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Saturday, May 18, 2013

WHO ALERT - Deadly Novel Coronavirus nCoV outbreak

The World Health Organization (WHO) is on high alert for a recently mutated form of the SARS Coronavirus recently named the novel coronavirus (nCoV) also known as Human coronavirus.  

According to a recent alert from the World Health Origanization, the following people should be investigated and tested for nCoV novel coronavirus:
A person with an acute respiratory infection, which may include history of fever and cough and indications of pulmonary parenchymal disease (e.g. pneumonia or ARDS), based on clinical or radiological evidence of consolidation, who requires admission to hospital.

1.  In addition, clinicians should be alert to the possibility of atypical presentations in patients who are immunocompromised. AND any of the following:

  • The disease is in a cluster that occurs within a 10- day period, without regard to place of residence or history of travel, unless another a etiology has been identified.
  • The disease occurs in a health care worker who has been working in an environment where patients with severe acute respiratory infections are being cared for, particularly patients requiring intensive care, without regard to place of residence or history of travel, unless another a etiology has been identified.
  • The person has history of travel to the Middle East within 10 days before onset of illness, unless another a etiology has been identified. 
  • The person develops an unusual or unexpected clinical course, especially sudden deterioration despite appropriate treatment, without regard to place of residence or history of travel, even if another a etiology has been identified, if that alternate a etiology does not fully explain the presentation or clinical course of the patient.

2.  Individuals with acute respiratory illness of any degree of severity who, within 10 days before onset of illness, were in close physical contact with a confirmed or probable case of novel coronavirus infection (nCoV), while that patient was ill.

3.  For countries in the Middle East, the minimum standard for surveillance should be testing of patients with severe respiratory disease requiring mechanical ventilation. The minimum standard should also include investigation of all those in three categories listed above
patients with unexplained pneumonia or ARDS occurring in clusters; health care workers requiring admission for respiratory disease and patients with unusual presentation or clinical course. However, countries in the Middle East are also strongly encouraged to consider adding testing for novel coronavirus nCoV to current testing algorithms as part of routine sentinel respiratory disease surveillance and, if local capacity can support it, some testing of patients with milder, unexplained, community - acquired pneumonia requiring admission to hospital.

Since April 2012, there have been 40 laboratory-confirmed cases of human infection with novel coronavirus (nCoV). Several countries in the Middle East have been affected, including Jordan, Saudi Arabia, the United Arab Emirates (UAE), and Qatar. Cases have also been reported by three countries in Europe: France, Germany, and the United Kingdom. All of the European cases have had a direct or indirect connection to the Middle East. However, in France and the United Kingdom, there has been limited local transmission among close contacts who had not been to the Middle East but had been in contact with a traveller recently returned from the Middle East. 

About Coronavirus (It is important to differentiate between the common coronavirus and the recently announced Novel Corona Virus (nCoV) most of the Q&A applies to the common coronavirus with some additions specific to SARS CoV and nCoV

 Q:What is the coronaviruses?
 A: Coronaviruses are common viruses most people get some time in their life. Human coronaviruses usually cause mild to moderate upper-respiratory tract illnesses. Coronaviruses are named for the crown-like spikes on their surface.
 There are three main sub-groupings of coronaviruses, known as alpha, beta and gamma, and a fourth provisionally-assigned new group called delta coronaviruses. Human coronaviruses were first identified in the mid 1960s. The five coronaviruses that can infect people are: alpha coronaviruses 229E and NL63 and beta coronaviruses OC43, HKU1, and SARS-CoV, the coronavirus that causes severe acute respiratory syndrome. Coronaviruses may also infect animals. Most of these coronaviruses usually infect only one animal species or, at most, a small number of closely related species. However, SARS-CoV can infect people and animals, including monkeys, Himalayan palm civets, raccoon dogs, cats, dogs, and rodents.  

 Q: How common are human coronavirus infections?  
 A: People around the world commonly get infected with human coronaviruses. Until May 2013, the more serious strain of the Coronavirus know as SARS Coronavirus or SARS-CoV was not known to spread from human to human.

 Q: Who can get infected?  
 A: Most people will get infected with human coronaviruses in their life time. Young children are most likely to get infected. However, you can have multiple infections in your life time. The more serious novel Corona Virus nCoV has started its' spread in the Middle East. The WHO is warning anyone travelling to or in contact with anyone who has travelled to the Middle east to beware of the Symptoms of nCoV

  Q: How do I get infected?
   A: The ways that human coronaviruses spread have not been studied very much, except for SARS. However, it is likely that human coronaviruses spread from an infected person to others through— the air by coughing and sneezing, and close personal contact, such as touching or shaking hands. These viruses may also spread by touching contaminated objects or surfaces then touching your mouth, nose, or eyes.

