Rapid risk assessment, update: Severe respiratory disease associated with a novel coronavirus

Risk assessment

Since June 2012 and up to 25 November 2012, a total of six confirmed cases of infection with the novel coronavirus (of whom two died) have been reported to WHO. All cases share a history of residence in, or travel to, the Kingdom of Saudi Arabia (KSA) or Qatar. The source and possible routes of transmission of the virus remain unknown.
ECDC updated risk assessment concludes that in the absence of evidence of sustained person-to-person transmission outside of household settings, the current facts still point towards a hypothesis of a zoonotic or environmental source with occasional transmission to exposed humans. WHO does not advise any travel or trade restrictions at this point for KSA or Qatar.

Executive summary

Today, ECDC publishes an update of its risk assessment on the novel coronavirus that has been identified earlier this year. Six cases have been confirmed as of 25 November 2012. All six confirmed cases visited, or resided in, Saudi Arabia or Qatar when falling ill, between June and November 2012. Two of the cases were treated in the United Kingdom and Germany after medical evacuation, but so far, despite intensive surveillance, there are no indications of transmission of the virus within the EU.

The source and possible routes of transmission of the virus remain unknown. Investigations have yet to identify the source or route of infection and infectiousness. At this stage, the detection of a household cluster does not provide conclusive evidence for or against limited person-to-person transmission. It is possible that enhanced surveillance in the Kingdom of Saudi Arabia, Qatar and elsewhere will detect additional sporadic cases and clusters.

Healthcare workers should be made aware of the possibility of attending to patients matching the characteristics of patients requiring investigation as per WHO case-definition; however, the geographical area should be extended from Kingdom of Saudi Arabia and Qatar to include the whole of the Middle East. Healthcare workers caring for patients under investigation should exercise stringent infection control measures following national or international guidance. Testing for the novel coronaviruses should be considered in patients potentially undergoing medical evacuation for acute respiratory distress syndrome (ARDS) prior to their transfer. Healthcare workers caring for confirmed cases and close contacts of confirmed cases should be monitored for symptoms.

Patients returning from the Middle East with unexplained pneumonia or ARDS, i.e. where full diagnostic workup for respiratory pathogens (bacterial and viral) is negative, should be considered for investigation and tested for novel coronavirus by EU national reference and research laboratories capable of such testing.