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Thursday, February 14, 2013

Any Road will take you there


Questions and answers - novel coronavirus 2012

How many new cases have been reported to date?

This new coronavirus was first identified in September 2012 in a patient who died from a severe respiratory infection in June 2012. As of 12 February 2013 there have been 11 cases detected globally. However, this is a dynamic situation and more cases may be reported. For the latest case updates please see WHO [external link].

What are coronaviruses?

Human coronaviruses were first identified in the mid 1960s and are named for the crown-like projections on the surface of the virus. They are a group of viruses causing respiratory infections in humans and animals. There are 3 main sub-groupings of coronaviruses, known as alpha, beta and gamma.

What type of coronavirus is this?

This is a new subtype/strain of coronavirus, first identified in the Netherlands in 2012. The virus identified by the Health Protection Agency's virus reference laboratories at Colindale is genetically very similar to the strain identified in the Netherlands.  The virus identified in the UK has now been fully sequenced and detailed analysis indicates that the nearest relatives are bat coronaviruses. Since only a handful of cases have been reported, there is limited information on clinical impact, transmission and severity at this stage.

What are the main symptoms?

The virus has only been identified in a small number of cases of acute, serious respiratory illness who presented with fever, cough, shortness of breath, and breathing difficulties. At this point it is not clear whether this is a typical presentation or whether it could be circulating more widely, but causing a milder illness, and only rarely causing severe illness.

What is the treatment?

There is insufficient information to make specific treatment recommendations. However, acute respiratory support for those with severe symptoms and who have been hospitalised is advised.

How do you catch this infection?

Coronaviruses are typically spread like other respiratory infections such as influenza.

How infectious is it?

Although transmission appears to be very limited, this is based on a very small number of confirmed cases. If it were very infectious, many more cases in other countries or among the people caring for cases would have been seen by now.
With any new infection associated with severe illness, it is better to err on the side of caution. All infection control measures to prevent the spread of this virus are taken for any case with a confirmed diagnosis. This includes isolation of the patient, barrier nursing and ensuring that all staff wear the appropriate protective equipment.
Coronaviruses are fairly fragile, and outside of the body their survival time is only around 24 hours. They are easily destroyed by most detergents and cleaning agents.
 

Where has this infection come from?

At this stage the origin is unclear, but phylogenetic analysis suggests that the closest relatives are bat coronaviruses. New infections may occur as a result of a mutation (change) to an existing virus changing the way it is transmitted or the illness it causes.
Some new infections may appear when an organism circulating in the animal population are introduced to human beings (zoonoses). Certain infections may cause mild disease in an animal species but more severe illness in people (and vice versa).

Is there a vaccine for coronavirus?

No, a vaccine is not available.

Is there a laboratory test?

Yes. The main test for this particular coronavirus is a screening PCR test followed by a more specific confirmatory test. A number of laboratories in the UK can now carry out the screening test for this virus.

What should I do if I am planning to travel to the Middle East?

Given that there have only been a small number of confirmed cases worldwide, people planning to travel to the Middle East should continue with their plans. Travel advice will be kept under review if additional cases occur or when the patterns of transmission become clearer. For the latest travel advice please see the National Travel Health Network and Centre (NaTHNaC) [external link].

If I visited the Middle East and have signs of a cold/fever should I be worried?

If the symptoms are mild then they are probably due to a common respiratory virus such as the common cold. However if the symptoms worsen and you become breathless you should contact your General Practitioner or NHS Direct mentioning which countries in the Middle East you have visited. Even with severe respiratory illness it is still most likely that the diagnosis will be one of the more common respiratory viruses, rather than this newly recognised coronavirus.

Is this similar to SARS?

SARS was also caused by a coronavirus but this is not SARS. Coronaviruses can cause a range of symptoms varying from mild symptoms such as the common cold to more serious respiratory illnesses.


