Novel Coronavirus Infections Novel Coronavirus Infections - Epidemiology & Preparedness- Epidemiology & Preparedness

Macao Association of Health Policy

Dr. Tong Ka Io

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。

OutlineOutline Clinical and epidemiological evidences

Analysis and risk assessment

WHO recommendations

Local preparedness

Clinical and epidemiological evidencesClinical and epidemiological evidences

Line list 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 DeadHospital 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

Family A8 2012.10.28 39 M Saudi Arabia Dead

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

Family B12 2013.02.05 ?? F United Kingdom Alive

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

2012 Apr – Zarqa, Jordan – Hospital cluster2012 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.

2012 Jun – Jeddah, Saudi Arabia – Sporadic case2012 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.

2012 Sep – Doha, Qatar – Sporadic case2012 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.

2012 Oct~Nov – Qatar & SA 2012 Oct~Nov – Qatar & SA – Sporadic cases & family cluster– 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.

2013 Jan~Feb – SA – Sporadic cases2013 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.

2013 Jan~Feb – SA→UK – Family cluster2013 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

Clinical pictureClinical 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

The virusThe virus

Analysis and risk assessmentAnalysis and risk assessment

Temporal distributionTemporal distribution

Spatial distributionSpatial distributionJordan → Saudi Arabia → Qatar

→ United Kingdom

Existence in other parts of the world cannot be excluded

Interpersonal distributionInterpersonal 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

Source of infectionSource of infection Undetermined

Animals?

Symptomatic patients probably

Asymptomatic carriers?

Route of transmissionRoute of transmission Undetermined

Droplet and direct contact probably

SusceptibilitySusceptibility Undetermined

Presumably universal

Presumable vulnerability in elder people with pre-existing medical conditions

Lower risk for children and women?

Human-to-human transmissionHuman-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

Resume of evidencesResume of evidencesSuggestive The virus is persistent Limited transmissibility

up to the moment

Undetermined Spatial spread Epidemic center Source of infection Route of exposure Biological, behavioral,

and occupational risk factors

Possibility of evolution

Risk assessmentRisk assessmentConditions 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

WHO recommendationsWHO recommendations

SurveillanceSurveillance 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

Travel measuresTravel measures WHO does not advise special

screening at points of entry nor any travel or trade restrictions

Case definitionCase 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

Case managementCase 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

Local preparednessLocal preparedness

StrategiesStrategiesCore

Case finding

Isolation

Complementary

Infection prevention and control in health care, nurseries and schools

Public education and risk communication