4. 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
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 2013.01.24 60 M Saudi Arabia/Pakistan Alive
Family B12 2013.02.05 ?? F United Kingdom Alive
13 2013.02.06 39 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
130. 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
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 2013.01.24 60 M Saudi Arabia/Pakistan Alive
Family B12 2013.02.05 ?? F United Kingdom Alive
13 2013.02.06 39 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
131. 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.
132. 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.
133. 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.
134. 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.
135. 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.
136. 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, in
Mecca and Medina on pilgrimage),
onset on 01.24, 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
137. 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
141. Spatial distribution
Jordan → Saudi Arabia → Qatar
→ United Kingdom
Existence in other parts of the world
cannot be excluded
142. 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
145. Susceptibility
Undetermined
Presumably universal
Presumable vulnerability in elder
people and people with pre-existing
medical conditions
Higher risk for rich people?
Lower risk for children and women?
146. 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 exposure-onset interval 4~14 days
Secondary transmission not excluded
Intermediary case is possible
Existence and role of latent infection or milder cases
not clear
147. Resume of evidences
Suggestive
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
148. 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
152. Strategies
Core
Case finding
Isolation
Complementary
Infection
prevention and
control in health
care, nurseries
and schools
Public education
and risk
communication
153. Phases and major actors
No case Imported case Local case
Coordinating
entity
Coordination,
management,
communication
.... ….
Hospitals and
health centers
Surveillance,
preparedness
+ Cases and
contacts
management
….
Laboratory
Preparedness,
surveillance
+ Cases and
contacts testing
….
CDC
Intelligence,
surveillance,
consultancy
+ Cases and
contacts tracing
+ Community
interventions
154. 154
First Meeting of the Asia Pacific Technical Advisory Group on the Asia Pacific Strategy for Emerging Diseases (2010)
26-28 July, Manila, Philippines
Structure of APSED (2010)
157. Surveillance
Carefully investigate and test for novel
coronavirus
Acute respiratory infection + pneumonia + residence
or history of travel + unexplained by other etiology
Acute respiratory illness + close contact with case
Cluster of severe acute respiratory infection (SARI) +
unexplained by other etiology
Health care workers + pneumonia + unexplained by
other etiology
Unusual pneumonia + unexplained by other etiology
158.
159. 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
160. 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
