PRESENTER Genevie Ntshoe (on behalf of Dr. Moushumi Ann Mathews) - - PowerPoint PPT Presentation

PRESENTER Genevie Ntshoe (on behalf of

• Dr. Moushumi Ann Mathews)

Date: 31 January 2020 Civil Aviation Authority Conference

Human coronaviruses

First isolated in the 1960s Circulate among animals (zoonotic) and humans HCoVs, which commonly cause mild upper respiratory tract infections (URTIs):

HCoV-229E HCoV-OC43 HCoV-NL63 HCoV-HKU1

Recent zoonosis with more severe disease (LRTI):

SARS-CoV (2002-2003 global outbreak; spread to 37 countries within 2 weeks of original outbreak reporting; 8,098 probable cases and 774 deaths) MERS-CoV (first ID-ed in 2012; as of Oct 2019 >2400 lab-confirmed cases with >850 deaths; high mortality; mostly contained within the Middle East, but has been detected in 17 other countries.)

2019-nCoV

• Identified Dec 2019 in Wuhan City of the Hubei Province

2019-nCoV

• Zoonotic, but unknown source
• >6000 lab-confirmed cases, >150 deaths
• Limited human-to-human transmission evidenced by infection
• f

– Close household contacts – Health care workers

• All reported cases:

– Travel history to Wuhan City OR – Contact with confirmed case

2019-nCoV

2019-nCoV Timeline

2019-nCoV global reach

• Limited information
• Mainly clinical features fever and cough
• Few patients presenting with difficulty in breathing

and bilateral infiltrates on chest X-rays

• Of 7783 confirmed cases with available data (29

January)

– 170 deaths (CFR=2.2%) – 133 recovered – Treatment: supportive

• No antivirals or vaccines

Clinical presentation

Severe illness

– Any person with a severe acute respiratory illness (SARI), i.e. fever (≥38°C) or history of fever and cough with pneumonia or Acute Respiratory Distress Syndrome (ARDS) (based on clinical/ radiological findings) requiring admission to hospital AND any of the following: – A documented travel history to Hubei Province, China within 14 days before symptom onset; or – Patient is a healthcare worker who was exposed to patients with severe acute respiratory infections unless another aetiology has been identified to explain the clinical presentation

Current NICD case definition for testing

* Please check www.nicd.ac.za for latest update

Current NICD case definition

Respiratory illness of any degree

– A person with acute respiratory illness (ARI) of any severity who presented with symptom onset within 14 days and had been exposed to the following: – Close physical contact with a confirmed patient with nCoV-2019 while he/she is symptomatic; or – Healthcare facility in a country where hospital-associated nCoV-2019 infections have been reported; or – Any direct contact with animal source in countries where nCoV-2019 is known or where human infections have occurred (due to the animal source remaining undetermined, guidance for this point will be updated); or – A documented travel history to Hubei Province, China within 14 days of symptom onset

* Please check www.nicd.ac.za for latest update

Please Note:

• China is doing exit screening of all passengers

leaving the country

• Passengers from China are finding new and

innovative travel routes to facilitate entry into the country so screening direct flights from China is no longer enough

Target Flights: In the event of a suspected case…

In flight

• Communicate general awareness about current 2019-nCoV to all passengers on board; encourage them to complete brief

screening tool

• If a sick traveler is coughing, ask him/her to wear a face mask. If no mask is available or the sick traveler cannot tolerate

the mask, e.g. because of breathing difficulties, provide tissues and ask him/her to cover the mouth and nose when coughing, sneezing or talking (IATA Guidelines)

• Administer brief screening questionnaire
• If a suspect case is identified in-flight – report to Port Health

At Port of entry into the country

• Port Health with further assess any passengers at risk
• Port Health to report any suspect cases after review

to Provincial CDC & NICD

Presenting to a Clinician after leaving the airport

• Many passengers will only present to their

healthcare providers after leaving the airport

• Please provide them with contact details if

symptoms do develop

• 1. Ksiazek TG et al. A novel coronavirus associated with severe acute respiratory
• syndrome. (2003) NEJM. Vol 348 (20).
• 2. Corman V, Landt O, Koopmans M, Zambon M, Peiris M. Diagnostic detection of Wuhan

coronavirus 2019 by real-time RT-PCR. (13 Jan 2020) Published on https://www.who.int/health-topics/oronavirus/laboratory-diagnostics-for-novel- coronavirus

• 3. https://www.cdc.gov/coronavirus/2019-ncov/summary.html
• 4. https://www.who.int/internal-publications-detail/clinical-management-of-severe-

acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected

References

• Prof Cheryl Cohen (Head: Center for

Respiratory Diseases and Meningitis)