  Q: When can I get infected?
 A: In the United States, people usually get infected with the common human coronaviruses in the fall and winter. However, you can get infected at any time of the year.

  Q: What are the symptoms of SARS CoV / Coronavirus / nCoV?
  A: Human coronaviruses usually cause mild to moderate upper-respiratory tract illnesses of short duration. Symptoms may include runny nose, cough, sore throat, and fever. These viruses can sometimes cause lower-respiratory tract illnesses, such as pneumonia. This is more common in people with cardiopulmonary disease or compromised immune systems, or the elderly.
Symptoms of Novel coronavirus nCoV All confirmed cases of novel corona virus nCoV have had respiratory disease and most have had pneumonia However, one immunocompromised patient presented initially with fever and diarrhea and was only incidentally found to have pneumonia on a radiograph. Half of all confirmed cases have died. Complications during the course of novel coronavirus nCoV have included severe pneumonia with respiratory failure requiring mechanical ventilation , acute respiratory distress syndrome (ARDS) with multi-organ failure, renal failure requiring dialysis, consumptive coagulopathyand pericarditis. A number of novel coronavirus nCoV cases have also had gastrointestinal
symptoms including diarrhea during the course of their contracting novel corona virus nCoV.

 Q: How can I protect myself from the various strains of the Coronavirus including novel coronavirus nCoV ?
  A: There are currently no vaccines available to protect you against human coronavirus infection and especially not the more deadly novel coronavirus nCoV. You may be able to reduce your risk of infection by— washing your hands often with soap and water, not touching your eyes, nose, or mouth, and avoiding close contact with people who may have been exposed to novel coronavirus. Currently the novel coronavirus nCoV strain of the coronavirus has seen an outbreak in area's of the middle east. With modern methods of travel, the WHO is concerned the novel coronavirus will soon spread to the rest of the world.

  Q: What should I do if I experience symptoms of the novel coronavirus nCoV?
  A: If you have an illness caused by human coronaviruses, you can help protect others by— staying home while you are sick, avoiding close contact with others, covering your mouth and nose when you cough or sneeze, and keeping objects and surfaces clean and disinfected.
If you feel you have the symptoms of the more serious novel coronavirus nCoV, the WHO is recommending you seek immediate medical treatment. It is believed standard nasal swab testing is not  as accurate as obtaining a lower respiratory sample.

  Q: How do I get diagnosed for novel coronavirus nCoV ?
  A: Laboratory tests can be done to confirm whether your illness may be caused by human coronaviruses. However, these tests are not used very often because people usually have mild illness. Also, testing may be limited to a few specialized laboratories. Specific laboratory tests may include: virus isolation in cell culture, polymerase chain reaction (PCR) assays that are more practical and available commercially, and serological testing for antibodies to human coronaviruses. In the case of the novel coronavirus nCoV strain, a lower respiratory specimen is recommended if a nasal swab does not detect nCoV in a patient displaying symptoms of nCoV.

  Q: Are there treatments?
 A: There are no specific treatments for illnesses caused by human coronaviruses. Most people with coronavirus illness will recover on their own. However, some things can be done to relieve your symptoms, such as— taking pain and fever medications (Caution: Aspirin should not be given to children), and using a room humidifier or taking a hot shower to help ease a sore throat and cough. If you are sick, you should — drink plenty of liquids, and stay home and rest.
IMPORTANT - The above is for common coronavirus. If you are displaying symptoms of novel coronavirus (nCoV) you should seek IMMEDIATE medical attention. There is no known common cure for novel coronavirus (nCoV) as over half of those infected with nCoV have died. If you are concerned about your symptoms, you should see you healthcare provider.

Basic information on coronaviruses as a whole. 
(Partially obtained from Wikipedia)

Coronaviruses are species in the genera of virus belonging to the subfamily Coronavirinae in the family Coronaviridae. Coronaviruses are enveloped viruses with a positive-sense RNA genome and with a nucleocapsid of helical symmetry. The genomic size of coronaviruses ranges from approximately 26 to 32 kilobases, extraordinarily large for an RNA virus.

