Update, Case Definitions, and Guidance
Update
CDC 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 May 8, 2013, 31 laboratory-confirmed cases have been reported to WHO - 22 from Saudi Arabia, two from Qatar, two from Jordan, three from the United Kingdom, one from the United Arab Emirates, and one from France. The onset of illness was between April 2012 and May 2013 (1). Among the 31 cases, 18 were fatal. Two of the 31 cases 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, two 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.
A fourth cluster among two family contacts occurred in Saudi Arabia in February 2013. One of the individuals died, and one recovered after experiencing a mild respiratory illness.
In May 2013, a fifth cluster was reported in Saudi Arabia and is linked to one healthcare facility. A total of 13 cases have been reported in the cluster, of which seven have died. The Kingdom of Saudi Arabia Ministry of Health is investigating the situation.
There is clear evidence of limited, not sustained, human-to-human transmission, possibly involving different modes of transmission such as droplet and contact transmission. But further studies are required to better understand the risks. 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.
Case Definitions(2)
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 forcommunity-acquired pneumonia** according to local management guidelines.
In addition, the following persons may be considered for evaluation for novel coronavirus infection:
- 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.
For more information, see Interim Guidance for State and Local Health Departments.
