Novel coronavirus infections epidemiology & preparedness

1. Novel Coronavirus Infections
- Epidemiology & Preparedness
Macao Association of Health Policy
Dr. Tong Ka Io

2. 重要聲明
1. 作者以公共衛生專業人士個人身份發表本簡報，
並不代表澳門特別行政區政府衛生局或其他官方
機構。
2. 簡報內描述和分析乃基於已公開的資料，如有不
確，敬祈指正。
3. 簡報僅供專業人士和公眾參考和討論，傳媒請勿
引用。

3. Outline
 Clinical and epidemiological evidences
 Analysis and risk assessment
 WHO recommendations
 Local preparedness

4. Clinical and epidemiological evidences

5. Line list 15 cases from Apr/12 to Feb/13
No. Date of onset Age Sex Probable place of infection Outcome cluster
1 2012.04.?? 40 F Jordan Dead
Hospital A
2 2012.04.?? 25 M Jordan Dead
3 2012.06.06 60 M Saudi Arabia Dead
4 2012.09.03 49 M Qatar/Saudi Arabia Alive
5 2012.10.10 45 M Saudi Arabia Alive
6 2012.10.12 45 M Qatar Alive
7 2012.10.14* 70 M Saudi Arabia Dead
8 2012.10.28 39 M Saudi Arabia Dead Family A
9 2012.11.04 31 M Saudi Arabia Alive
10 2013.01.24 61 F Saudi Arabia Dead
11 2013.01.26 60 M Saudi Arabia/Pakistan Alive
12 2013.02.05 ?? F United Kingdom Alive Family B
13 2013.02.06 ?? M United Kingdom Dead
14 2013.02.05 69 M Saudi Arabia Dead
15 2013.02.24 39 M Saudi Arabia Dead
* Date of hospitalization

6. 2012 Apr – Zarqa, Jordan – Hospital cluster
On 19 Apr 2012, Jordan
MOH reported an outbreak
of pneumonia in the Zarqa
Public Hospital’s ICU. 7
nurses, 1 doctor and 1
brother of a nurse were
among the 11 affected. 1 of
the nurses died.
In Nov 2012, testing of
stored samples from two
died patients of this cluster
confirmed novel coronavirus
infection, and a number of
HCWs with pneumonia
associated with the cases
were considered probable
cases. Index case among
this cluster cannot be
determined. No history of
travel or contact with
animals.

7. 2012 Jun – Jeddah, Saudi Arabia – Sporadic case
60y male, occupation
unknown, no travel
history, “limited exposure
to animals prior to onset”,
onset on 06.06,
hospitalized on 06.13,
died on 06.20.

8. 2012 Sep – Doha, Qatar – Sporadic case
49y male, occupation
unknown, travel history to
Saudi Arabia, “limited
exposure to animals prior
to onset”, onset on
2012.09.03, hospitalized
on 09.07.

9. 2012 Oct~Nov – Qatar & SA
– Sporadic cases & family cluster
SA case: 45y male.
Qatar case: 45y male.
SA household cluster:
 Father: 70y, many
comorbidities, hospitalized
on 2012.10.14, died on
10.24.
 Son A: 39y, onset on
10.28, died four days later.
 Son B: 31y, similar
illness, test positive,
discharged on 11.20.
 Grandson: similar illness,
test negative, discharged on
11.20.

10. 2013 Jan~Feb – SA – Sporadic cases
61y female, onset on
2013.01.24, died on
02.10, travel history to
Egypt (2013.01.10-18).
69y male, onset on
2013.02.05, died on
02.19, no contact or
travel history.
39y male, onset on
2013.02.24, died on
03.02.

