- Coronaviruses are important human and animal pathogens that cause respiratory infections. The novel coronavirus (nCoV) was first identified in 2012 in patients from Saudi Arabia and Qatar. - As of May 15, 2013, 40 laboratory-confirmed cases of nCoV infection have been reported to WHO, including 20 deaths. Limited human-to-human transmission is suspected based on clusters in Saudi Arabia and Jordan. - Clinical features of nCoV infection include fever, cough, shortness of breath, and pneumonia. Diagnosis requires real-time reverse-transcriptase polymerase chain reaction testing of respiratory samples. There is no specific treatment, and management involves supportive care.

2. The situation is dynamic and subject
to new discoveries and changes.
Data are up to 15/May/2013.

4.  Coronaviruses are important human and
animal pathogens.
 Up to 1/3 of community acquired upper
respiratory tract infections in adults.
 Play a role in severe respiratory tract
infections in both adults and children.
 They were first identified in the 1960s,
and were named after the crown-like
projections on the surface of the virus.

5.  Members of nidovirus family.
 Replicate using a nested set of mRNAs.
 Human coronaviruses are classified into 2
genera:
oAlpha: HCoV-229E and HCoV-NL63
oBeta: HCoV-HKU1, HCoV-OC43, nCoV, and
the SARS coronavirus

6.  Coronaviruses are medium-
sized, enveloped, positive-stranded RNA
viruses.
 Have the largest known viral RNA
genomes, with a length of 27 to 32 kb.
 The genome encodes four or five
structural proteins, S, M, N, HE, and E.

7.  Replication of viral RNA occurs in the host cytoplasm by
a unique mechanism in which RNA polymerase binds to a
leader sequence and then detaches and reattaches at
multiple locations, allowing for the production of a nested
set of mRNA molecules
Proteins Function
M (Membrane glycoprotein) Budding, envelope formation
S (Spike glycoprotein) R. binding, cell fusion, as Ag
HE (Hemagglutinin-acetylesterase gp) Beta, adsorption to host cell
N (Nucleocapsid phosphoprotein) Ribonucleoprotein
E (envelope) Unknown function

9.  The novel coronavirus (nCoV; also abbreviated as HCoV-
EMC), has been classified through sequencing as a
betacoronavirus.
 Closely related to several bat coronaviruses.
 Dipeptidyl peptidase 4 (DPP4; also known as CD26), which
is present on the surfaces of human non-ciliated bronchial
epithelial cells, is a functional receptor for nCoV.
 nCoV appears to infect several other human cell
lines, including lower (but not upper)
respiratory, kidney, intestinal, and liver cells, as well as
histiocytes.
 nCoV can also infect non-human primate, porcine, bat, and
rabbit cell lines

10. Epidemiology
So far …

11. On 19 Apr 2012, Jordan: 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. In Nov 2012, testing of stored samples from two died
patients of this cluster confirmed novel coronavirus infection

12. 22/Sep/2012: UK: 49 yrs previously healthy Qatari male.
Travel history to KSA

13. 23/Nov/2012: 3 cases in KSA, 2 died, 1 survived, 2 are family members
1 case in Qatar.

14. 28/Nov/2012: 1 case in KSA, died.

15. Oct 2012: KSA: A family member of the 2 earlier cases in Nov.

16. 11/Feb/2013: UK: Critically ill male, with travel history to Pakistan and KSA.
Later he died.

17. 13/Feb/2013: UK: Relative of the patient reported 2 days earlier, no travel
history, no comorbidities.
Later he died.

18. 16/Feb/2013: UK: Relative of the other 2 UK cases.
Mild

19. 21/Feb/2013: KSA: Sporadic case, died.

20. 6/Mar/2013: KSA: Sporadic case, no contact with other reported cases, and
no travel history.
Died.

21. 12/Mar/2013: KSA: Sporadic case, no contact with other reported cases, and
no travel history.
Died.

