promed@promedmail.org> NOVEL CORONAVIRUS - SAUDI ARABIA (18): WHO, NEW CASES, FAMILY CLUSTER, FATALITY ******************************************************************************** A ProMED-mail post http://www.promedmail.org [To summarize what appears to be going on right now is that there are now 6 cases of illness with the novel coronavirus [nCoV] confirmed and reported to WHO. Of these 6 cases, 4 have occurred in Saudi Arabian citizens and 2 have occurred in Qatari citizens. ProMED-mail has reported on 4 of these cases in prior reports -- 3 in Saudi Arabian citizens and 1 in a Qatari citizen (see prior ProMED-mail reports Novel coronavirus - Saudi Arabia (17): 4th case, RFI 20121121.1418018, Novel coronavirus - Saudi Arabia (15): new case 20121104.1391285, Novel coronavirus - Saudi Arabia (03): UK HPA, WHO, Qatar 20120923.1305982, Novel coronavirus - Saudi Arabia (02): additional cases, RFI 20120923.1305931, Novel coronavirus - Saudi Arabia: human isolate 20120920.1302733). Of these 6 cases, 2 had fatal outcomes (the 1st reported case mentioned in ProMED-mail archive 20120920.1302733, and one of the newly reported cases in the above reports of this update). In addition, the WHO report mentions that 2 of the newly confirmed cases were epidemiologically linked as family members (one case recovered and one fatality), and that there were 2 additional family members with similar clinical presentations of whom one was found negative for the nCoV while the other (a fatality) was still pending laboratory results. Information on the full clinical presentations of cases has only been available for the 1st 2 cases reported in September 2012 -- severe pneumonia with renal failure. Detailed clinical information on the more recent cases reported this month (November 2012) are not as yet available. At present it appears as though "severe acute respiratory infections (SARI)" is the operative clinical description that should lead clinicians to obtain specimens for testing for infection with this nCoV. The presence of cases in the same family can either be a sign of human to human transmission or could be related to exposure of the family members to the same common source such as farm animals or bat excreta or other bat bodily fluids (the nCoV is genetically related to known bat CoVs (coronaviruses)). To date, it does appear as though this new nCoV is not easily transmitted from human to human (the absence of prior secondary cases in close contacts at home, in the community and among healthcare workers caring for the cases). If human to human transmission is identified in the above mentioned family cluster, one wonders if there would be a similar situation as had been seen with the SARS CoV where there were some individuals who were responsible for "super spreading events" and were responsible for infecting many other individuals, while the majority of individuals were not. (see the Consensus document on the epidemiology of severe acute respiratory syndrome (SARS) available at: http://www.who.int/csr/sars/en/WHOconsensus.pdf). Early attention to universal precautions including respiratory secretions and bodily fluids should prevent these superspreading events from occurring in the healthcare environment where nosocomial transmission is always a concern. The decision to increase heightened surveillance for SARI related to infection with this nCoV worldwide, irrespective of known travel history or known contact with travelers is a prudent decision. As there are more questions than answers about the epidemiology and transmission of this nCoV, the possibility of having had more "silent" spread with less severe clinical presentations separating the chain of identifiable transmission between infected individuals needs to be considered early on in the investigations related to this novel new agent. Epidemiologically there has been a major population movement through this region recently. This moderator also wonders if specimens were available to retrospectively test for this nCoV infection in the cluster of SARI cases reported in a hospital based outbreak in Jordan in April 2012 mentioned in the prior ProMED-mail report Novel coronavirus - Saudi Arabia (04): RFI, Jordan, April 2012 20120925.1308001. We await further information on the results of laboratory and epidemiologic investigations as well as clinical presentations of the confirmed cases. For the HealthMap/ProMED map of the region showing Saudi Arabia and Qatar, see http://healthmap.org/r/1HAJ. - Mod.MPP] http://www.promedmail.org/