RAPID RISK ASSESSMENT Update: Severe respiratory disease associated with a novel coronavirus

• As of 4 December 2012, nine laboratory-confirmed cases of severe pneumonia caused by the novel coronavirus have been reported to WHO. Five of the nine cases were fatal. Onset of disease was from April to October 2012; all cases were resident in Saudi Arabia, Qatar or Jordan during the presumed 10 days incubation period. • Two retrospectively tested and confirmed cases in Jordan in April 2012 have increased the geographical area in which transmission has occurred. The two fatal cases were part of a cluster of 11 patients with respiratory symptoms linked to a hospital, but the limited information available about this outbreak does not allow for an assessment of whether any human-to-human transmission occurred or whether the cases in this cluster had the same cause. • Healthcare workers should be alerted to the possibility of attending to patients who meet the WHO case definition. Such cases should be investigated rapidly and managed according to WHO recommendations or national guidance documents. • The new WHO recommendations for the investigation of patients favour the investigation of patients returning from the Arabian Peninsula or its neighbouring countries, but do not exclude the testing of patients with unexplained pneumonia in the absence such travel. • Healthcare workers caring for patients under investigation should exercise stringent infection control measures as indicated by national or international guidance. Similarly, health professionals engaged in the medical evacuation of patients presenting with acute respiratory distress syndrome (ARDS) should be particularly vigilant, especially if patients originate from the Arabian Peninsula or its neighbouring countries. • Testing for the novel coronaviruses should be considered in patients undergoing medical evacuation for ARDS prior to their transfer out of the Arabian Peninsula or its neighbouring countries. All public and private hospitals and private healthcare facilities should test patients on admission for the novel coronaviruses if they present with ARDS and have been medically evacuated from the Arabian Peninsula or its neighbouring countries. Referring providers should inform the recipient hospital if testing for novel coronavirus has been performed. • Healthcare workers caring for confirmed cases should be monitored for early symptoms of infection. This includes healthcare workers who provided direct clinical or personal care, or performed examination of the cases while they were symptomatic. Close contacts of confirmed cases must be monitored for symptoms as well. RAPID RISK ASSESSMENT