Euroopan kanta SARS-CoV-2 virukseen ja COVID-19 tautiin

https://www.ecdc.europa.eu/sites/default/files/documents/SARS-CoV-2-risk-assessment-14-february-2020.pdf.pdf

 RAPID RISK ASSESSMENT

 Outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): increased transmission beyond China – fourth update14 February 2020 
Summary 
On 31 December 2019, a cluster of pneumonia cases of unknown aetiology was reported in Wuhan, Hubei Province, China. On 9 January 2020, China CDC reported a novel coronavirus as the causative agent of this outbreak, which is phylogenetically in the SARS-CoV clade. The novel coronavirus has thus been named ‘severe acute respiratory syndrome coronavirus 2’ (SARS-CoV-2), while coronavirus disease associated with it is now referred to as COVID-19.  
As of 13 February 2020, 9:00, more than 60 330 cases of COVID-19 have been reported worldwide, mainly in China and from all Chinese provinces; of these cases, more than 450 cases were reported from other countries. As of 13 February, 13 countries reported local transmission: the United Arab Emirates, Canada, France, Germany, Japan, Malaysia, South Korea, Singapore, Taiwan, Thailand, the United Kingdom, the United States of America and Vietnam. In the EU/EEA and the UK, 44 cases have been reported as of 13 February. Among them, 21 are locallyacquired: Germany (14), France (6) and the UK (1). All of these cases have epidemiological links to earlier identified clusters with importations from outside the EU/EEA and the UK.

 Updates on the epidemiology of SARS-CoV-2 can be found on ECDC’s website. According to available evidence, the transmissibility of this virus is assessed as sufficient for sustained community transmission. Further cases and deaths in China are expected in the coming days and weeks. Further cases or clusters are also expected from other countries that are already reporting increasing numbers of cases, including community transmission. Therefore, health authorities in the EU/EEA and the UK should remain vigilant and strengthen their capacity to respond to possible importation of cases from China or, potentially, other areas with presumed ongoing community transmission; increase their capacity for surveillance and review their pandemic preparedness plans.There are considerable uncertainties in assessing the risk of this event, due to lack of detailed epidemiological analyses.ECDC assesses the risk based on the probability of transmission and the impact of the disease. On the basis of the information currently available, the Centre’s assessment is as follows: •The risk for healthcare systems capacity in the EU/EEA and the UK that would arise in the face of widespread transmission of SARS-CoV-2 at the peak of the influenza season is considered to be low to moderate.•The risk associated with SARS-CoV-2 infection for the EU/EEA and UK population is currently low.•The risk for people from the EU/EEA/UK travelling/resident in areas with presumed community transmissionis currently high


RAPID RISK ASSESSMENTOutbreak of SARS-CoV-2 : increased transmission beyond China 2  

What is new in this update? 

 •Updated number of cases in and beyond China•Description of cases and transmission reported in the EU/EEA and the UK•Findings on disease and transmissibility from recent studies •Risk to the healthcare systems in the EU/EEA and the UK•Risk to citizens from the EU/EEA and UK travelling or living in areas with presumed community transmission •ECDC guidance documents (listed under ‘Options for response’). Information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in China is being regularly updated on ECDC’s website, the European Commission website, and the World Health Organization’s (WHO) website. This risk assessment is based on published information available as of 13 February 2020, 9:00.

Event background

 Forr event background information, please visit ECDC’s website. For the most recent information on the current situation regarding SARS-CoV-2, please visit this page. Since ECDC’s third update on novel coronavirus published on 31 January 2020 – and as of 13 February 2020, 9:00 – an additional 52 506 cases have been reported, with 375 additional cases in 21 countries outside of China, including seven in the EU/EEA and the UK. It is likely that the true number of infections, including those that are unreported and unrecognised due to mild symptoms or being asymptomatic, is much higher [1]. The case definition was reported to have changed in China several times during the course of the outbreak and since the last risk assessment, which led to an increase in the number of more severe cases. The most recent case definition on 13 February includes not only laboratory-confirmed cases but also cases diagnosed on clinical grounds only. Both of these issues introduce great uncertainties regarding the exact number of cases and the extent of the spread of the virus.On 7 February, France was informed about a COVID-19 case in a British citizen who visited France from 24 to 28 January 2020. This case had attended a meeting in Singapore between 20 and 22 January where he was in contact with Chinese citizens from Wuhan, travelled to France and then back to the UK, where he was laboratory confirmed for SARS-CoV-2 on 6 February 2020. French authorities identified 11 contacts, of which five tested positive for SARS-CoV-2, including one child for whom numerous school contacts were identified. All these cases were admitted to hospital and isolated [2]. On 9 February, Spanish authorities reported a confirmed case in a British citizen who stayed in the same resort as the British index case. This additional case was diagnosed in Mallorca, Spain [3]. On 10 February, the UK reported four additional confirmed cases, all linked to the British case who had travelled back from Singapore. Among the four additional cases, two are healthcare workers [4]. As of 13 February 2020, 174 SARS-CoV-2 infections have been detected on a passenger cruise ship off the coast of Japan.As of 13 February, outside of China, local transmission has been reported in 13 countries: United Arab Emirates, Canada, France, Germany, Japan, Malaysia, South Korea, Singapore, Taiwan, Thailand, the United Kingdom, the United States of America and Vietnam. There is evidence from several of these countries that local transmission has occurred, in some countries in multiple locations, without direct or indirect epidemiological link to China. For detailed information regarding the cases detected in the EU/EEA, please visit the following page on ECDC’s website. 