Last reviewed: 12 February 2013

That's What it Takes

Horse To The Water


... Dr Ghimire added that many poultry owners tend to conceal their dead chickens without informing the authorities. He said some owners had even been found to have sold dead chickens to pig farmers, thereby facilitating the transmission of the bird-flu virus to various other areas.
Meanwhile, Junga Bahadur BC, president of the Nepal Chicken Sellers’ Business Association, refuted the claims, saying they were baseless.
“In case of Nayapati, no chickens had perished due to bird-flu. Officials were stopped from culling fowl for hours,” BC said. “This means that we need to start questioning the quality of tests conducted at the Central Veterinary Laboratory.”...  http://www.kantipuronline.com/2013/02/12/capital/farm-owners-negligence-causing-bird-flu-outbreaks-say-experts/366979.html

Dark Horse

latest patient seemed to have got it from his father

The coronavirus conundrum: when to press the panic button

We have become very good at detecting risk, but it's impossible to know if this latest virus will be another Sars or disappear
Never mind that there have been a total of just three confirmed cases in the UK and 11 worldwide, half those infected have died and, as there is no vaccine, health officials are "worried". They are worried not least because we have been here before: in 2003, to be precise, when severe acute respiratory syndrome (Sars), also caused by a coronavirus, suddenly emerged from Guangdong, China, sparking an epidemic that resulted in 1,000 deaths worldwide and grounded planes from Hong Kong to Toronto.
On that occasion, civet cats – a popular delicacy in Chinese animal markets – were to blame; this time the animal reservoir is thought to be bats. But the truth is that no one knows for certain, least of all the scientists whose job it is to keep tabs on new pathogens and alert us to the threat before they can be reprimanded for not speaking up sooner.
And that's the dilemma: press the panic button too early and you risk being labelled a wolf-crier. Do it too often and when a real wolf comes along – albeit in the guise of a bird, cat or bat – no one will believe you.
For all the current fuss about the coronavirus, the pathogen that still keeps most scientists awake at night is H5N1 bird flu, a virus that first emerged in Hong Kong around the..

Isn't it a pity


Toddler latest bird flu death in Cambodia

The three-year-old girl from Kampot province confirmed to have the year’s seventh case of bird flu in Cambodia died at Kantha Bopha hospital yesterday morning.
The girl had come in contact with poultry in her home village of Chrey Korng, where several chickens recently had died, before developing a fever and rash on February 3 and being admitted to Kantha Bopha after her condition worsened to include stomach pain and drowsiness, the World Health Organization (WHO) and Ministry of Health said yesterday.
“This is the highest we’ve seen in terms of monthly cases,” said Sonny Krishnan, communications officer for the WHO in Cambodia, noting that six had died from the
virus in the past three weeks.
Treatment by tamiflu within 48 hours of the onset of symptoms ought to prevent bird-flu-related deaths, but Cambodia sees a high rate of fatalities because “most arrive in public health facilities already in an advanced stage of the disease”, said Krishnan.
Since H5N1 emerged a decade ago, Cambodia has seen 28 of the world’s 619 cases, and 25 deaths from the virus.
Most victims have been young girls.
Swabs taken by a Ministry of Health rapid response team showed no signs of the virus among others in the girl’s village, Krishnan said, adding that samples would be taken again in two weeks.

Wednesday, February 13, 2013

Patient Suspect Bird Flu, H5N1 Negative

Results Laboratory Patient Suspect Bird Flu, H5N1 Negative Darali 
Wednesday, 13 February 2013 

PADANG, METRO- Darali (73), a farmer from Padangpariaman suspected of having the H5N1 virus (avian influenza) or more commonly known as bird flu turned out to be not infected with the virus. Of laboratory inspection results in the negative and said Darali only affected by the virus. 

Chief Medical Officer (PHO) Sumbar Rosnini Savitri when contacted by reporters on Wednesday (13/2) during the call, the patient suspect bird flu has been hospitalized since a few days ago on the third floor isolation Medicine Dr M Djamil Padang has improved his condition. In addition, the results of the laboratory did show negative. 

"At this time, the victim suspect bird flu was getting better and maybe in the next few days had been allowed to go home," said Rosnini. 

