Announcement

Collapse
No announcement yet.

Outbreak of Pneumonia of Unknown Etiology (PUE) in Wuhan, China (CDC HAN, Updated January 17, 2020)

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • Outbreak of Pneumonia of Unknown Etiology (PUE) in Wuhan, China (CDC HAN, Updated January 17, 2020)

    This is January 8 version. Scroll down to see latest version published on January 17.



    Outbreak of Pneumonia of Unknown Etiology (PUE) in Wuhan, China



    Health Alert Network logo.





    Distributed via the CDC Health Alert Network
    January 8, 2020, 1615 ET (04:15 PM ET)
    CDCHAN-00424

    Summary
    The Centers for Disease Control and Prevention (CDC) is closely monitoring a reported cluster of pneumonia of unknown etiology (PUE) with possible epidemiologic links to a large wholesale fish and live animal market in Wuhan City, Hubei Province, China. An outbreak investigation by local officials is ongoing in China; the World Health Organization (WHO) is the lead international public health agency. Currently, there are no known U.S. cases nor have cases been reported in countries other than China. CDC has established an Incident Management Structure to optimize domestic and international coordination if additional public health actions are required.

    This HAN Advisory informs state and local health departments and health care providers about this outbreak and requests that health care providers ask patients with severe respiratory disease about travel history to Wuhan City. Wuhan City is a major transportation hub about 700 miles south of Beijing with a population of more than 11 million people.

    Background
    According to a report from the Wuhan Municipal Health Commission, as of January 5, 2020, the national authorities in China have reported 59 patients with PUE to WHO. The patients had symptom onset dates from December 12 through December 29, 2019. Patients involved in the cluster reportedly have had fever, dyspnea, and bilateral lung infiltrates on chest radiograph. Of the 59 cases, seven are critically ill, and the remaining patients are in stable condition. No deaths have been reported and no health care providers have been reported to be ill. The Wuhan Municipal Health Commission has not reported human-to-human transmission.

    Reports indicate that some of the patients were vendors at the Wuhan South China Seafood City (South China Seafood Wholesale Market) where, in addition to seafood, chickens, bats, marmots, and other wild animals are sold, suggesting a possible zoonotic origin to the outbreak. The market has been closed for cleaning and disinfection. Local authorities have reported negative laboratory test results for seasonal influenza, avian influenza, adenovirus, severe acute respiratory syndrome-associated coronavirus (SARS-CoV), and Middle East respiratory syndrome coronavirus (MERS-CoV) among patients associated with this cluster. Additional laboratory testing is ongoing to determine the source of the outbreak. Health authorities are monitoring more than 150 contacts of patients for illness.

    CDC has issued a level 1 travel notice (“practice usual precautions”) for this destination. (https://wwwnc.cdc.gov/travel/notices...neumonia-china). On January 5, 2020, WHO posted an update on this situation, including an early risk assessment, which is available at: https://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en/external icon.

    Recommendations for Health Care Providers
    1. Providers should consider pneumonia related to the cluster for patients with severe respiratory symptoms who traveled to Wuhan since December 1, 2019 and had onset of illness within two weeks of returning, and who do not have another known diagnosis that would explain their illness. Providers should notify infection control personnel and local and state health departments immediately if any patients meet these criteria. State health departments should notify CDC after identifying a case under investigation by calling CDC’s Emergency Operations Center at (770) 488-7100.
    2. Multiple respiratory tract specimens should be collected from persons with infections suspected to be associated with this cluster, including nasopharyngeal, nasal, and throat swabs. Patients with severe respiratory disease also should have lower respiratory tract specimens collected, if possible. Consider saving urine, stool, serum, and respiratory pathology specimens if available.
    3. Although the etiology and transmissibility have yet to be determined, and to date, no human-to-human transmission has been reported and no health care providers have been reported ill, CDC currently recommends a cautious approach to symptomatic patients with a history of travel to Wuhan City. Such patients should be asked to wear a surgical mask as soon as they are identified and be evaluated in a private room with the door closed. Personnel entering the room to evaluate the patient should use contact precautions and wear an N95 disposable facepiece respirator. For patients admitted for inpatient care, contact and airborne isolation precautions, in addition to standard precautions, are recommended until further information becomes available. For additional information see: https://www.cdc.gov/infectioncontrol...ion/index.html.

    This guidance will be updated as more information becomes available.

    For More Information
    1-800-CDC-INFO
    https://www.cdc.gov/cdc-info/index.html
    CDC’s Emergency Operations Center: 770-488-7100

    The Centers for Disease Control and Prevention (CDC) protects people’s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national and international organizations. DEPARTMENT OF HEALTH AND HUMAN SERVICES

    HAN Message Types
    • Health Alert: Conveys the highest level of importance; warrants immediate action or attention.
    • Health Advisory: Provides important information for a specific incident or situation; may not require immediate action.
    • Health Update: Provides updated information regarding an incident or situation; unlikely to require immediate action.
    • Info Service: Provides general information that is not necessarily considered to be of an emergent nature.

