novel coronavirus infections epidemiology & preparedness ppt
DESCRIPTION
Novel coronavirus infections epidemiology & preparednessTRANSCRIPT
Novel Coronavirus Infections Novel Coronavirus Infections - Epidemiology & Preparedness- Epidemiology & Preparedness
Macao Association of Health Policy
Dr. Tong Ka Io
重要聲明
1. 作者以公共衛生專業人士個人身份發表本簡報,並不代表澳門特別行政區政府衛生局或其他官方機構。
2. 簡報內描述和分析乃基於已公開的資料,如有不確,敬祈指正。
3. 簡報僅供專業人士和公眾參考和討論,傳媒請勿引用。
OutlineOutline Clinical and epidemiological evidences
Analysis and risk assessment
WHO recommendations
Local preparedness
Clinical and epidemiological evidencesClinical and epidemiological evidences
Line list Line list 15 cases from Apr/12 to Feb/13
No. Date of onset Age Sex Probable place of infection Outcome cluster
1 2012.04.?? 40 F Jordan DeadHospital A
2 2012.04.?? 25 M Jordan Dead
3 2012.06.06 60 M Saudi Arabia Dead
4 2012.09.03 49 M Qatar/Saudi Arabia Alive
5 2012.10.10 45 M Saudi Arabia Alive
6 2012.10.12 45 M Qatar Alive
7 2012.10.14* 70 M Saudi Arabia Dead
Family A8 2012.10.28 39 M Saudi Arabia Dead
9 2012.11.04 31 M Saudi Arabia Alive
10 2013.01.24 61 F Saudi Arabia Dead
11 2013.01.26 60 M Saudi Arabia/Pakistan Alive
Family B12 2013.02.05 ?? F United Kingdom Alive
13 2013.02.06 ?? M United Kingdom Dead
14 2013.02.05 69 M Saudi Arabia Dead
15 2013.02.24 39 M Saudi Arabia Dead
* Date of hospitalization
2012 Apr – Zarqa, Jordan – Hospital cluster2012 Apr – Zarqa, Jordan – Hospital cluster
On 19 Apr 2012, Jordan MOH reported an outbreak of pneumonia in the Zarqa Public Hospital’s ICU. 7 nurses, 1 doctor and 1 brother of a nurse were among the 11 affected. 1 of the nurses died.
In Nov 2012, testing of stored samples from two died patients of this cluster confirmed novel coronavirus infection, and a number of HCWs with pneumonia associated with the cases were considered probable cases. Index case among this cluster cannot be determined. No history of travel or contact with animals.
2012 Jun – Jeddah, Saudi Arabia – Sporadic case2012 Jun – Jeddah, Saudi Arabia – Sporadic case
60y male, occupation unknown, no travel history, “limited exposure to animals prior to onset”, onset on 06.06, hospitalized on 06.13, died on 06.20.
2012 Sep – Doha, Qatar – Sporadic case2012 Sep – Doha, Qatar – Sporadic case
49y male, occupation unknown, travel history to Saudi Arabia, “limited exposure to animals prior to onset”, onset on 2012.09.03, hospitalized on 09.07.
2012 Oct~Nov – Qatar & SA 2012 Oct~Nov – Qatar & SA – Sporadic cases & family cluster– Sporadic cases & family cluster
SA case: 45y male.
Qatar case: 45y male.
SA household cluster: Father: 70y, many comorbidities, hospitalized on 2012.10.14, died on 10.24. Son A: 39y, onset on 10.28, died four days later. Son B: 31y, similar illness, test positive, discharged on 11.20. Grandson: similar illness, test negative, discharged on 11.20.
2013 Jan~Feb – SA – Sporadic cases2013 Jan~Feb – SA – Sporadic cases
61y female, onset on 2013.01.24, died on 02.10, travel history to Egypt (2013.01.10-18).
69y male, onset on 2013.02.05, died on 02.19, no contact or travel history.
39y male, onset on 2013.02.24, died on 03.02.
