Novel Coronavirus 2012

Transcription

1 Novel Coronavirus 2012 Susan I. Gerber, MD Respiratory Virus Program Division of Viral Diseases National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention Jan. 30, 2013 San Jose, Costa Rica

2 Coronaviruses (CoVs) Enveloped positive strand RNA virus Human CoVs isolated in the 1960s Five human CoVs (HCoVs) have been identified to date: HCoV-229E HCoV-OC43 HCoV-NL63 HCoV-HKU1 SARS-CoV

3 Coronaviruses- EM Petal-shaped spikes Size: nm diameter

4 Coronavirus Classification Alpha Human examples: HCoV-229E, HCoV-NL63 Pig, dog, and cat CoVs Beta HCoV-OC43, HCoV-HKU1, HCoV-SARS MHV, rat, pig and cow CoVs Novel coronavirus- (EMC, London isolates.) Gamma Chicken and turkey CoVs Delta Bird CoVs

5 Clinical Spectrum of Illness: HCoVs: 229E, NL-63, OC-43, HKU1 Most often associated with upper respiratory tract infections in children Pneumonia and lower tract infections in immunocompromised individuals and the elderly May play a role in exacerbations of underlying respiratory diseases

6 Epidemiology: HCoVs: 229E, Worldwide NL-63, OC-43, HKU1 Seasonality: Winter and spring in temperate climates Exposure common in early childhood Transmission likely to be droplet, contact, and indirect contact Symptoms and viral loads high first few days of illness Incubation period 2-5 days

7 Clinical Spectrum of Illness: SARS Fever, myalgia, headache, chills 1-2d, followed by a nonproductive cough and shortness of breath 5-7d after onset Most identified illnesses recognized in adults ~25 % diarrhea 20-30% management in ICUs ARDS, mechanical ventilation ~ % mortality rate, higher in adults >60y

8 Epidemiology: SARS First recognized Nov., 2002 as sporadic cases in Guandong province, China Outbreak period Hong Kong hotel contributed to spread of virus to several countries 8,098 probable SARS cases 774 deaths

9 Epidemiology: SARS Incubation period is 2-10d* (median 4d) Transmission through droplets Aerosol spread? Fomites? Fecal- respiratory transmission at an apartment complex in Hong Kong Transmission most likely during 2 nd week of illness Super spreading events

10 Novel CoV Timeline 6 June 2012 Saudi national presents with ARI symptoms 13 June 2012 Admitted to hospital in Jeddah, SA 14 June 2012 Admitted to ICU 24 June 2012 Patient died 3 Sept 2012 Qatari national presents with ARI symptoms 7 Sept 2012 Admitted to ICU in Doha, Qatar 11 Sept 2012 Medivaced to UK 12 Sept 2012 Admitted to ICU 21 Sept 2012 CoV identified by HPA in LRT samples by pan CoV RT-PCR 15 Sept 2012 Novel CoV first reported by A. Zaki on ProMED 27 Sept 2012 rrt-pcr protocol (Corman/Drosten) posted on Eurosurveillance 27 Sept 2012 Genome sequence posted (van Boheemen/Fouchier) on GenBank 2 4 Nov 2012 Second SA case published on ProMED Nov 2012 Family cluster of novel CoV infections in SA Nov 2012 Second Qatar case identified, transferred to German rehab facility Nov 2012 Two retrospective (April, 2012) cases reported from Jordan and cases may be associated with a cluster of respiratory illnesses among healthcare workers at a hospital

11 Summary of Known Cases 9 confirmed cases 5 deaths Jordan, Saudi Arabia, Qatar 8/9 male Age: years

12 First Case 60 year old Saudi man Presented on June 13 th with fever and cough; recent shortness of breath CXR: Interstitial pneumonia Died June 24 th No close contacts with severe illnesses reported History of farm exposure

13 49 year old Qatari national Second Case Onset of illness September 3 rd with mild respiratory symptoms September 9 th - admission to Qatar hospital with bilateral pneumonia- subsequent intubation September 12 th admitted to London ICU with respiratory failure and renal failure Fully dependent on ECMO History of travel to Saudi Arabia July 31- Aug. 18, where noted to have URI symptoms (and traveling companions) History of farm (camels and sheep) exposure, but no history of direct contact with these animals Eurosurv, Vol. 17:40, Oct. 4, 2012

14 Second Case: Management Airborne precautions Close contacts monitored for 10d 64 contacts identified among healthcare personnel (HCP), family, and friends No severe acute respiratory illnesses identified 13 HCP with mild respiratory symptoms 10 HCP negative for novel coronavirus Eurosurv, Vol. 17:40, Oct. 4, 2012

15 Novel Coronavirus: Diagnosis Virus from second case compared to virus isolated from lung tissue of first case 99.5% identity: One nucleotide mismatch over regions (replicase) compared Genome sequence: JX

16 Novel Coronavirus Beta-coronavirus Genomic similarity to bat coronaviruses Not close to HCoV-SARS genetically or other human CoVs

17 Novel Coronavirus: Phylogenetic Tree Eurosurv Vol 17: 40, Oct. 4, 2012

18 The RT-PCR Assays UpE gene Orf 1a Orf 1b Nucleocapsid RNA-dependent RNA polymerase

19 Coronaviruses: Genomic Organization L-leader ORF1a/1b- replicase HE-hemagglutinin-esterase S-spike E- small membrane envelope M- membrane N- nucleocapsid I- internal Weiss S, Leibowitz JL, Adv Vir Res, 2011

20 World Health Organization Testing Recommendation

21 WHO Case Definition Patients to be investigated (referred to as Patient Under Investigation ): A person with an acute respiratory infection, which may include fever ( 38 C, F) and cough; AND suspicion of pulmonary parenchymal disease (e.g. pneumonia or Acute Respiratory Distress Syndrome (ARDS)) based on clinical or radiological evidence of consolidation; AND travel to or residence in an area where infection with novel coronavirus has recently been reported or where transmission could have occurred;* AND not already explained by any other infection or aetiology, including all clinically indicated tests for community-acquired pneumonia according to local management guidelines. *Arabian peninsula or neighboring countries

22 Novel Coronavirus Issues Human surveillance for additional cases Available specimens SARI surveillance Monitoring for human to human transmission Animal surveillance False positives Geography Management of patients under investigation Rule out other etiologies