Britain reports novel coronavirus family cluster

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Feb 13, 2013 (CIDRAP News) – A male family member of a British man hospitalized with a novel coronavirus (CoV) infection has also been hospitalized with the same virus, pointing to another instance of human-to-human spread, UK and international health authorities reported today.

The newly confirmed CoV case is in a UK resident who is being treated in an intensive care unit at The Queen Elizabeth Hospital in Birmingham, the country's Health Protection Agency (HPA) said today in a statement. The patient has a preexisting medical condition that increases susceptibility to respiratory infections. The case raises the world's number of confirmed CoV cases to 11, including 5 deaths.

The European Centre for Disease Prevention and Control (ECDC) said today that the patient is a male family contact who was hospitalized on Feb 9 after a short history of respiratory symptoms.

An earlier case from the same family was hospitalized in Manchester on Jan 31 with a severe lower respiratory tract infection, and tests revealed that he was co-infected with CoV and the 2009 H1N1 (pH1N10 influenza virus, according to previous reports. The 60-year-old man started having symptoms 10 days after a trip to Pakistan, then Saudi Arabia.

The World Health Organization (WHO) said in a statement today that the relative who is sick did not have any recent travel history outside the United Kingdom, indicating that the patient was infected locally, which suggests human-to-human spread. So far evidence of such transmission has been limited, and based on current data the risk of sustained person-to-person transmission appears to be very low, the WHO said.

The agency urged countries to continue surveillance for severe acute respiratory infections (SARIs) and to carefully analyze any unusual patterns. The WHO added that any SARI clusters or SARIs in healthcare workers should be thoroughly investigated, "regardless of where in the world they occur."

So far three CoV cases have been detected in Britain. The first patient, a 49-year-old man from Qatar, was hospitalized in England in September. A spokeswoman from the HPA told CIDRAP News that the man is still hospitalized in London.

Earlier reports on the man's condition said he had renal impairment, a complication that has affected some of the other CoV patients. Another patient from Qatar was hospitalized in Germany in November with a CoV infection but has since been released.

John Watson, MB BS, MSc, head of respiratory diseases with the HPA, said in the agency's statement that although the new case provides strong evidence of person-to-person transmission, the risk of infection in most circumstances is still very low.

"If novel coronavirus were more infectious, we would have expected to have seen a larger number of cases than we have seen since the first case was reported 3 months ago," he said. "However, this new development does justify, the measures that were immediately put into place to prevent any further spread of infection and to identify and follow up contacts of known cases."

The HPA continues to monitor close contacts of the two new CoV patients, as well as members of health teams treating them. The ECDC said so far none have shown symptoms

The ECDC also said the HPA is in contact with an airline to follow up on passengers who may have been exposed to the virus while flying with the first patient.

In another development related to 60-year-old man's infection, Ziad Memish, MD, Saudi Arabia's deputy minister for public health, yesterday suggested that health experts reconsider the current CoV case definition, according to his post on ProMED-Mail, the online reporting system of the International Society for Infectious Diseases.

He wrote that although the HPA emphasized the patient's travel to the Middle East, the incubation period and the appearance of symptoms are ambiguous enough to warrant a more cautious statement. "…it remains unknown where and when this patient became infected," he wrote.

Memish also urged caution about interpreting the pH1N1 co-infection until the test results are confirmed by an independent source. He said a thorough search hasn't turned up any similar dual infections in Saudi Arabia.

Surveillance for SARIs in Saudi Arabia is ongoing, tests on 300 sick Hajj pilgrims found no coronavirus cases, and personal communications with French and Egyptian health officials have also revealed no CoV infections, Memish wrote.

He pressed for an expanded search for more cases. "Thus far it is less associated with focused or even regional outbreaks than it is with sporadic disease in widely separated locales. Unless and until SARI investigations are expanded, our understanding of its epidemiology and disease spectrum will remain limited. An urgent discussion of the current case definition is needed.

The WHO's Eastern Mediterranean Regional Office (EMRO) issued a statement today saying it continues to investigate the novel coronavirus. It noted that it held a technical meeting in Cairo on Jan 14 and 15 to discuss what is known about the natural history of the disease, the sources of infection, the mode of transmission, transmissibility, pathogenicity, and lab testing capacity. It said the meeting included health officials from the three countries in the region that have reported cases and key partners from WHO collaborating centers and headquarters.

See also:

Feb 13 HPA statement

Feb 13 ECDC epidemiologic update

Feb 13 WHO statement on new coronavirus case

Feb 12 ProMED-Mail post

Feb 13 WHO EMRO statement on coronavirus investigations

Feb 11 CIDRAP News story "Novel coronavirus case in UK raises global total to 10"

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