Thursday, November 29, 2012

Interim surveillance recommendations for human infection with novel coronavirus

(28 November 2012)
Based on additional information reported since the original surveillance recommendations, WHO is
updating its previously  published guidance. WHO will continue to update these recommendations as more information becomes available.
As of 28 November 2012, seven confirmed and one probable case of novel coronavirus infection 
in humans are known to have occurred. These cases range in time from June through November 2012 and 
occurred in the areas around Jeddah and Riyadh of Saudi Arabia (which are about 850 km apart), and in 
Doha, Qatar. Infection with the virus appears to have been acquired locally in each of these situations. All 
of the patients were male but the significance of this is unknown. 

The clinical picture in all cases was an acute respiratory infection presenting with signs and
symptoms of pneumonia. Four patients developed acute renal failure; one of these died. The remaining
three patients had pneumonia that required intensive support, without renal failure, and recovered. Three
confirmed cases and the one probable case all belong to the same family and were living in the same
The source of the virus is unknown, as is the mode of transmission. Available genetic sequence 
data indicate that the virus is most closely related to a coronavirus found in bats; however, this does not 
conclusively support bats as a reservoir for the virus. Early investigations do not support direct exposure 
to bats as a mode of transmission. 
The newly reported cases demonstrate that the virus has persisted over a period of at least 5 
months and is geographically distributed over a wider area than was evidenced by the first two cases. 
Given that the exact extent of the distribution is unknown, WHO is taking the precaution of 
recommending an expansion of surveillance to monitor for the appearance of the virus in other countries.

The following should be carefully investigated and tested for novel coronavirus:
1. Patients under investigation
A person with an acute respiratory infection, which may include history of fever or measured 
fever (≥ 38°C , 100.4°F) and cough
Suspicion of pulmonary parenchymal disease (e.g. pneumonia or Acute Respiratory Distress 
Syndrome (ARDS)), based on clinical or radiological evidence of consolidation. 
ANDResidence in or history of travel to the Arabian Peninsula or neighboring countries within 10 
days before onset of illness. 
Not already explained by any other infection or aetiology
, including all clinically indicated tests
for community-acquired pneumonia according to local management guidelines. It is not necessary
to wait for all test results for other pathogens before testing for novel coronavirus.
2. Ill contacts
Individuals with acute respiratory illness of any degree of severity who, within 10 days before 
onset of illness, were in close physical contact
with a confirmed or probable case of novel
coronavirus infection, while the case was ill.
Any person who has had close contact with a probable or confirmed case while the probable or 
confirmed case was ill should be carefully monitored for the appearance of respiratory symptoms. 
If symptoms develop with the first 10 days after contact, the individual should be considered a 
“patient under investigation”, regardless of the severity of illness, and investigated accordingly.

3. Clusters
Any cluster
of severe acute respiratory infection (SARI)

, particularly clusters of patients
requiring intensive care, without regard to place of residence or a history of travel
Not already explained by any other infection or aetiology, including all clinically indicated tests 
for community-acquired pneumonia according to local management guidelines.

4. Health care workers:
Health care workers who care for patients with severe acute respiratory infections, particularly 
patients requiring intensive care,