    ###
    This message was distributed to state and local health officers, state and local epidemiologists, state and local laboratory directors, public information officers, HAN coordinators, and clinician organizations.
    ###

    https://emergency.cdc.gov/han/HAN00424.asp
    Last edited by sharon sanders; January 18th, 2020, 01:42 PM. Reason: added top sentence
    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela

  • #2
    Update and Interim Guidance on Outbreak of 2019 Novel Coronavirus (2019-nCoV) in Wuhan, China

    Health Alert Network logo.





    Distributed via the CDC Health Alert Network
    January 17, 2020, 2030 ET (8:30 PM ET)
    CDCHAN-00426

    Summary
    The Centers for Disease Control and Prevention (CDC) continues to closely monitor an outbreak of a 2019 novel coronavirus (2019-nCoV) in Wuhan City, Hubei Province, China that began in December 2019. CDC has established an Incident Management System to coordinate a domestic and international public health response.

    Coronaviruses are a large family of viruses. Some cause illness in people; numerous other coronaviruses circulate among animals, including camels, cats, and bats. Rarely, animal coronaviruses can evolve and infect people and then spread between people such as has been seen with Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) (https://www.cdc.gov/coronavirus/mers/index.html) and Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) (https://www.cdc.gov/sars/index.html).

    Chinese authorities report most patients in the Wuhan City outbreak have been epidemiologically linked to a large seafood and animal market, suggesting a possible zoonotic origin to the outbreak. Chinese authorities additionally report that they are monitoring several hundred healthcare workers who are caring for outbreak patients; no spread of this virus from patients to healthcare personnel has been reported to date. Chinese authorities are reporting no ongoing spread of this virus in the community, but they cannot rule out that some limited person-to-person spread may be occurring. China has reported that two of the patients have died, including one with pre-existing medical conditions. Chinese health officials publicly posted the genetic sequence of the 2019-nCoV on January 12, 2020. This will facilitate identification of infections with this virus and development of specific diagnostic tests.

    Thailand and Japan have confirmed additional cases of 2019-nCoV in travelers from Wuhan, China. It is possible that more cases will be identified in the coming days. This is an ongoing investigation and given previous experience with MERS-CoV and SARS-CoV, it is possible that person-person spread may occur. There is much more to learn about the transmissibility, severity, and other features associated with 2019-nCoV as the investigations in China, Thailand, and Japan continue. Additional information about this novel virus is needed to better inform population risk.

    This HAN Update provides a situational update and guidance to state and local health departments and healthcare providers that supersedes guidance in CDC’s HAN Advisory 424 distributed on January 8, 2020. This HAN Update adds guidance for evaluation of patients under investigation (PUI) for 2019-nCoV, prevention and infection control guidance, including the addition of an eye protection recommendation, and additional information on specimen collection.

    Background
    An outbreak of pneumonia of unknown etiology in Wuhan City was initially reported to WHO on December 31, 2019. Chinese health authorities have confirmed more than 40 infections with a novel coronavirus as the cause of the outbreak. Reportedly, most patients had epidemiological links to a large seafood and animal market. The market was closed on January 1, 2020. Currently, Chinese health authorities report no community spread of this virus, and no transmission among healthcare personnel caring for outbreak patients. No additional cases of infection with 2019-nCoV have been identified in China since January 3, 2020.

    On January 13, 2020 public health officials in Thailand confirmed detection of a human infection with 2019-nCoV in a traveler from Wuhan, China. This was the first confirmed case of 2019-nCoV documented outside China. On January 17, 2020 a second case was confirmed in Thailand, also in a returned traveler from Wuhan City. On January 15, 2020 health officials in Japan confirmed 2019-nCoV infection in a returned traveler from Wuhan City. These persons had onset dates after January 3, 2020. These cases did not report visiting the large seafood and animal market to which many cases in China have been linked.

    On January 11, 2020, CDC updated the level 1 travel health notice (“practice usual precautions”) for Wuhan City, Hubei Province, China with additional information (originally issued on January 6, 2020): https://wwwnc.cdc.gov/travel/notices...onavirus-china.

    Recommendations for Healthcare Providers
    Limited information is available to characterize the spectrum of clinical illness associated with 2019-nCoV. No vaccine or specific treatment for 2019-nCoV infection is available; care is supportive.

    The CDC clinical criteria for a 2019-nCoV patient under investigation (PUI) have been developed based on what is known about MERS-CoV and SARS-CoV and are subject to change as additional information becomes available.

    Healthcare providers should obtain a detailed travel history for patients being evaluated with fever and acute respiratory illness. CDC guidance for evaluating and reporting a PUI for MERS-CoV remains unchanged.

    Criteria to Guide Evaluation of Patients Under Investigation (PUI) for 2019-nCoV
    Patients in the United States who meet the following criteria should be evaluated as a PUI in association with the outbreak of 2019-nCoV in Wuhan City, China.
    1) Fever1 AND symptoms of lower respiratory illness (e.g., cough, shortness of breath)
    –and in the last 14 days before symptom onset,
    • History of travel from Wuhan City, China
      -or-
    • Close contact2 with a person who is under investigation for 2019-nCOV while that person was ill.

