UK - HPA says NOT fourth case in coronavirus family cluster

[Treyfish]

Helen Branswell, The Canadian Press February 21, 2013 4:00 am
TORONTO – The current cluster of novel coronavirus cases in Britain may have included another infection, a World Health Organization official says.

To date, three members of an extended family have tested positive for the new virus, which is a cousin of the SARS coronavirus. One of the three died earlier this week.

But officials investigating how the virus moved from one member of the family to the next suspect another relative may have contracted the virus and may even have spread it to the third confirmed case in the cluster. This fourth family member had a respiratory illness but was not tested until after she recovered, at which point the test came back negative.

Dr. Anthony Mounts, the WHO’s point person for the new coronavirus outbreak, says the U.K. cluster adds slightly to the WHO’s concern over the virus, but in the main serves to confirm some things the organization has already strongly suspected.

Those are: In some circumstances, person-to-person spread can occur, though so far, it appears those chains of infection has been short. And while the first few cases spotted all involved severe illness, some infections can produce mild symptoms only....

http://www.news1130.com/2013/02/21/there-may-have-been-a-fourth-case-in-uk-coronavirus-family-cluster-who/

[Giuseppe]

Re: There may have been a fourth case in UK coronavirus family cluster: WHO

Source: ProMedMail.org, http://www.promedmail.org/direct.php...130222.1555507 - Edited.


Published Date: 2013-02-22 16:33:52
Subject: PRO/AH/EDR> Novel coronavirus - Eastern Med. (08): UK, 4th case, NOT
Archive Number: 20130222.1555507

NOVEL CORONAVIRUS - EASTERN MEDITERRANEAN (08): UNITED KINGDOM, 4TH CASE, NOT
************************************************** **************************
A ProMED-mail post http://www.promedmail.org
ProMED-mail is a program of the International Society for Infectious Diseases http://www.isid.org

Date: Fri 22 Feb 2013 - From: Nick Phin nick.phin@hpa.org.uk

Subject: Correction to ProMED-mail statement [in Novel coronavirus - East. Med. (07): Saudi Arabia, UK, Germany 20130221.155410

Re: UK - 4th case in cluster suspected
Date: Thu 21 Feb 2013
Source: The Canadian Press via The Province [edited]
http://www.theprovince.com/health/Th...904/story.html

There may have been a 4th case in UK coronavirus family cluster: WHO

In relation to the above post, we would like to confirm that the HPA is not currently investigating any 4th possible case associated with the UK cluster of novel coronavirus.

The latest clinical update from the HPA was published on Tuesday [19 Feb 2013] http://www.hpa.org.uk/hpr/infections/respiratory.htm and the whole genome sequence of the 2nd UK case of coronavirus was published on Thursday [21 Feb 2013]http://www.hpa.org.uk/Topics/Infecti...elcoronavirus/

--
Yours faithfully,
Professor Nick Phin
Consultant Epidemiologist
Preparedness and Response Section
Respiratory Diseases Department
Health Protection Agency
London, UK
<nick.phin@hpa.org.uk>

[ProMED-mail would like to thank Professor Nick Phin for this clarification as well as for providing URL links to the most recent information on this outbreak and viral genome sequence.

Of note, the interpretation of the sequencing of the whole genome of the novel coronavirus identified in the above cluster, referred to as England 2 CoV is stated at the above provided link: "Phylogenetic Analysis indicated that England 2 CoV clustered with England1 CoV and the virus identified in the Netherlands (EMC 2012, JX869059). The level of similarity within this cluster of novel coronaviruses was greater than 99.6 percent."

The HPA most recent report is included below:

"Novel coronavirus 2012 in the UK: situation at 19 Feb 2013
Since the 1st identification of a novel coronavirus in September 2012 [1], 4 confirmed cases had been identified in the United Kingdom (UK) by the Health Protection Agency (HPA) by [19 Feb 2013]: 2 imported cases and 2 indigenously acquired cases linked to the 2nd imported case.