Added, to see the condition of the Darali, West Sumatra Health Office will be fielded to Dr M Djamil Padang specifically to monitor the progression of the patient's health. Then, a new future can be ascertained whether the patient can go home or not. 

Previously, Darali suspected of having bird flu after some birds that surround her home in Korong Patokan, Nagari Sunua, Sabaris Nan Subdistrict, Regency Padangpariaman died suddenly. Coupled with a high fever Darali after the incident. 

Seeing Darali condition worsens, he was taken to the nearest health center was referred to Dr M Djamil Padang on Saturday (9/2). Then, after examination of the victim. Not yet certain whether the victim suffered from bird flu or not. http://posmetropadang.com/index.php?option=com_content&task=view&id=2094&Itemid=29  HATTIP DBG

Dozens Of Dead Birds Suddenly In Bali



Dozens Of Dead Birds Suddenly In Sidawa [Bali] 
Wednesday, February 13, 2013 

Bangli (Metrobali.com) - People in Banjar Tingkat Batu, Jehem, Metra, and Banjar village Yangapi Sidawa, Tamanbali, Bangli fidgety with the death of poultry type chicken suddenly.For fear that caused the death of the bird is the bird flu virus, the local residents to the Department Livestock report it Bangli. 

Some Wayan Darmada, residents Sidawa said poultry deaths have occurred since a few days ago. Sudden death of chickens impressed. No less anxious, are citizens of Banjar Tingkat Batu and Banjar Metra, Tembuku. Because, in the two series is also identified sudden death of chickens. "We fear that strikes us is the chicken bird flu virus, so we reported to the department and Perikana nearby farms," said Wayan Merta, local residents, Wednesday (13/2). 

Citizen unrest is quite reasonable. Because, in a number of villages in Bangli, has contracted the bird flu virus. One is in Selat Nyuan, Susut and Metra. After doing check rapid test, the clerk stated that poultry ducks that died when H1 N1 [sic] virus. 

While Head of Livestock and Fisheries Bangli Ir. AA. Ngurah Shamba as confirmed confirmed the reports of chickens sudden death in a number of the village. "We did get a report like that," said the former Kadisdik Bangli it. 

Further figures Puri Kanginan Bangli it, it has lowered the duty to follow up reports of residents. Where, officer down doing disinfected and do rapid test. "Rapid test result of negative results. Hence, we do not do calling forth [culling?], could just do spraying it, "Shamba said, when contacted claimed was in Banjar Sidawa to follow up reports of residents. 

It is said, since some food then it is already on alert to combat bird flu chain entered Bangli, by alerting the monitoring post. In addition, it also calls on citizens to be careful in mobilizing poultry. Because the season today, many diseases that can affect birds, including bird flu.  http://metrobali.com/2013/02/13/puluhan-unggas-mati-mendadak-di-sidawa/ 

HATTIP DBG

Race to stop spread of 'Sars': Hunt for family and friends of two Brits with deadly virus




Six NHS staff were today being closely monitored for signs of symptoms after they had “close” contact with one of the patients
Getty
Doctors are scrambling to trace dozens of friends and relatives of two Brits hit by a deadly Sars-like virus to stop it spreading across the UK .
They want to test them urgently to see if they have caught the new ­coronavirus – and prevent them passing it on to yet more people.
Six NHS staff were today being closely monitored for signs of symptoms after they had “close” contact with one of the patients.
The Health Protection Agency today revealed a Birmingham patient being treated for the strain is related to a Brit fighting for life in Manchester.
The Birmingham patient is the world’s 11th person to be diagnosed with the new strain, which has killed five people.
It is the third UK case but the first time it has passed between humans.
The first here was a 49-year-old man not from the UK.
He was flown by air ambulance from Qatar to St Thomas’ Hospital, London, in September and is still seriously ill.
The second, a middle-aged man who recently visited the Middle East and Pakistan, is isolated in intensive care at Wythenshawe Hospital, Manchester.
He is thought to have passed the bug to a relative, who has not been abroad recently.
That relative, who has an existing medical condition which makes sufferers more susceptible to respiratory infections, arrived at Queen Elizabeth Hospital, Birmingham, on Saturday night. Nurses caring for all three are wearing protective masks, goggles, aprons and gloves.
Prof John Watson, HPA head of respiratory diseases, said: “This infection of someone with no Middle East travel history suggests UK person-to-person transmission.”
The NHS Trust that runs Queen Elizabeth Hospital said: “Our patient had no direct contact with any other patient.
"The person is stable and the isolation room is cleaned daily with detergent.”
The coronavirus family ranges from colds to Sars – severe acute respiratory syndrome.
They are spread by coughs and sneezes but this strain differs from previous ones identified in humans.
Sars symptoms include fever, coughing and difficulty breathing.
A 2002 global outbreak killed about 800 victims before it was halted.
The World Health Organisation is trying to find the new strain’s source, with bats the leading theory.