    2) Fever1 OR symptoms of lower respiratory illness (e.g., cough, shortness of breath)
    –and in the last 14 days before symptom onset,
    • Close contact2 with an ill laboratory-confirmed 2019-nCoV patient.
    The above criteria are also available at https://www.cdc.gov/coronavirus/2019...-criteria.html. The criteria are intended to serve as guidance for evaluation. Patients should be evaluated and discussed with public health departments on a case-by-case basis if their clinical presentation or exposure history is equivocal (e.g., uncertain travel or exposure).

    Recommendations for Reporting, Testing, and Specimen Collection
    Healthcare providers should immediately notify both infection control personnel at their healthcare facility and their local or state health department in the event of a PUI for 2019-nCoV. State health departments that have identified a PUI should immediately contact CDC’s Emergency Operations Center (EOC) at 770-488-7100 and complete a 2019-nCoV PUI case investigation form available at https://www.cdc.gov/coronavirus/2019-ncov/downloads/pui-form.pdfpdf icon. CDC’s EOC will assist local/state health departments to collect, store, and ship specimens appropriately to CDC, including during afterhours or on weekends/holidays. At this time, diagnostic testing for 2019-nCoV can be conducted only at CDC. Testing for other respiratory pathogens should not delay specimen shipping to CDC. If a PUI tests positive for another respiratory pathogen, after clinical evaluation and consultation with public health authorities, they may no longer be considered a PUI. This may evolve as more information becomes available on possible 2019 nCoV co-infections.

    For biosafety reasons, it is not recommended to perform virus isolation in cell culture or initial characterization of viral agents recovered in cultures of specimens from a PUI for 2019-nCoV. To increase the likelihood of detecting 2019-nCoV infection, CDC recommends collecting and testing multiple clinical specimens from different sites, including all three specimen types—lower respiratory, upper respiratory, and serum specimens. Additional specimen types (e.g., stool, urine) may be collected and stored. Specimens should be collected as soon as possible once a PUI is identified regardless of time of symptom onset. Additional guidance for collection, handling, and testing of clinical specimens is available at https://www.cdc.gov/coronavirus/2019-nCoV/.

    Interim Healthcare Infection Prevention and Control Recommendations for Patients Under Investigation for 2019-nCoV
    Although the transmission dynamics have yet to be determined, CDC currently recommends a cautious approach to patients under investigation for 2019-nCoV (https://www.cdc.gov/coronavirus/2019...-criteria.html). Such patients should be asked to wear a surgical mask as soon as they are identified and be evaluated in a private room with the door closed, ideally an airborne infection isolation room if available. Healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and use eye protection (e.g., goggles or a face shield). Immediately notify your healthcare facility’s infection control personnel and local health department.

    Additional Infection Control Practices Resources
    Notes
    1Fever may not be present in some patients, such as those who are very young, elderly, immunosuppressed, or taking certain fever-lowering medications. Clinical judgment should be used to guide testing of patients in such situations.
    2Close contact with a person who is under investigation for 2019-nCOV.
    Close contact is defined as—
    a) being within approximately 6 feet (2 meters), or within the room or care area, of a novel coronavirus case for a prolonged period of time while not wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection); close contact can include caring for, living with, visiting, or sharing a healthcare waiting area or room with a novel coronavirus case.
    – or –
    b) having direct contact with infectious secretions of a novel coronavirus case (e.g., being coughed on) while not wearing recommended personal protective equipment.
    See CDC’s Interim Healthcare Infection Prevention and Control Recommendations for Patients Under Investigation for 2019 Novel Coronavirus (https://www.cdc.gov/coronavirus/2019...n-control.html).

    Data to inform the definition of close contact are limited. Considerations when assessing close contact include the duration of exposure (e.g., longer exposure time likely increases exposure risk) and the clinical symptoms of the person with novel coronavirus (e.g., coughing likely increases exposure risk as does exposure to a severely ill patient). Special consideration should be given to those exposed in healthcare settings.

    For More Information
    More information is available at at https://www.cdc.gov/coronavirus/2019-nCoV/index.html or by calling 800-CDC-INFO | (800-232-4636) | TTY: (888) 232-6348

    The Centers for Disease Control and Prevention (CDC) protects people’s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national and international organizations. DEPARTMENT OF HEALTH AND HUMAN SERVICES

    HAN Message Types

    • Health Alert: Conveys the highest level of importance; warrants immediate action or attention.
    • Health Advisory: Provides important information for a specific incident or situation; may not require immediate action.
    • Health Update: Provides updated information regarding an incident or situation; unlikely to require immediate action.
    • Info Service: Provides general information that is not necessarily considered to be of an emergent nature.

    ###
    This message was distributed to state and local health officers, state and local epidemiologists, state and local laboratory directors, public information officers, HAN coordinators, and clinician organizations.
    ###

    https://emergency.cdc.gov/han/han00426.asp
    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela

    Comment

    Working...
    X