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CDC Health Alert: Severe Respiratory Illness Associated with a Novel Coronavirus – Updated Guidelines

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SafetyShare® newsletter brought to you by the Premier Safety Institute®
March 13, 2013


Human-to-human transmission of novel coronavirus – Updated CDC guidelines for evaluation of severe respiratory illness

The CDC issued the following
Health Alert Network (HAN) Health Advisory.
Download a copy of the CDC Health Advisory.

Notice to Health Care Providers: Updated Guidelines for Evaluation of Severe Respiratory Illness Associated with a Novel Coronavirus


The Centers for Disease Control and Prevention (CDC) is working closely with the World Health Organization (WHO) and other partners to better
understand the public health risk posed by a novel coronavirus that was first reported to cause human infection in September 2012. The purpose of this
HAN Advisory is to provide guidance to state health departments and health care providers in the evaluation of patients for novel coronavirus
infection. Please disseminate this information to infectious diseases specialists, intensive care physicians, internists, infection preventionists, as
well as to emergency departments and microbiology laboratories.


Novel coronavirus is a beta coronavirus that was first described in September 2012, when it was reported to have caused fatal acute lower respiratory
illness in a man in Saudi Arabia. As of March 8, 2013, 14 laboratory-confirmed cases of novel coronavirus infection have been reported to WHO-seven from
Saudi Arabia, two from Qatar, two from Jordan, and three from the United Kingdom (UK). Illness onsets were from April 2012 through February 2013. Of the 14
cases, eight were fatal. One of the 14 persons with novel coronavirus infection experienced a respiratory illness not requiring hospitalization. Diagnoses
rely on testing with specific polymerase chain reaction (PCR) assays. Genetic sequence analyses have shown that this new virus is different from other
known human coronaviruses, including the one that caused severe acute respiratory syndrome (SARS). There is no specific treatment for novel coronavirus
infection; care is supportive. To date, no cases have been reported in the United States.

The three confirmed cases in the UK were reported in February 2013 as part of a cluster within one family; only the index patient had a history of recent
travel outside the UK (to Pakistan and Saudi Arabia). This index patient is receiving intensive care treatment and tested positive for both novel
coronavirus and influenza A (H1N1) virus. The other two patients became ill after contact with the index patient; one died, and one has recovered from mild
illness. This cluster of illnesses is still under investigation by the UK Health Protection Agency, but provides the first clear evidence of human-to-human
transmission of this novel coronavirus, co-infection of this novel coronavirus with another pathogen (influenza A), and a case of mild illness associated
with this novel coronavirus infection. Additional details can be found in the
March 7, 2013 MMWR Early Release.


In light of these developments, updated guidance has been posted on the CDC coronavirus
website. Persons who develop severe acute lower respiratory illness within 10 days after traveling from the Arabian Peninsula or neighboring countries*
should continue to be evaluated according to current guidelines. In particular, persons who meet the following criteria for “patient under investigation”
(PUI) should be reported to state and local health departments and evaluated for novel coronavirus infection:

  • A person with an acute respiratory infection, which may include fever (≥ 38°C , 100.4°F) and cough; AND
  • suspicion of pulmonary parenchymal disease (e.g., pneumonia or acute respiratory distress syndrome based on clinical or radiological evidence of
    consolidation); AND
  • history of travel from the Arabian Peninsula or neighboring countries* within 10 days; AND
  • not already explained by any other infection or etiology, including all clinically indicated tests for community-acquired pneumonia
    according to local management guidelines.

CDC requests that state and local health departments report PUIs for novel coronavirus to CDC. To collect data on PUIs, please use the CDC Novel Coronavirus Investigation Short Form. State health departments should FAX
completed investigation forms to CDC at 770-488-7107 or attach in an email to (subject line: NCV
Patient Form).

In addition, the following persons may be considered for evaluation for novel coronavirus infection:

  • Persons who develop severe acute lower respiratory illness of known etiology within 10 days after traveling from the Arabian Peninsula or neighboring
    countries* but who do not respond to appropriate therapy; OR
  • Persons who develop severe acute lower respiratory illness who are close contacts of a symptomatic traveler who developed fever and
    acute respiratory illness within 10 days of traveling from the Arabian Peninsula or neighboring countries.*

Testing of specimens for the novel coronavirus will be conducted at CDC. Recommendations and guidance on the case definitions, infection control (including
use of personal protective equipment), case investigation, and specimen collection and shipment for testing, are available at the
CDC coronavirus website. Additional information and potentially
frequent updates will be posted on the CDC coronavirus website. State and local health departments with questions should contact the CDC Emergency
Operations Center (770-488-7100).

* Countries considered to be on or neighboring the Arabian Peninsula include Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian
territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen.

Examples of respiratory pathogens causing community-acquired pneumonia include influenza A and B, respiratory syncytial virus, adenovirus, Streptococcus pneumoniae, and Legionella pneumophila.

Close contact is defined as

  1.  any person who provided care for the patient, including a health-care worker or family member, or who had other similarly
    close physical contact, or
  2.  any person who stayed at the same place (e.g., lived with or visited) as the patient while the patient was ill.

For more information:

For additional information, please consult the CDC coronavirus website at:

State and local health departments with questions should contact the CDC Emergency Operations Center (770-488-7100).

Safety Institute




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