11. 2013 Jan~Feb – SA→UK – Family cluster
Index case: 60y male, travel to
Pakistan (2012.12.16~2013.01.20)
and Saudi Arabia (01.20~01.28),
onset on 01.26, hospitalized on
01.31, co-infected with influenza
A(H1N1).
Adult female member of extended
family, limited exposure to the
index case on three occasions in
hospital (possibility of an
intermediary case), onset on
02.05, mild influenza-like illness.
Adult male household member, in
sustained close contact with the
index case at home, pre-existing
medical conditions, onset on 02.06,
died on 02.17.
Saudi Arabia

12. Clinical picture
 Common symptoms: fever, cough, shortness of
breath, and breathing difficulties
 Milder ILI may present
 Radiological features: pulmonary parenchymal
disease (pneumonia or ARDS)
 Complications: renal failure, pericarditis, heart
failure, DIC, multiple organ failure
 Deaths:
 Fatality rate = 9/15 = 60%
 4~14d after onset, 2~10d after hospitalization

13. The virus

15. Analysis and risk assessment

16. Temporal distribution

17. Spatial distribution
Jordan → Saudi Arabia → Qatar
→ United Kingdom
 Existence in other parts of the world
cannot be excluded

18. Interpersonal distribution
 All confirmed cases are adults (25y~70y)
 At least 1 child was involved in SA’s
household cluster, with similar but milder
illness and negative test
 Male : Female = 12:3
 Occupation of most cases unknown
 A number of HCWs (at least 7 nurses and 1
doctor) were involved in Jordan’s hospital
cluster, with at least 1 nurse died

19. Source of infection
 Undetermined
 Animals?
 Symptomatic patients probably
 Asymptomatic carriers?

20. Route of transmission
 Undetermined
 Droplet and direct contact probably

21. Susceptibility
 Undetermined
 Presumably universal
 Presumable vulnerability in elder
people with pre-existing medical
conditions
 Lower risk for children and women?

22. Human-to-human transmission
 Most family members and HCWs closely
exposed to confirmed and probable cases did
not develop disease
 Probably occurred in the 3 clusters
 Settings: hospital, household
 Index case may not be apparent
 Route of exposure not clear
 Observed case interval 5~14 days
 Secondary transmission not excluded
 Intermediary case is possible
 Existence and role of latent infection or milder cases
not clear

23. Resume of evidences
Suggestive Undetermined
 The virus is persistent  Spatial spread
 Limited transmissibility  Epidemic center
up to the moment  Source of infection
 Route of exposure
 Biological, behavioral,
and occupational risk
factors
 Possibility of evolution

24. Risk assessment
Conditions up to the moment
 The risk for any person to be infected is extremely
low
 The risk for any person travelling to affected areas to
be infected is very low
 The risk of human-to-human transmission for any
infected patient is low
The risk of the virus to evolve to be more
transmissible is undetermined, and actually no
intervention is taken to reduce this risk

25. WHO recommendations

26. Surveillance
 Surveillance for severe acute respiratory
infections (SARI) and careful review of
any unusual patterns
 Patients with unexplained pneumonia
 Patients with unexplained, severe,
progressive or complicated respiratory
illness not responding to treatment
 Persons travelling from or resident in areas
known to be affected
 Clusters of SARI
 SARI in health care workers

27. Travel measures
 WHO does not advise special
screening at points of entry nor any
travel or trade restrictions

28. Case definition
 Confirmed case
 A person with laboratory confirmation of infection
with the novel coronavirus
 Probable case
 A person with an acute respiratory infection with
clinical, radiological, or histopathological evidence of
pulmonary parenchymal disease (pneumonia or
ARDS); AND
 No possibility of laboratory confirmation for novel
coronavirus either because the patient or samples are
not available for testing; AND
 Close contact with a laboratory confirmed case

29. Case management
 Droplet precautions should be added to
standard precautions for any patient
known or suspected to have infection
with novel coronavirus
 Airborne precautions should be used for
aerosol-generating procedures

30. Local preparedness

31. Strategies
Core Complementary
 Case finding  Infection
prevention and
 Isolation control in health
care, nurseries
and schools
 Public education
and risk
communication