The name "coronavirus" is derived from the Latin corona, meaning crown or halo, and refers to the characteristic appearance of virions under electron microscopy (E.M.) with a fringe of large, bulbous surface projections creating an image reminiscent of the solar corona. This morphology is created by the viral spike (S) peplomers, which are proteins that populate the surface of the virus and determine host tropism.

Coronaviruses are grouped in the order Nidovirales, named for the Latin nidus, meaning nest, as all viruses in this order produce a 3' co-terminal nested set of subgenomic mRNA's during infection. Proteins that contribute to the overall structure of all coronaviruses are the spike (S), envelope (E), membrane (M) and nucleocapsid (N). In the specific case of the SARS coronavirus, a defined receptor-binding domain on S mediates the attachment of the virus to its cellular receptor, angiotensin-converting enzyme 2 (ACE2).

Some coronaviruses (specifically the members of Betacoronavirus subgroup A) also have a shorter spike-like protein called hemagglutinin esterase (HE). Coronaviruses primarily infect the upper respiratory and gastrointestinal tract of mammals and birds. Four to five different currently known strains of coronaviruses infect humans. The most publicized human coronavirus, SARS-CoV which causes SARS, has a unique pathogenesis because it causes both upper and lower respiratory tract infections and can also cause gastroenteritis. Coronaviruses are believed to cause a significant percentage of all common colds in human adults. Coronaviruses cause colds in humans primarily in the winter and early spring seasons.

The significance and economic impact of coronaviruses as causative agents of the common cold are hard to assess because, unlike rhinoviruses (another common cold virus), human coronaviruses are difficult to grow in the laboratory. In chickens, the Infectious bronchitis virus (IBV), a coronavirus, targets not only the respiratory tract but also the uro-genital tract. The virus can spread to different organs throughout the chicken. Coronaviruses also cause a range of diseases in farm animals and domesticated pets, some of which can be serious and are a threat to the farming industry. Economically significant coronaviruses of farm animals include porcine coronavirus (transmissible gastroenteritis coronavirus, TGE) and bovine coronavirus, which both result in diarrhea in young animals.

Feline Coronavirus: two forms, Feline enteric coronavirus is a pathogen of minor clinical significance, but spontaneous mutation of this virus can result in feline infectious peritonitis (FIP), a disease associated with high mortality. There are two types of canine coronavirus (CCoV), one that causes mild gastrointestinal disease and one that has been found to cause respiratory disease.

Mouse hepatitis virus (MHV) is a coronavirus that causes an epidemic murine illness with high mortality, especially among colonies of laboratory mice.

Prior to the discovery of SARS-CoV, MHV had been the best-studied coronavirus both in vivo and in vitro as well as at the molecular level. Some strains of MHV cause a progressive demyelinating encephalitis in mice which has been used as a murine model for multiple sclerosis.

Significant research efforts have been focused on elucidating the viral pathogenesis of these animal coronaviruses, especially by virologists interested in veterinary and zoonotic diseases. Following the high-profile publicity of SARS outbreaks, there has been a renewed interest in coronaviruses in the field of virology.

For many years, scientists knew only about the existence of two human coronaviruses (HCoV-229E and HCoV-OC43). The discovery of SARS-CoV added another human coronavirus to the list. By the end of 2004, three independent research labs reported the discovery of a fourth human coronavirus. It has been named NL63, NL or the New Haven coronavirus by the different research groups. The naming of this fourth coronavirus is still a controversial issue, because the three labs are still battling over who actually discovered the virus first and hence earns the right to name the virus.

Early in 2005, a research team at the University of Hong Kong reported finding a fifth human coronavirus in two pneumonia patients, and subsequently named it HKU1. In September 2012, what is believed to be a new type of coronavirus, tentatively referred to as Novel Coronavirus 2012 (nCoV), being similar to SARS (but still distinct from it, and also different from the common cold-causing coronavirus) was discovered in Qatar and Saudi Arabia.

The World Health Organisation has issued a global alert accordingly and issued an interim case definition to help countries strengthen health protection measures against the new virus. The WHO update on 28 September 2012 said that the virus did not seem to transmit easily from person to person. However, on May 12, 2013, a case of contamination from human to human was confirmed by French Ministry of Social Affairs and Health. Some confusion exists between Novel Corona Virus 2012 (NCoV) and Human Corona Virus-Erasmus Medical Centre (HCoV-EMC). Both variants are the same. The name Novel Corona Virus 2012 (NCoV) was given to the virus before it was properly sequenced. When the Dutch Erasmus Medical Centre managed to do just that, the virus was given its proper scientific name, in line with accepted procedure.