Feb 11, 2013 (CIDRAP News) – A 60-year-old British man is under intensive care in a UK hospital for both a novel coronavirus (CoV) infection and influenza, marking the 10th known illness caused by the novel virus, European and British authorities reported today.
The man had visited Pakistan and Saudi Arabia in December and January, the European Centre for Disease Prevention and Control (ECDC) said in a statement. All nine previous novel CoV cases, all reported last year, arose in or had links to the Arabian Peninsula. Five of the nine cases were fatal.
The British patient fell ill on Jan 26, 6 days after arriving in Saudi Arabia, after having been in Pakistan from Dec 16 until Jan 20, the ECDC said. After returning to England, he was hospitalized on Jan 31 with a severe lower respiratory tract illness. Lab tests subsequently revealed both the CoV and a 2009 H1N1 flu infection, the agency said.
The UK Health Protection Agency (HPA) said the man was hospitalized in Manchester. The ECDC said he required extracorporeal membrane oxygenation—a heart-lung machine—starting Feb 5.
John Watson, MB BS, MSc, of the HPA said any risk related to the novel virus remains "extremely low" for the general UK population and that the risk for travelers to the Arabian Peninsula and surrounding countries is "very low."
No travel restrictions are advised, but people who have respiratory symptoms after visiting the affected countries should seek medical advice, said Watson, who heads the HPA's respiratory diseases department. He also said the HPA is checking on the health of the patient's contacts.
Health officials expressed no suspicion that the new case is directly linked to any of the previous ones, including one in a Qatari man who has been under treatment in the UK for months. Today's HPA statement said the Qatari patient is still being treated.
The World Health Organization (WHO) commented on the new case today, saying, "This is a sporadic case and does not alter the current WHO risk assessment on NCoV, but the new case does indicate that the virus is persistent."
The novel virus is related to coronaviruses found in bats in a number of countries, but its source has not been identified. It is also related to the SARS (severe acute respiratory syndrome) virus, which spread internationally in 2003 and killed about 900 people.
The ECDC said, "The wide geographical distribution [of the CoV], the long intervals between cases and clusters, and the absence of evidence for mild or asymptomatic human infections which could maintain a chain of transmission between outbreaks, point to intermittent zoonotic transmission or an environmental source. Zoonotic transmission does not exclude human-to-human transmission from an index case, but there is only limited evidence to date that this has occurred."
The previous novel coronavirus cases have included five in Saudi Arabia, including three deaths; two fatalities in Jordan; the Qatari man still being treated in the UK; and a Qatari man who was treated in Germany and recovered. Three of the Saudi cases were part of one family cluster of illnesses.
The virus first came to light in late September with reports of the first Saudi Arabian case and the first Qatari patient. The first Saudi case occurred in June, but it was preceded by the two fatal cases in Jordan, which occurred in April as part of a hospital cluster of respiratory infections. The two cases were not identified as due to the new virus until November.
Although the latest patient got sick in Saudi Arabia, he could have been exposed to the virus while still in Pakistan, the ECDC commented.
The agency also said sporadic detections of novel CoV cases should be expected "in the context of the enhanced surveillance for cases and clusters implemented in the Arabian Peninsula and worldwide."
The WHO said countries should continue surveillance for severe acute respiratory infections (SARI) and carefully review any unusual patterns. The agency said testing for the new virus should be considered when patients have unexplained pneumonia or severe, progressive or complicated illness not responding to treatment, especially if the patients live in or are returning from the Arabian peninsula and neighboring countries.
"Any clusters of SARI or SARI in health care workers should be thoroughly investigated, regardless of where in the world they occur," the WHO added.
No influenza co-infection has been reported in any of the previous novel CoV cases. Today's statements offered no comments on how the patient's H1N1 flu might have affected his condition. H1N1 viruses have accounted for many of the flu cases in Europe this winter, though the H1N1 strain has been rare in the United States this season.
Feb 11 UK HPA statement
Feb 11 WHO statement
Feb 11 ECDC update
Nov 30, 2012, CIDRAP News story "Two Jordan cases shift novel coronavirus picture"