Virus has no vaccine

THE new Sars-like virus has sparked pneumonia in some patients and can also cause kidney failure, the World Health Organisation has said.
Coronaviruses are usually caught from people coughing, sneezing or just talking but it is not known exactly how the latest bug is transmitted.
There is no available vaccine or specific treatment for sufferers. Coronaviruses are fragile and can survive outside the body for only 24 hours. They can be killed using detergents and cleaning agents.
Of the five people diagnosed in Saudi Arabia since the new strain emerged there last year, three have died. Two patients in Jordan have both died.
One patient has been diagnosed in Germany plus the two in the UK. http://www.mirror.co.uk/news/uk-news/sars-hunt-family-friends-two-1708617

ECDC Revising Beta Coronavirus Risk Assessment



Recombinomics Commentary 20:30
February 13, 2013
In light of this human-to-human transmission of the NCoV within the family cluster, ECDC is now updating its risk assessment, previously published on 7 December 2012.

Onset Age (yrs) Sex Probable place of infection Date reported Source Outcome 
1 April 2012 45 F Jordan** 30/11/2012 WHO/IHR Dead 
2 April 2012 25 M Jordan** 30/11/2012 WHO/IHR Dead 
3 13/06/2012 60 M KSA* 20/09/2012 KSA/Promed Dead 
4 03/09/2012 49 M Qatar/KSA*** 22/09/2012 HPA/WHO Alive 
5 NK NK NK KSA 04/11/2012 KSA/Promed/SMJ Alive 
6 12/10/2012 45 M Qatar**** 23/11/2012 RKI/WHO Alive 
7 NK NK M KSA* 19/11/2012-23/11/2012 KSA/Promed/WHO Alive 
8 28/10/2012 NK M KSA* 23/11/2012 WHO Dead 
9 Oct 2012 NK M KSA* 28/11/2012 WHO Dead 
10 26/1/2013 60 M Pakistan/KSA 8/11/2013 EWRS Alive/Hospitalised 
11 6/2/2013 NK M United Kingdom* 12/02/13 HPA Alive/Hospitalised

* Part of family cluster 
** Healthcare worker and part of outbreak linked to hospital 
*** Patient transferred to UK 
**** Patient transferred to Germany
NK: not known

The above comment and list of novel beta coronavirus confirmed cases are from the latest ECDC update.  The prior report claimed that human transmission was unlikely because of an absence of confirmed mild cases, which somehow indicated that the source of infection was animal or environmental.  However, as seen in the above list, 7 of the 11 confirmed cases were from the three cited clusters (linkage to an ICU in Jordan, a familial cluster in Saudi Arabia, or a familial cluster in the UK.  Even prior to the latest case, the two earlier clusters included 5 of the 10 confirmed cases as well as a number of milder cases which WHO classified as “probable” because of failures to confirm the presence of the novel coronavirus.

However, above list has glaring omissions with regard to disease onset dates, as well as the linkage between the above confirmed cases and symptomatic milder cases, which were not confirmed.  These symptomatic contacts were cited as probable cases by WHO indicating that the epidemiological data suggested that there were milder cases which were not confirmed due to testing limitations.