Disease background

 For information on novel coronavirus virus (SARS-CoV-2) and disease (COVID-19), please visit this page on ECDC’s website.

 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections

 In December 2019, a novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) was first isolated from three patients with pneumonia, connected to the cluster of acute respiratory illness cases from Wuhan, China. Genetic analysis revealed that SARS-CoV-2 is closely related to SARS-CoV and genetically clusters within the genus Betacoronavirus, forming a distinct clade in lineage B of the subgenus Sarbecovirus together with two bat-derived

3  RAPID RISK ASSESSMENTOutbreak of SARS-CoV-2 : increased transmission beyond China 3

 SARS-CoV-like strains [5,6]. The origin of the virus is not clear yet. A recent study confirmed that angiotensin-converting enzyme 2 (ACE 2), a membrane exopeptidase, is the receptor used by SARS-CoV-2 for entry into the human cells,  imilar to SARS-CoV [7]. The virus was initially isolated in bronchoalveolar lavage (BAL) fluid samples [6], and viral RNA has thereafter been detected in nasopharyngeal and throat swabs as well as in serum [8,9], blood [10], rectal swabs, saliva, urine [11]and stool [11,12]. Information on the epidemiological and clinical characteristics of the infection caused by SARS-CoV-2 is accumulating. In the first published studies using patient data from Chinese hospitals, the most common clinical symptom in hospitalised patients was fever, followed by cough, dyspnoea and myalgia [8,10,13], one of the studies also reported fatigue as a very common symptom [8]. Diarrhoea and vomiting, however, were reported as uncommon symptoms. Approximately one-third of the patients developed dyspnoea after five days (interquartile range (IQR) 1-10) from the onset of symptoms, and 23–26% required admission to the intensive care unit (ICU) after a median of 10 days (IQR 6-12). Invasive mechanical ventilation was reported for 47% of the ICU patients in another study; extracorporeal membrane oxygenation (ECMO) was reported for seven patients in the two studies with over 200 patients [8,13]. Additionally, computed tomography imaging and x-ray of the chest identified 75% of the cases having bilateral abnormalities [13], while another study reported all patients showing bilateral involvement in computed tomography [8]. Current estimates suggest a median incubation period from five to six days, with a range of up to 14 days. A recent modelling study confirmed that it remains prudent to consider the incubation period of at least 14 days[14,15]. The current estimates of R0 are between 2 and 3 [1,14,16]. Updated estimates of these parameters are likely to be published as more information becomes available.There remains considerable uncertainty regarding the overall severity and case fatality rate (CFR) of SARS-CoV-2 infections. Estimation of case fatality can be biased in different directions: upwards by under-ascertainment of mild or asymptomatic cases or downwards by the short follow-up period for recently identified cases for whom the outcome is not yet known [17]. There is little agreement between estimates published to date, with variation and uncertainty introduced by the choice of modelling method, denominator, population group and geographical area of reporting [18]. Published analyses using data for hospitalised patients reported from China have reported case fatality estimates in the range of 11–14%, also depending on the method used and the selected population [13,19]. There is currently no specific treatment or vaccine against SARS-CoV-2 infection.

 Disease surveillance for COVID-19 in the EU

 Surveillance of COVID-19 in the EU/EEA was established in January 2020 through The European Surveillance System (TESSy) based on the WHO interim case reporting form [20]. The EU case definition for probable and confirmed cases of COVID-19 reflects that recommended by the World Health Organization in their interim guidance for global surveillance of novel coronavirus infection [21]. As of 13 February 2020, 31 cases have been reported in TESSy from six EU/EEA countries. Among the 25 cases where the place of infection was reported, seven were infected in China, including six in Hubei province, while the province was not reported for the remaining case. Of the 18 cases infected in the EU/EEA, 11 were part of the cluster in Bavaria, and seven cases were infected in France [2,22]. The median age of reported cases is 40 years (range 2 to 81 years) and 65% are male. Among the 30 cases where hospitalisation data were reported, 29 were hospitalised but information for the reason of hospitalisation is not available. No deaths have been reported in the EU/EEA.

Risk assessment questions

 •What is the risk for healthcare systems in the EU/EEA and the UK during the peak of the flu season?
 •What is the risk associated with SARS-CoV-2 infection for the EU/EEA and UK populations? •What is the risk associated with SARS-CoV-2 infection for people from the EU/EEA and UK who are travelling or live in areas with presumed ongoing community transmission?

 ECDC risk assessment

Many unknowns remain regarding the virulence/pathogenicity of SARS-CoV-2, the mode of transmission, the reservoir and the source of infection. So far, detailed epidemiological data available are still limited, and therefore there are significant uncertainties in this risk assessment.This assessment is based on facts known to ECDC at the time of publication. It is also based on an evaluation of the limited evidence available and on expert knowledge. It follows the ECDC rapid risk assessment methodology with relevant adaptations [23].

 

 

 

 

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