WHO updates guidance on novel coronavirus surveillance

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Mar 19, 2013 (CIDRAP News) – The World Health Organization (WHO) yesterday updated its surveillance recommendations for the novel coronavirus (NCoV), advising clinicians to be wary of the virus even if patients with a severe respiratory illness have been confirmed to have another disease.

The agency also offered specific surveillance advice to nations in which NCoV has been detected, as well as investigations and studies to conduct where cases are detected. The WHO previously updated its guidance on Nov 28, 2012.

NCoV has infected at least 15 people worldwide, 9 of them fatally. Most cases have involved travel to or residence in the Middle East.

This year the third cluster of NCoV cases, in the United Kingdom, was confirmed, providing "clear evidence of limited, non-sustained human-to-human transmission," according to the guidance.

"A number of unanswered questions remain," the WHO added, "including the virus reservoir, the means by which seemingly sporadic infections are being acquired, the mode of transmission between infected persons, the clinical spectrum of infection, and the incubation period."

The UK cluster included a patient who originally tested positive for influenza A and was not thought to be infected with NCoV until tests came back positive, the agency said.

In part because of that experience, the WHO now recommends testing anyone who has a severe respiratory infection and develops unexpectedly severe disease despite appropriate treatment, even if another cause has been identified, if that other disease does not fully explain the patient's illness. Such a person should be tested regardless of place of residence or history of travel.

The guidance also recommends testing for patients who have a severe respiratory infection—without regard to residence or travel history and unless another cause has been identified—in these situations:

  • The case is part of a cluster
  • The case is in a healthcare worker who had contact with patients with severe acute respiratory infections

Additionally the WHO recommends testing of people with any acute respiratory disease who had contact, within 10 days before symptom onset, with a confirmed or probable NCoV case-patient while the case-patient was ill.

The agency strongly encourages countries in which a case has been detected to consider adding  NCoV testing as part of routine sentinel respiratory disease surveillance. It also recommends additional testing of milder, unexplained community-acquired pneumonia that requires hospital admission if resources can support the testing.

The WHO "does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions be applied," the guidance says.

The agency recommends several investigative steps, such as complete data collection during history taking, investigation of potential exposures, and contact tracing. It also details recommended epidemiologic studies, such as serologic surveys in healthcare workers and retrospective testing of stored specimens from patients who had respiratory disease.

See also:

Mar 18 WHO guidance

Nov 29, 2012, WHO guidance

Mar 14 CIDRAP News story "UK officials detail novel coronavirus cluster findings"

Mar 12 CIDRAP News story "Saudi Arabian death marks 15th novel coronavirus case"

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