The largest group of probable cases was in the Jordan ICU cluster, which included the first two cases on the above list.  WHO has not been transparent on the age, gender, or disease onset dates for these cases..  Since the ECDC has published “risk assessments” they should have access to the IHR reports, which should include disease onset dates.

The  Jordan Ministry of Health initially denied that the death of the second health care work (25M intern) was unrelated to the first death (40F nurse), the second cases, but after these cases were confirmed he acknowledged that the deaths were 7 days apart (April 19 and 26, respectively).  The week gap in the dates of death suggests the disease onset dates were similarly gapped, which is more consistent with human to human transmission than a common environmental source.  Moreover, one of the symptomatic cases was the son of the nurse and most of the symptomatic co-workers were hospitalized.  The failure to confirm any of the surviving cluster members suggests that the assay’s ability to identify mild cases is suspect.


Similarly, WHO has withheld disease onset dates for the familial cluster in Riyadh (cases 7-9).  However media reports indicated the two fatal cases were father and son, with the father being 70 years of age.  Moreover, the dates of death were four days apart, which also supports human to human transmission.  Similarly, WHO failed to confirm the presence of one of the symptomatic family members, who was also classified as a probable case, raising additional concerns for the lab testing.

Thus, the ECDC earlier position had little support, and mild cases are likely widespread but undetected due to a limited testing protocol, as well as heavily biased testing which targets severe cases.

The latest cluster has a large disease onset time gap in two well separate locations, providing the most compelling data on human to human transmission.

An update of the ECDC risk assessment is long overdue.  http://www.recombinomics.com/News/02131303/nCoV_ECDC_Revise.html

WHO-Novel coronavirus infection – update



 The United Kingdom (UK) has informed WHO of another confirmed case of infection with the novel coronavirus (NCoV). The patient is a UK resident and a relative of the case announced on 11 February 2013.
The latest confirmed case does not have any recent travel history outside the UK and is currently hospitalized in an intensive care unit. It is understood that this patient has pre-existing medical conditions that may have increased susceptibility to respiratory infections.
Confirmed NCoV in a person without recent travel history indicates that infection was acquired in the UK. To date, evidence of person-to-person transmission has been limited. Although this case is suggestive of person-to-person transmission, on the basis of current evidence, the risk of sustained person-to-person transmission appears to be very low.
The Health Protection Agency (HPA) is following up on all close contacts (family and healthcare workers) who may have been exposed to either of these two new confirmed cases.
As of 13 February 2013, a total of 11 confirmed cases of human infection with NCoV have been notified to WHO, with no change in the number of fatalities i.e., five deaths since April 2012.
Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns. 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 SARI or SARI in healthcare workers should be thoroughly investigated, regardless of where in the world they occur.
New cases and clusters of the NCoV should be reported promptly both to national health authorities and to WHO.
WHO does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions be applied.
WHO continues to monitor closely the situation. http://www.who.int/csr/don/2013_02_13/en/index.html

More Media Myths On Beta Coronavirus Transmission


More Media Myths On Beta Coronavirus Transmission
Recombinomics Commentary 16:00
February 13, 2013
A novel coronavirus has been diagnosed in a third person in the UK,providing the first evidence that it can be passed between people.

The Health Protection Agency (HPA) has confirmed that a third UK resident has been confirmed with the respiratory disease and is receiving intensive care treatment at the Queen Elizabeth Hospital in Birmingham.

Unlike the other two cases, the third patient has no history of recent travel and so did not pick up the infection overseas.

The above comment, claiming that the latest novel beta coronavirus infection provides “the first evidence that it can pass between people” is demonstrably false.  The latest case is the 11th confirmed case, and creates the third cluster.  

The first cluster was confirmed late, but was clearly the largest involving probable and confirmed cases.  The outbreak was among people (largely health care workers) linked to an ICU in Jordan.  The two fatal cases were lab confirmed and the 1 week time gap between the death of the nurse (45F) and the intern (25M) strongly signaled human to human transmission, as did the infection of the nurse’s son.  Although the non-fatal cases were not lab confirmed, all but one was hospitalized and a WHO epidemiological analysis concluded that most if not all of the symptomatic cases were “probable” cases.