2013 Jan~Feb – SA→UK – Family cluster2013 Jan~Feb – SA→UK – Family cluster
Index case: 60y male, travel to Pakistan (2012.12.16~2013.01.20) and Saudi Arabia (01.20~01.28), onset on 01.26, hospitalized on 01.31, co-infected with influenza A(H1N1).
Adult female member of extended family, limited exposure to the index case on three occasions in hospital (possibility of an intermediary case), onset on 02.05, mild influenza-like illness.
Adult male household member, in sustained close contact with the index case at home, pre-existing medical conditions, onset on 02.06, died on 02.17.
Saudi Arabia
Clinical pictureClinical picture Common symptoms: fever, cough, shortness of
breath, and breathing difficulties Milder ILI may present Radiological features: pulmonary parenchymal
disease (pneumonia or ARDS) Complications: renal failure, pericarditis, heart
failure, DIC, multiple organ failure Deaths:
Fatality rate = 9/15 = 60% 4~14d after onset, 2~10d after hospitalization
The virusThe virus
Analysis and risk assessmentAnalysis and risk assessment
Temporal distributionTemporal distribution
Spatial distributionSpatial distributionJordan → Saudi Arabia → Qatar
→ United Kingdom
Existence in other parts of the world cannot be excluded
Interpersonal distributionInterpersonal distribution All confirmed cases are adults (25y~70y)
At least 1 child was involved in SA’s household cluster, with similar but milder illness and negative test
Male : Female = 12:3
Occupation of most cases unknown
A number of HCWs (at least 7 nurses and 1 doctor) were involved in Jordan’s hospital cluster, with at least 1 nurse died
Source of infectionSource of infection Undetermined
Animals?
Symptomatic patients probably
Asymptomatic carriers?
Route of transmissionRoute of transmission Undetermined
Droplet and direct contact probably
SusceptibilitySusceptibility Undetermined
Presumably universal
Presumable vulnerability in elder people with pre-existing medical conditions
Lower risk for children and women?
Human-to-human transmissionHuman-to-human transmission Most family members and HCWs closely exposed to
confirmed and probable cases did not develop disease
Probably occurred in the 3 clusters Settings: hospital, household Index case may not be apparent Route of exposure not clear Observed case interval 5~14 days Secondary transmission not excluded Intermediary case is possible Existence and role of latent infection or milder cases not
clear
Resume of evidencesResume of evidencesSuggestive The virus is persistent Limited transmissibility
up to the moment
Undetermined Spatial spread Epidemic center Source of infection Route of exposure Biological, behavioral,
and occupational risk factors
Possibility of evolution
Risk assessmentRisk assessmentConditions up to the moment
The risk for any person to be infected is extremely low
The risk for any person travelling to affected areas to be infected is very low
The risk of human-to-human transmission for any infected patient is low
The risk of the virus to evolve to be more transmissible is undetermined, and actually no intervention is taken to reduce this risk
WHO recommendationsWHO recommendations
SurveillanceSurveillance Surveillance for severe acute respiratory
infections (SARI) and careful review of any unusual patterns Patients with unexplained pneumonia Patients with unexplained, severe, progressive or
complicated respiratory illness not responding to treatment
Persons travelling from or resident in areas known to be affected
Clusters of SARI SARI in health care workers
Travel measuresTravel measures WHO does not advise special
screening at points of entry nor any travel or trade restrictions
Case definitionCase definition Confirmed case
A person with laboratory confirmation of infection with the novel coronavirus
Probable case A person with an acute respiratory infection with
clinical, radiological, or histopathological evidence of pulmonary parenchymal disease (pneumonia or ARDS); AND
No possibility of laboratory confirmation for novel coronavirus either because the patient or samples are not available for testing; AND
Close contact with a laboratory confirmed case
Case managementCase management Droplet precautions should be added to
standard precautions for any patient known or suspected to have infection with novel coronavirus
Airborne precautions should be used for aerosol-generating procedures
Local preparednessLocal preparedness
StrategiesStrategiesCore
Case finding
Isolation
Complementary
Infection prevention and control in health care, nurseries and schools
Public education and risk communication