Oct 4, 2012 (CIDRAP News) - Clinicians and scientists in the United Kingdom who are treating a Qatari man infected with a novel coronavirus issued new reports on their investigations today, with fresh details such as that the man had indirect exposure to camels and sheep in his home country.
The two reports appear in the latest issue of Eurosurveillance. One focuses mainly on the patient's illness course, the epidemiological investigation, and the public health response, and the other describes clinical findings, diagnostic testing, and the analysis of the virus, which has been named hCoV-EMC.
Both reports credited a Saudi Arabian doctorÕs ProMED Mail post about a patient from Saudi Arabia who died in June from the same coronavirus, which they said raised suspicions about the unexplained fever and respiratory infection in the Qatari man, who had traveled recently to Saudi Arabia. ProMED Mail is the online reporting system of the International Society for Infectious Diseases.
In a related development, the US Centers for Disease Control and Prevention (CDC) issued a report on the new coronavirus today and addressed travel issues, especially those related to the upcoming Hajj pilgrimage in Saudi Arabia, which takes place from Oct 24 through 29.
According to the first report, the 49-year-old man, who has been treated in the United Kingdom since Sep 12, was in Saudi Arabia with a group in the first weeks of August, where he and several others experienced rhinorrhea and fever. He returned to Qatar on Aug 18, and his respiratory symptoms got better 3 days later.
In Qatar he spent time on a farm where he keeps camels and sheep, though he reportedly had no direct contact with them.
On Sep 3 he reported mild respiratory symptoms, which later worsened, and he was hospitalized 6 days later for bilateral pneumonia. When he didnÕt improve, he was flown to London for intensive care unit (ICU) treatment, where his health team found renal impairment. The man was transferred to another London hospital on Sep 20Ñthe same day as the ProMED postÑwhen his condition deteriorated further.
In light of the ProMED post, the patientÕs UK health team the next day tested him and got positive results on a pan-coronavirus assay. Genetic sequencing the following day revealed that the manÕs virus was closely related to the novel coronavirus that killed the Saudi Arabian man.
Health officials immediately isolated the man in a negative-pressure single room, instituted a full personal protective equipment protocol, and worked up case and close-contact definitions to start looking for other possible cases. They monitored close contacts for 10 days after exposure.
The authors wrote that the man was probably infected in Qatar, since he was there 16 days before his most recent respiratory illness, and they noted that the earlier mild illness he had had in Saudi Arabia resolved 2 weeks before his most recent illness onset. Noting 95% of SARS (severe acute respiratory syndrome) cases had an incubation period of less than 10 days, they said that unless hCoV-EMC has an unusual biphasic feature or a very long incubation period, Qatar was the probable site of the manÕs exposure.
Investigation identified 64 people who had been in close contact with the man during his medical stay in the UK. So far, none have had severe respiratory infections, but 13 had mild symptoms that resolved. A hospitalized patient who got sick after possible contact with the man was tested, with negative results. The new virus hasnÕt been detected in any of 10 symptomatic healthcare worker contacts who were tested as of today.
In addition, four possible cases in people with a recent history of travel to Saudi Arabia were found in the UK. Samples, available for three of them, were negative. An investigation is ongoing in the illness of the fourth patient, who died in early September.
So far there is no confirmed evidence of ongoing person-to-person spread of the virus.
However, UK officials pointed out that a severe respiratory illness outbreak in the Middle East was reported earlier this year, and said further investigation is needed to determine if a new coronavirus has been circulating more widely in the area or if it recently made the jump from an animal reservoir. They cited an outbreak of severe respiratory disease at a hospital in Jordan that sickened 11 people, including 8 healthcare workers.
A brief report on the outbreak appeared in a May 4 communicable disease threat report from the European Centre for Disease Prevention and Control. One nurse who had underlying medical conditions died. The Jordanian health ministry suspected the source of the infections was viral, though lab results werenÕt available at the time.
Diagnostic testing and sequencing clues
In the second ECDC report today, UK officials described the care the patient received in Qatar, along with his illness course so far and testing that has been conducted during his hospitalization in London.
The patient has been on dialysis for renal failure since Sep 14, and on Sep 20 his medical team placed him on extracorporeal membrane oxygenation (ECMO). They added that as of Oct 2 his condition is stable, but dependent on ECMO.
At first, his medical team suspected a viral source, but samples were negative on extensive influenza tests. Genetic sequencing on a small segment enabled them to develop a new real-time RT-PCR assay that they tested on novel coronavirus tissue cultures and clinical samples from the patient.
Though more extensive sequencing is needed on the virus obtained from the patient, they said their communications with the Dutch lab that sequenced the virus found in the Saudi Arabian man who died suggests that the two samples are nearly identical.
CDC addresses travel risks, resources for physicians
Meanwhile, the CDC said it was working closely with the World Health Organization (WHO) and other partners to better understand the health risk posed by the new coronavirus, according to an early-release report today in Morbidity and Mortality Weekly Report (MMWR).
The CDC said neither it nor the WHO has issued any travel alerts; the agency estimated that the risk to US residents traveling in the region is low and emphasized that the recommendations for the Hajj have not changed.
The agency urged people who get sick with an acute respiratory illness within 10 days of returning from Saudi Arabia or Qatar, except for just passing through an airport, see their doctors and report the travel. Physicians who evaluate patients with the travel history and severe lower respiratory tract infections should consult guidance on the CDCÕs coronavirus Web site, which is based on the WHO's case definition.
Because widely available diagnostic tests for coronaviruses arenÕt suitable for detecting the new virus, the CDC said for now it will be conducting tests for the new virus.
Pebody RG, Chand MA, Thomas HL, et al. The United Kingdom public health response to an imported laboratory confirmed case of a novel coronavirus in September 2012. Eurosurveill 2012 Oct 4;17(40):[Full text]
Bermingham A. Chand MA, Brown CS, et al. Severe respiratory illness caused by a novel coronavirus in a patient transferred to the United Kingdom from the Middle East, September 2012. Eurosurveill 2012 Oct 4;17(40):[Full text]
May 4 ECDC weekly communicable disease threat report
Oct 4 MMWR early release