The largest cluster of confirmed cases was a familial outbreak in Riyadh.  Like the cluster in Jordan, WHO has withheld the disease onset days for the symptomatic family members, but media reports indicated the two fatal cases were father and son (father was 70 years old) and they died 4 days apart, once again supporting human transmission within the cluster.  Both fatal cases were confirmed, as was the novel coronavirus in one of the symptomatic surviving family members.  The fourth symptomatic family member tested negative, but again WHO classified the case as probable, based on symptoms and disease onset date.


The recent cluster in the UK limits unfounded speculation in the media suggesting that the human cases are linked to contaminated fruit or ground water, or other animals, including camels!  There was little scientific basis for any the above because an extensive survey of animals, including bats in Europe, Africa, and Asia, failed to identify any coronavirus that was more than 91% identical to the sequences from the human cases, which were all at least 99.5% identical to each other (in contrast to SARS-CoV where bat sequences had a 98% identity with human sequences). 

Moreover, most of the cases had no linkage to animals, but did have linkages to symptomatic humans as noted in the above three clusters which involve 7 of the 11 confirmed cases. 
http://www.recombinomics.com/News/02131302/nCoV_MM_Trans_More.html?

Familial Beta Coronavirus Cluster In The UK


Familial Beta Coronavirus Cluster In The UK
Recombinomics Commentary 16:00
February 13, 2013
The Health Protection Agency (HPA) can confirm a further case of novel coronavirus infection in a family member of the case announced on Monday 11 February. The patient, who is a UK resident, does not have any recent travel history and is currently receiving intensive care treatment at The Queen Elizabeth Hospital, Birmingham.

The above comments confirm a familial beta coronavirus cluster in the UK.  The index case (60M) developed symptoms in Saudi Arabia prior his return to the UK, supporting human to human transmission to the latest confirmed case.  The index case was co-infected with H1N1pdm09.  Details on the collection date for the sample positive for H1N1pdm09 has not been released, which is also true for the sequence of the influenza virus.

The HPA announcement and associated media reports have been silent on testing of the latest case for H1N1pdm09.  However, the infection of a relative in the UK eliminates most of the unfounded speculation that the cases and clusters of novel coronavirus infections involve an environment or animal source.

The latest case forms the third cluster, and raises the number of the confirmed cases that are contacts of other confirmed cases to 7 (out of 11).

Details on influenza testing of the latest case, as well as release of the H1N1pdm09 sequence, from the index case, would be useful.

Bird Flu Attack Batam


2270 Sudden Death Chickens


BATAM (HK) - The bird flu virus (avian influenza) again attacked the city of Batam, Riau Islands. A total of 2270 chickens of three Joint Business Group (KUB) in Urban Water King, District Tanjungriau Nongsa and died suddenly in the last month. Death of poultry in two places due to bird flu.
Data Department of Marine, Fisheries, Agriculture and Forestry (KP2K) mentions Batam city, from 2270 chickens died, about 200's tail belong Seitemiang Agricultural Plot 20 residents, Village of Tanjung Riau. The rest is owned by three KUB poultry which is a relief from the Ministry of Social Affairs. Third KUB was the Flower Durian, Sariwati and Sari Bloom. Dept. of Marine Fisheries, Agriculture and Forestry (KP2K) Batam City DVM Suhartini MM confessed chicken deaths since January. However, the new farmer's report two weeks later. Suhartini After receiving the report says, it lowers Tim PDSR (Participatory Disease Surveillance and Respond) untukmelakukan pamantauan and inspection to the site on Wednesday-Sunday (9-13/2) ago. From the results of the rapid test is known as the sudden death of poultry tested positive for bird flu. For that Suhartini appealed to farmers may not sell sick birds to the consumer or the carrying out of the location. This is so not spread.mentioned that chickens are exposed firus it will be destroyed no later than next week. This is in accordance with the rules Dirjend Ranch RI 2009. In the rules it stated positive bird avian influenza in an area should be selective depopulation or culling. Likewise diradius birds are one kilometer from the site was destroyed. "Please note poultry deaths over 1,000 animals, it is wabah.Jadi inevitably have to be destroyed," jelasnnya. hopes he returned to the farmers in order to comply with preventive measures, do to infect humans. Hence, with this condition, people should maintain environmental sanitation and housing. "This incident just happened again. Previous occurrence of the same in 2010," he said. Disinggugn poultry imported from outside, he asked the quarantine supervision. Therefore, the current bird flu, has been handed over to the area since 2011, the central government is not anymore. "But do not panic, because we've done cleanliness or something similar. Hence, farmers not to sell sick chickens to others or to the market because it will expand its distribution. while for symptoms in humans, penangananya submitted to the Department of Health, "said Suhartini.(Mnb)   http://www.haluankepri.com/batam/42137-flu-burung-serang-batam.html?utm_source=dlvr.it&utm_medium=twitter

