Updated ECDC Rapid Risk Assessment: Cluster of pneumonia cases caused by a novel coronavirus, Wuhan, China, 2020

Since 31 December 2019 and as of 17 January 2020, 205 laboratory confirmed cases of novel coronavirus 2019-nCoV infection, including three deaths (case fatality ratio: 1.5%), have been reported in Wuhan City, China. In addition, three cases of 2019-nCoV have been reported in Beijing (2) and Guangdong (1) in China, all with a travel history to Wuhan. A further four imported cases ex-Wuhan have been reported in Thailand (2), Japan (1) and South Korea (1).

The clinical information on confirmed 2019-nCoV cases reported so far suggests a milder disease course than that observed in SARS and MERS cases, however it is early days as yet. Most of those affected worked or visited a seafood market in Wuhan, which also sells live animals.

Environmental sanitation of the involved seafood market took place and the market was closed on 1 January 2020 . According to Wuhan Municipal Health Commission, samples from the market tested positive for the novel coronavirus. In addition, according to media quoting health authorities, these positive environmental samples were from floors, tabletops and gloves from the areas where aquatic products were sold.

Risk of importation/infection for travellers

• The likelihood of importation of cases of this new virus to Ireland or other European countries is considered to be low. There are no direct flights between Ireland and Wuhan City. Only three EU airports have direct flight connections to Wuhan-Rome, Paris and London. To prevent the spread of the virus to other countries, Wuhan Tianhe International Airport has implemented exit screening for passengers travelling from Wuhan. Passengers' temperatures are measured and those found to be febrile are put under temporary quarantine. The WHO does not recommend entry screening at receiving airports at this time.
• The likelihood of infection for travellers visiting Wuhan, but not visiting seafood or live animal markets, is also considered low, because so far there is no indication of virus circulation in the community. The risk for those visiting any seafood or live animal markets in Wuhan is considered to be moderate, even though the implicated market has been closed. If the sources of the infection are indeed certain animals sold in that market, other markets in the city may still be selling those animals and they may continue to pose a risk of infection. 
• Travellers to Wuhan should therefore minimise contact with birds and animals in markets in Wuhan as a precaution. Travellers are also advised to take simple precautions such as practicing good hand, respiratory and personal hygiene.

Standard recommendations to prevent infection spread include:

• Regular hand washing,
• Covering mouth and nose when coughing and sneezing, binning the tissue and washing ones hands, or cough or sneeze into the elbow
• Avoiding close contact with anyone showing symptoms of respiratory illness such as cough or sneezing
• Avoiding wet or live markets and contact with animals, excretions and droppings 
• Thoroughly cooking meat and eggs.
• Making contact with a healthcare provider if unwell after returning from travel to an affected area

The upcoming Chinese New Year celebrations at the end of January will cause an increased travel volume to/from China and within China, hence increasing the likelihood of arrival in the EU of possible cases. Should a case of the new virus be identified in the EU, the evidence of limited human-to-human transmission and the vigorous infection prevention and control measures that would be applied, mean the likelihood of further spread in the community setting within the EU is considered very low.

Guidance

• Clinical management guidance is available from the WHO

• Infection Prevention and Control guidance is available from WHO

• Laboratory guidance is available from WHO

• FAQs are available form WHO

• Most recent RRA from ECDC

Further information, guidance and algorithms will be circulated as they become available.