22. 23/Mar/2013: KSA: Relative of the patient reported on 12/Mar
Mild, Recovered.

23. 26/Mar/2013: Germany: 73 yrs Male, from Abu-Dhabi hospital.

24. 2/May/2013: KSA: 7 cases, no travel history, no animal contact, not relatives
or cluster.

25. 3/May/2013: KSA: 3 cases, same region, 2 are family members, critical
condition.

26. 6/May/2013: KSA: 3 cases, 2 died, 1 in critical condition.

27. 8/May/2013: France: immunocompromised, travel history to Dubai.

28. 9/May/2013: KSA: 2 cases, both with comorbidities, both recovered.
Same cluster

29. 12/May/2013: France: 1 case, shared a room with the other French case

30. 14/May/2013: KSA: 4 cases, all with comorbidities, 1 died, 1 recovered, 2 in
critical condition.

31. 15/May/2013: KSA: 2 cases, a male in critical condition, a female in stable
condition.

32.  From September 2012 to 15/May/2013 WHO has been
informed of 40 laboratory confirmed cases.
 Of whom 20 died.
30

36.  The incubation period is currently considered
to be up to ten days.

37.  The mode of transmission is currently unknown.
Coronaviruses typically spread like other
respiratory infections such as influenza.
 The two clusters in Saudi Arabia and Jordan raise
the possibility of limited human-to-human
transmission, but could also be explained by
exposure to a common source.
 It is possible that some infections occur via
intermittent zoonotic transmission or an
environmental source.

38.  All patients presented generally as pneumonia
with symptoms of fever, cough, shortness of
breath and breathing difficulties.
 Some cases have had acute kidney injury.
 Other clinical manifestations that have been
reported (in one patient each) are pericarditis
and DIC.
 Two cases presented with mild respiratory
illness.

39.  Pulmonary parenchymal disease.
 Evidence of consolidation.
 Localized infiltrates and increased
interstitial markings.

41.  Patient under investigation:

42.  Considered for evaluation:

43.  Probable case:

44.  Confirmed case:

46.  Testing for the novel coronavirus is undertaken only
when there is clinical or epidemiological evidence
that nCOV may be the cause in an individual or
cluster of patients.
 To avoid the inappropriate use of scarce resources,
the generation of false positives and the risk of
overwhelming the health system by unnecessary
activation of hospital-based and public health
response teams.

47. 

48.  Routine confirmation of of nCOV will be based on
detection of unique sequences of viral RNA by real-
time reverse-transcriptase polymerase chain reaction
(RT-PCR) and sequencing.
 Laboratories with the appropriate experience and
containment facilities, may attempt to isolate the
virus in cell culture, not routine.

49.  A number of RT-PCR assays that are specific for nCOV have
been developed and published. Currently described tests include:
o Upstream of the E protein gene (upE)
o open reading frame 1b (ORF 1b) gene
o open reading frame 1a (ORF 1a) gene.
 The assay for the upE target is considered highly sensitive, with
the ORF 1a assay considered of equal sensitivity.
 The ORF 1b assay is considered less sensitive than the ORF 1a
assay but may be more specific.
 Other target sites on the nCOV genome suitable for sequencing
to aid confirmation: RNA-dependent RNA polymerase (RdRp)
and nucleocapsid (N) protein genes.

52.  As with other CoVs, no antiviral agents are recommended for the
treatment of nCoV infection.
 The WHO has issued recommendations for the management of
severe respiratory infections suspected to be caused by nCoV.

53.  Patient under investigation for nCOV.
 Severe pneumonia, ARDS.
 Sepsis, septic shock.
 Initiate infection prevention and control measures.
 Collect specimens for laboratory testing.
 Empiric antimicrobials to treat suspected pathogens including
community acquired pathogens.
 Conservative fluid management if there is no evidence of shock

56. Permissive hypercapnia, PEEP, double triggering, deep
sedation, prolonged inspiratory time.
Neuromuscular block, prone, recruitment maneuvers.

63. Thank you…