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The Centers for Disease Control and Prevention (CDC) has issued an official health update1 for the outbreak of novel coronavirus 2019-nCoV, which began in Wuhan City, Hubei Province, China and has now reached the United States.
Coronaviridae is a large family of viruses, of which some strains cause respiratory illness in humans, while others circulate among animals such as camels, cats and bats. Rarely, animal coronaviruses can evolve and infect people; this infection can then become epidemic among humans via respiratory droplets between close contacts, as occurred with the outbreaks of Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). The CDC does highlight that, presently, it is unclear how 2019-nCoV is being transmitted between humans.
On December 31, 2019, the World Health Organization received a report of an outbreak of pneumonia of unknown origin in Wuhan City. Since then, Chinese health officials have confirmed >40 cases of this infection, which was later identified as a novel virus of the coronaviridae. The point of origin of the infection was found to be a large open seafood and animal market, which was subsequently closed on January 1, 2020. Chinese health officials have reported that there have been no additional cases of 2019-nCoV since January 3, 2020, and that there has been no evidence of community spread, or transmission among healthcare personnel.
On January 13, 2020 the first case of human infection with 2019-nCoV was documented by health officials in Thailand. Four days later, a second case in Thailand was confirmed; both individuals were travelers from Wuhan City. On January 15, 2019, Japanese health officials reported 1 confirmed case of 2019-nCoV, also in a traveler from Wuhan City. None of these individuals have provided a link to the market that was implicated in several cases in China. Therefore, officials are concerned about person-to-person transmission of the virus.
On January 21, 2020 the CDC confirmed the first case of the infection in the US.2 The patient returned to the state of Washington from Wuhan City on January 15 and sought care at a medical facility there. Clinicians suspected the patient was infected with 2019-nCoV based on symptomology and travel history and responded in accordance with CDC recommendations. A specimen was collected from the patient was sent to CDC laboratories overnight, where real time reverse transcription-polymerase chain reaction testing confirmed the clinically suspected diagnosis.
On January 11, 2020, CDC updated the travel health notice to level 2 (practice enhanced precautions) for Wuhan City, Hubei Province, China with additional information (originally issued on January 6, 2020).1 All travelers from Wuhan City, China on direct and indirect flights into John F. Kennedy International airport, San Francisco International airport, and Los Angeles International airport, as well as the international airports in Atlanta, Georgia and Chicago, Illinois will receive screening for infection.2
The CDC has outlined recommendations for healthcare providers in the United States.1 Clinicians are required to obtain a travel history for all patients presenting with a febrile illness. All patients who meet either of the following 2 criteria should be evaluated as a person under investigation, and the attending clinician should notify both their institutional infection control personnel and the local health department:
- Fever and symptoms of lower respiratory illness (eg, cough, shortness of breath) and in the last 14 days before symptom onset had
▪ A history of travel from Wuhan City, China or
▪ Close contact with a person who is under investigation for 2019-nCOV while that person was ill.
- Fever or symptoms of lower respiratory illness (eg, cough, shortness of breath) and in the last 14 days before symptom onset
▪ Had close contact with an ill laboratory-confirmed 2019-nCoV patient.
The CDC recommends collecting and testing multiple clinical specimens from different sites, including all 3 specimen types (lower respiratory, upper respiratory, and serum specimens), to increase the likelihood of detecting 2019-nCoV infection.1 Of note, the CDC provides assistance in identifying and obtaining necessary laboratory testing, as well as specimen collection and shipping, for respiratory pathogens, including 2019-nCoV.1
Limited information is available to characterize the spectrum and course of clinical illness associated with 2019-nCoV. No vaccine or specific treatment for 2019-nCoV infection is available and care is supportive. For the most up-to-date recommendations, please visit the CDC website, which provides updates on infection prevention and control, as well as a situation summary.
References
1. Centers for Disease Control and Prevention Health Alert Network. Update and interim guidance on outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. https://emergency.cdc.gov/han/han00426.asp. Accessed January 21, 2020.
2. First travel-related case of 2019 novel coronavirus Detected in United States [news release]. Atlanta, GA: Centers for Disease Control and Prevention; January 21, 2020. https://www.cdc.gov/media/releases/2020/p0121-novel-coronavirus-travel-case.html. Accessed January 21, 2020.