Epidemiological update: Plane passengers being followed up

Epidemiological update: Case of severe lower respiratory tract disease associated with a novel coronavirus
13 Feb 2013


ECDC
On 13 February 2013, the HPA announced that one family contact of the previously-confirmed case reported on 11 February was laboratory-confirmed to be infected with the novel coronavirus (NCoV). This second case from the same family was hospitalised on 9 February with a short history of respiratory symptoms. The patient has an existing medical condition that may make him more susceptible to respiratory infections. He does not have a recent travel history, and is currently receiving intensive care treatment.
The cases have been notified through the EU alerting system for communicable diseases.
This brings the total of laboratory-confirmed cases of severe pneumonia caused by the NCoV to eleven globally (see table below).
The information available suggests human-to-human transmission of the NCoV in this family cluster.
The HPA reports that surveillance of family, close contacts of the two patients and healthcare workers treating the two patients is ongoing, as per the UK National Guidelines. None are currently presenting with symptoms consistent with nCoV.
The HPA is also following-up regarding passengers who may have been exposed while flying with the case announced on 11 February 2013 and are in contact with the airline concerned.
In light of this human-to-human transmission of the NCoV within the family cluster, ECDC is now updating its risk assessment, previously published on 7 December 2012.

Case No.
Date of Onset
Age (years)
Sex
Probable place of infection
Date reported
Source
Outcome
1
April 2012
45
F
Jordan**
30/11/12
WHO/IHR
Dead
2
April 2012
25
M
Jordan**
30/11/12
WHO/IHR
Dead
3
13/06/12
60
M
Kingdom of Saudi Arabia*
20/09/12
Kingdom of Saudi Arabia/ProMed
Dead
4
03/09/12
49
M
Qatar/ Kingdom of Saudi Arabia***
22/09/12
HPA/WHO
Alive
5
NK
NK
NK
Kingdom of Saudi Arabia*
04/11/12
Kingdom of Saudi Arabia/ProMed / SMJ
Alive
6
12/10/12
45
M
Qatar****
23/11/12
RKI / WHO
Alive
7
NK
NK
M
Kingdom of Saudi Arabia*
19/11/12- 23/11/12
Kingdom of Saudi Arabia/ProMed/
WHO
Alive
8
28/10/12
NK
M
Kingdom of Saudi Arabia*
23/11/12
WHO
Dead
9
October 2012
NK
M
Kingdom of Saudi Arabia*
28/11/12
WHO
Dead
10
24 /1/2013
60
M
Pakistan/
Kingdom of Saudi Arabia*
8/1/13
EWRS
Alive/Hospitalised
11
6/2/2013
NK
M
United Kingdom*
12/02/13
HPA
Alive/Hospitalised
* Part of family cluster 
** Healthcare worker and part of outbreak linked to hospital 
*** Patient transferred to UK 
**** Patient transferred to Germany
NK: not known

http://www.ecdc.europa.eu/en/press/n...ews/Lists/News