"The 1st case of novel coronavirus identified in the UK was in a foreign national transferred to London for the treatment of a serious, unexplained respiratory illness in September 2012 [2]. Coronavirus testing was undertaken following the announcement that a new coronavirus had been discovered in a Saudi Arabian national with a similar illness. The patient was very unwell, requiring intensive care and extra corporeal membrane oxygenation (ECMO), and remains very unwell. Extensive follow up of all close contacts (household and health care) by the HPA identified a number of persons with mild respiratory illness in the 10 days following exposure but none of these contacts had novel coronavirus infection detected on respiratory sampling or serology [3].

"On [11 Feb 2013], the HPA published details of an adult UK resident (the index case), with confirmed novel coronavirus infection and influenza A infection, who had travelled to Pakistan and Saudi Arabia in the 10 days before illness onset. This individual had developed respiratory symptoms on [24 Jan 2013], prior to returning to the UK on [28 Jan 2013]. While staying with family at home in the UK, this individual's condition deteriorated and they were admitted to hospital in Birmingham, before being transferred to Manchester, where they remain in intensive care, with ECMO.

"On [6 Feb 2013], an adult household member of the case who had not recently travelled abroad -- but who had been in sustained close contact with the index case from their arrival in the UK until hospital admission -- became unwell with a febrile respiratory illness. This 3rd case, on admission to hospital in Birmingham, was confirmed to have novel coronavirus infection. Their condition worsened -- requiring intensive care and ECMO -- before the patient died on [17 Feb 2013]. This patient had an existing medical condition that may have made them more susceptible to a respiratory infection.

"On [5 Feb 2013], an adult member of the same extended family of the 2 confirmed cases -- who had not travelled abroad -- developed an influenza-like illness. The illness remained mild, not requiring hospital admission, and there has been a full recovery. A sputum sample from this case was later confirmed to contain novel coronavirus. This case had limited exposure to the index case on 3 occasions while the latter was in hospital, and had no contact with the 2nd case.

"Infection control measures around the 3 recent cases have followed UK national guidance [4] and contact tracing and follow-up is continuing for those persons who may have been in close contact with any of the 3 cases.

"Contacts in 3 main settings are being followed up:

- Aircraft: the aircraft passengers in the same row and the 2 rows in front and behind the case on a flight from Saudi Arabia to London when the 1st case had been unwell;

- Household: the family and friend household contacts of all 3 cases;

- Health care: the health care workers, patients and family and friends who were in contact with the cases in a health care setting.

- Follow-up of contacts of the 3 confirmed cases had not detected any further probable or confirmed secondary cases by [18 Feb 2013].

"The routes of transmission to humans of the novel coronavirus have not yet been fully determined, but the recent UK experience provides strong evidence of human-to-human transmission in at least some circumstances.

The limited contact that one of the cases had with the index case, however, leaves open the possibility of an intermediary case within the extended family.

"The 3 recent cases in the UK represent an important opportunity to obtain more information about the characteristics of this infection in humans and risk factors for its acquisition, particularly in the light of the first ever recorded instance of apparently lower severity of illness in one of the cases, and the occurrence of dual infection in the index case.


References

1. Corman VM, et al. Detection of a novel human coronavirus by real-time reverse-transcription polymerase chain reaction. Euro Surveill. 2012 Sep 27; 17(39). pii: 20285. http://www.eurosurveillance.org/View...rticleId=20285.

2. Bermingham A, et al. Severe respiratory illness caused by a novel coronavirus, in a patient transferred to the United Kingdom from the Middle East, September 2012. Euro Surveill. 2012 Oct 4; 17(40): 20290. http://www.eurosurveillance.org/View...rticleId=20290.

3. Pebody RG, et al. The United Kingdom public health response to an imported laboratory confirmed case of a novel coronavirus in September 2012. Euro Surveill. 2012 Oct 4; 17(40): 20292. http://www.eurosurveillance.org/View...rticleId=20292.

4. Health Protection Agency. Infection Control Advice - Novel coronavirus cases Version 1.3, HPA, 4 October 2012 http://www.hpa.org.uk/webc/HPAwebFil.../1317136232722.

For the interactive HealthMap/ProMED map of the UK, see http://healthmap.org/r/1lNY. - Mod.MPP]

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