new virus is NOT the SARS virus. They are distinct from each other. However, the fact that they are related has added to the worlds concern. We know this virus has infected people since 2012, but we dont know where this virus lives. We know that when people get infected, many of them develop severe pneumonia. What we dont know is how often people might develop mild disease. We also know that most of the persons who have been infected so far have been older men, often with other medical conditions. We are not sure why we are seeing this pattern and if it will change over time.
"There are many other things that we dont understand. For example, how are people getting infected? Is it from animals? Is it from contaminated surfaces? Is it from other people? Finally, we dont know how widespread is this virus, both in this region and in other countries.
"The greatest global concern, however, is about the potential for this new virus to spread. This is partly because the virus has already caused severe disease in multiple countries, although in small numbers, and has persisted in the region since 2012. Of most concern, however, is the fact that the different clusters seen in multiple countries increasingly support the hypothesis that when there is close contact this novel coronavirus can transmit from person-to-person. This pattern of person-to- person transmission has remained limited to some small clusters and so far, there is no evidence that this virus has the capacity to sustain generalized transmission in communities.
"At this point, several urgent actions are needed. The most important ones are the need for countries, both inside and outside of the region, to increase their levels of awareness among all people but especially among staff working in their health systems and to increase their levels of surveillance about this new infection. In Saudi Arabia, we have seen the importance of better surveillance. When new cases are found, as is likely, it is critical for countries to report these cases and related information urgently to WHO as required by the International Health Regulations because this is the basis for effective international alertness, preparedness and response. Countries also need to assess their level of preparedness and readiness if this virus should spread and to intensify strengthening the core capacities identified in the International Health Regulations if they are not adequate. WHO is ready to assist countries in this region and globaly in these tasks.
"There are also some questions that urgently need to be answered including how are people are getting infected, and what are the main risk factors for either infection or development of severe disease. The answers to these questions hold the keys to preventing infection.
"In closing, we want to note that the Government of Saudi Arabia has taken the novel coronavirus situation very seriously. The Ministry of Health has initiated crucial public health actions -- including intensifying surveillance, initiating investigations and important research and putting control measures in place."