ECDC updates risk assessment for novel coronavirus

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Dec 10, 2012 (CIDRAP News) – The European Centre for Disease Prevention and Control (ECDC) today announced an update of its risk assessment on novel coronavirus, which takes into account the possibility of human-to-human spread, the wider geographic area where infections occurred, and risks the virus may pose to healthcare workers.

The ECDC said two recent developments spurred the second update of its rapid risk assessment: the recent retrospective diagnosis of two fatal novel coronavirus cases, part of an 11-case hospital pneumonia cluster that occurred in Jordan in April, and a recent review showing that European laboratories have adequate capacity for diagnosing novel coronavirus cases. The 6-page revised risk assessment is dated Dec 7 and appears the ECDC's Web site.

Of the nine novel coronavirus cases that have been reported to the World Health Organization (WHO) so far, five have been fatal. All patients have had pneumonia and several also had renal failure. Two clusters have been reported: a family in Riyadh, Saudi Arabia, and healthcare workers at a hospital near Amman, Jordan.

The ECDC said the Jordan cluster, which involved 11 people including 8 healthcare workers, is notable because its size and the involvement of health staff raise questions about the possibility of human-to-human transmission. The ECDC said some or all of the nine nonfatal cases in the cluster were reportedly tested for novel coronavirus, but little information is available about the results.

The lack of information on testing and on the severity of the nonfatal cases makes it impossible to to confirm or rule out human-to-human transmission, the statement said.

It also noted that a serologic test for novel coronavirus infection is being developed, which will help health officials learn more about patients' past exposure to the virus and if there were mild or asymptomatic cases.

Intensive surveillance of patients treated in Germany and the United Kingdom has revealed no secondary or nosocomial spread, but experts should reassess the risk after more details are released about the Jordan cluster, the ECDC said.

So far, the broad geographic distribution, long intervals between cases, and lack of evidence for mild or symptomatic infections that could keep the disease going suggests intermittent zoonotic transmission or an environmental source for the virus, the ECDC said. Though zoonotic transmission doesn't rule out human-to-human spread from an index case, there is no evidence yet that it occurred, and there isn't enough information from the WHO or Jordan to assess the possibility, the group added.

Additional severely ill patients from the Arabian Peninsula will likely be transferred for care to EU hospitals, and clinicians should have a low threshold for testing for the virus in patients coming from the region, the ECDC said.

Because of the possibility of coinfections, health teams should test for the novel coronavirus even when another possible pathogen has been identified, the group added. Personal protective measures are needed to protect the family members of patients and healthcare workers treating patients with severe respiratory infections from the Arabian Peninsula.

In another development, a global clinical research consortium based at Oxford University proposed a framework for studying the pathogenesis and treatment of novel coronavirus infection.

In a Dec 8 ProMED Mail post, Kajsa-Stina Magnusson wrote that the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), which formed in 2011, is suggesting the framework to answer important questions about the disease, which is difficult to study, given that the number of cases so far is low and patients will likely be treated in hospitals in many different countries.

Magnusson, project manager of the ISARIC, wrote that it's crucial to standardize data collection to improve the understanding of clinical outcomes and that because randomized clinical trials might not be possible to guide clinical interventions, observational studies may be the only practical option for data collection. The group proposed a tiered strategy for prioritizing research questions, with the studies in the lowest tier geared toward nearly any hospital in any resource setting.

She said the group is providing a draft consent form, case report form, and outline protocols for parties who are interested in participating in collaborative research efforts.

Possible therapeutic options to study could include antivirals and immunomodulatory interventions, she wrote.

See also:

Dec 10 ECDC press release

Dec 7 ECDC novel coronavirus risk assessment update

Dec 8 ProMED Mail post

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