In November 2012, staff from WHO Headquarters and the Eastern Mediterranean Regional Office were invited to Jordan to #$%$ severe acute respiratory infection (SARI) surveillance and infection prevention and control measures, and to review the April 2012 outbreak. The mission included hospital site visits, interviews with patients, relatives and caregivers, and review of case files. In addition to the 2 previously confirmed cases, a number of health care workers with pneumonia associated with the cases were also included in the review and are now considered probable cases.
The main findings of this mission are:
- The index case among this cluster could not be determined.
- All patients had significant respiratory disease presenting as pneumonia. Disease was generally milder in the unconfirmed probable cases. One patient who is a probable case had symptoms that were mild enough to be managed at home and was not admitted to hospital.
- No patient in this cluster had renal failure.
- One patient presented with pneumonia and was discovered to also have pericarditis. This patient had laboratory confirmation of infection and has died.
- A 2nd patient developed disseminated intravascular coagulation as a complication of severe respiratory disease. This patient also had laboratory confirmation of infection and has died.
- The method of exposure is uncertain.
- There was no history of travel or contact with animals among confirmed or probable cases.
- Most family members and health care workers who were closely exposed to confirmed and probable cases did not develop respiratory disease. However, the appearance of pneumonia in some who provided care and in at least 2 family members with direct personal contact increases the suspicion that person-to-person transmission may have occurred. The possibility of exposure to a common source has not been definitively excluded. Further investigation with serological testing (when it becomes available) to confirm additional cases may help determine the types of exposures that result in infection.
The current understanding of this novel virus is that it can cause a severe, acute respiratory infection presenting as pneumonia. The additional unconfirmed probable cases in Jordan indicate that milder presentations may also be a part of the clinical appearance associated with infection. Acute renal failure has occurred in 5 of the 9 confirmed cases but was not a prominent feature of the Jordanian cluster. In addition, pericarditis and disseminated intravascular coagulation have now been seen in 2 confirmed cases.
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.
WHO has closely monitored the situation since detection of the 1st case and has been working with partners to ensure a high degree of preparedness should the new virus be found to be sufficiently transmissible to cause community outbreaks. Some viruses are able to cause limited human-to-human transmission under conditions of close contact, as occurs in families, but are not transmissible enough to cause larger community outbreaks.