Two Jordan cases in April shift novel coronavirus picture

Nov 30, 2012 (CIDRAP News) – The World Health Organization (WHO) reported today that two cases of novel coronavirus (CoV) infection occurred as part of a cluster of hospital respiratory infections in Jordan back in April. Besides adding one more to the list of affected countries, the announcement signaled that the virus emerged 2 months earlier than previously thought and increased the likelihood that it can spread from person to person.

Also today, the WHO said testing confirmed the virus in a fatal case that was part of a previously noted family cluster of four illnesses in Saudi Arabia. Today's developments increased the overall case count to nine, including five deaths, in three neighboring countries: Saudi Arabia, Qatar, and Jordan.

The cases include five, with three deaths, in Saudi Arabia; two in Qatar; and the two fatal illnesses in Jordan. The latest count is two more than reported yesterday. Five cases involved acute renal failure.

The Jordanian illness cluster in April involved 11 people, including eight healthcare workers, in a hospital intensive care unit in Zarqa, according to a report from the European Centre for Disease Prevention and Control (ECDC) on May 4. Health officials had mentioned the cluster previously as suspicious in light of the novel coronavirus. Until now, the first novel CoV infection was believed to be that of a Saudi man who died in his home country in June, though his case was not reported until September.

At the time of the Jordanian cluster, officials from US Naval Medical Research Unit 3 (NAMRU 3) in Cairo tested patient samples at Jordan's request and found they were all negative for known coronaviruses and other viruses, the WHO said in one of its two statements today. No specific tests for the novel virus existed at the time, since it hadn't been discovered yet.

In October, after the discovery of the novel CoV, Jordan sent stored samples to NAMRU-3 for testing, the WHO said. Recently the lab provided results that confirmed the novel virus in two of the cases. The WHO did not say how many of the patients were tested.

In response to Jordan's request, WHO experts arrived in Amman on Nov 28 to help investigate the cases and strengthen the country's sentinel surveillance for severe acute respiratory infections, the agency reported.

The WHO said the existence of the case clusters in Jordan and Saudi Arabia increases "the possibility of limited human-to-human transmission or, alternatively, exposure to a common source. Ongoing investigation may or may not be able to distinguish between these possibilities."

In the Saudi Arabian family cluster, two of the three confirmed cases were fatal. One more family member also had a similar illness and recovered but tested negative by polymerase chain reaction, the WHO noted.

Despite the two clusters, the WHO said, "Based on current information, it [the virus] does not appear to transmit easily between people, unlike the SARS [severe acute respiratory syndrome] virus." The SARS virus, also a coronavirus, sickened about 8,000 people and killed about 900 in 2003.

Saudi Arabia's deputy minister for public health, Ziad A. Memish, MD, today suggested that the virus in the Saudi Arabian family cluster may be different from the strain in the earlier cases.

"We think the virus in the last family cluster is different as it had significant spread among households while none of the previous cases behaved in a similar way," Memish said in e-mailed comments to CIDRAP News. Memish was among the authors of a description of Saudi Arabia's second novel CoV case, published this week in the Saudi Medical Journal.

The Jordanian cases seem to confirm the need to watch for the novel virus in places beyond just Saudi Arabia and Qatar, as recommended by the WHO lately. Last week the agency called for broader vigilance, and yesterday it offered more detailed surveillance recommendations.

The WHO reiterated those recommendations today. It said authorities should consider testing of patients with unexplained pneumonia, especially if they live in or visited the Arabian peninsula or neighboring countries. Any cluster of severe acute respiratory infections in healthcare workers should be carefully investigated, regardless of the location, the statement said.

Memish agreed on the need for wider surveillance, commenting, "We have been saying all along that cases of novel coronavirus are not limited to KSA [the Kingdom of Saudi Arabia] and Qatar. And today's announcement from WHO about the two cases from Jordan in early April 2012 is an evidence supportive of our suspicions.

"No country in the world screens all pneumonia patients for novel coronavirus except KSA and Qatar, and as long as this is the case no novel coronavirus cases will be recovered anywhere else," he added.

The WHO said it is not recommending special screening for the virus at points of entry, nor does it recommend any travel or trade restrictions.

In other developments, the WHO today revised a statement it issued yesterday to correct the number of deaths attributed to the virus at that point. Yesterday's statement mentioned seven cases with just one death; the revised statement changed the number of deaths to three.

See also:

Nov 30 WHO update reporting Jordan cases

Nov 30 WHO background and summary on the situation

Revised version of Nov 28 WHO statement

Related Nov 30 ECDC statement

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