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20 Feb 2013

Novel Coronavirus (NCoV) - Multistate - Severe respiratory syndrome (ECDC/CDTR, February 20 2013, edited)

[Source: European Centre for Disease Prevention and Control (ECDC), full PDF document: (LINK). Extract.]


Week 7, 10-16 February 2013 – CDTR


Novel Coronavirus - Multistate - Severe respiratory syndrome

Opening date: 24 September 2012 Latest update: 14 February 2013


Epidemiological summary

A first case reported, on 20 September 2012 through ProMED, was a 60-year-old patient in Jeddah, Saudi Arabia. He was admitted to hospital on 13 June with severe pneumonia. He developed acute renal failure and died on 24 June. Post mortem lung tissue tests were negative for influenza virus A, influenza virus B, parainfluenza virus, enterovirus and adenovirus. Testing with a pancoronavirus RT-PCR was positive for a coronavirus and the virus genome was later sequenced in Erasmus Medical Centre, Rotterdam, and identified as a putative novel beta-corononavirus, closely related to bat coronaviruses.

Another case was reported on Saturday 22 September 2012, by the UK Health Protection Agency (HPA). The case was a 49 -year-old Qatari with no underlying health conditions and a history of travel to Mecca, Saudi Arabia. He developed respiratory symptoms on 3 September, and on 7 September was admitted to an intensive care unit (ICU) in Doha, Qatar, where he subsequently developed renal failure. He was transferred by air ambulance to an ICU in the United Kingdom on 11 September. On 21 September, tests on samples from this patient using a pancoronavirus RT-PCR test were positive. Comparison of a 250bp PCR fragment between this and the isolate of the first case performed by the Erasmus Medical Centre showed 99.5% sequence homology (one nucleotide difference).

One more case of infection with the novel coronavirus was reported on 4 November 2012 by Saudi Arabia. The patient was admitted to hospital in Riyadh with pneumonia and was subsequently diagnosed with the novel coronavirus by RT-PCR. This patient also developed renal failure, however he did have a medical history of only one functional kidney. A case report on this case was published in the Saudi Medical Journal.

Germany reported a case of the novel coronavirus on 23 November 2012 in a patient from Qatar, with onset of symptoms in October. He was initially treated in Qatar but was later transferred to Germany for treatment for severe respiratory distress syndrome and acute renal failure. The diagnosis of the novel coronavirus was made at the Health Protection Agency using samples sent from Qatar. The patient has no epidemiological link to the previous cases.

On 23 November 2012, WHO provided information of two further confirmed cases in Saudi Arabia, one of whom died. These cases in Saudi Arabia were part of a cluster in a family household, involving two more cases. One of these two additional cases died and was confirmed as positive on 28 November; the other recovered and is considered a probable case.

On 30 November WHO confirmed that two samples, taken during an investigation into an unexplained respiratory disease cluster in Jordan in April 2012, have been retrospectively tested and found to be positive for novel coronavirus. Both of these cases had fatal outcomes.

On 11 February 2013, the UK Health Protection Agency (HPA) announced that an additional case of the novel coronavirus (NCoV) infection has been confirmed in a UK resident. The patient, a 60 year old male, became ill on 24 January 2013 and was admitted to hospital in England on 31 January, with a severe lower respiratory tract disease. In the 10 days before the onset of illness, the patient had visited both Pakistan (from 16 December 2012 to 20 January 2013) and Saudi Arabia (from 20 to 28 January 2013).

On 13 February 2013, the HPA announced that one family contact of the previously mentioned case in England was laboratory-confirmed to be infected with the novel coronavirus (NCoV). The patient has an existing medical condition that may made him more susceptible to respiratory infections. He did not have a recent travel history.

This brings the total of laboratory-confirmed cases of severe pneumonia caused by the NCoV to eleven globally, of which five cases were fatal (see Table on the ECDC website).



ECDC assessment

The information available suggests human-to-human transmission of the NCoV in this family cluster.

Research on the complete genome sequence of HCoV-EMC/2012 has characterised the virus as a new genotype that is closely related to bat coronaviruses that are distinct from SARS-CoV. At present, the source and possible routes of transmission of the virus remain unknown; however, all cases have been reported from the countries of the Arabian Peninsula and the neighbouring country of Jordan.

It is possible that enhanced surveillance in the Arabian Peninsula, neighbouring countries, and worldwide will detect additional sporadic cases or clusters.



In light of this human-to-human transmission of the NCoV within the family cluster, ECDC is now updating its rapid risk assessment, previously published on 7 December 2012. The results of a survey to determine the laboratory capacity for testing for the novel coronavirus in Europe, conducted by ECDC in coordination with WHO Regional Office for Europe, was published recently in EuroSurveillance.

The HPA is also following-up regarding passengers who may have been exposed while flying with the case announced on 11 February 2013 and are in contact with the airline concerned.

ECDC continues to closely monitor this event.