An additional case of NCov was identified. The patient fell ill 6 days after entering Saudi Arabia, but the exposure could have happened while in Pakistan or in Saudi Arabia. All nine previous cases identified were reported as having some link with the Arabian Peninsula: Kingdom of Saudi Arabia (5), Qatar (2) and Jordan (2). However the virus reservoir and routes of transmission remain unknown and it should not be excluded that these novel viruses can be found in other parts of the world.
The wide geographical distribution, the long intervals between cases and clusters, and the absence of evidence for mild or asymptomatic human infections which could maintain a chain of transmission between outbreaks, point to intermittent zoonotic transmission or an environmental source. Zoonotic transmission does not exclude human-to-human transmission from an index case but there is only limited evidence to date that this has occurred.
WHO recognizes that the emergence of a new coronavirus capable of causing severe disease raises concerns because of experience with SARS. Although this novel coronavirus is distantly related to the SARS CoV, they are different. Based on current information, it does not appear to transmit easily or sustainably between people, unlike the SARS virus.
The occurrence of such sporadic cases is to be expected in the context of the enhanced surveillance for cases and clusters implemented in the Arabian Peninsula and worldwide.
ECDC notes the WHO advice encouraging Member States to maintain surveillance for severe acute respiratory infections and to carefully review any unusual patterns of infection. Testing for the new coronavirus in patients with unexplained pneumonias, or patients with severe, progressive or complicated illness not responding to treatment, should be considered along with investigations for more likely infections.
This event does not affect the conclusions of the rapid risk assessment published by ECDC on 7 December 2012. However, ECDC will be reviewing and updating its risk assessment in the light of this additional case and other developments in the last 2 months.