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Epidemiological update: additional confirmed cases of novel coronavirus including sixth case diagnosed in Europe

27 Mar 2013
Epidemiological update: additional confirmed cases of novel coronavirus including sixth case diagnosed in Europe

Since the ECDC epidemiological update of 22 February 2013, four new confirmed cases of novel coronavirus (nCoV) infection have been reported worldwide, totalling 17 cases and including eleven deaths. Three of the four recent cases have been reported by the Ministry of Health of Saudi Arabia to WHO on:

  • 6 March 2013: a 69 year old male, with no recent history of travel or contact with a confirmed case, hospitalised on 10 February 2013 and who died on 19 February [1].
  • 12 March 2013: a 39 year old male reported to have developed symptoms on 24 February and who died on 2 March while hospitalised. Potential exposures are under investigation [2].
  • 23 March 2013: a patient with mild symptoms diagnosed with nCoV infection and hospitalised, who has since recovered. The mode and source of transmission has not been identified, but the case is known to be a contact of the above case reported on 12 March [3].

The fourth case was reported on 25 March by Robert Koch Institute (RKI), Germany, and is the second imported case to be reported in this EU Member State. The patient, a 73 year old male with underlying clinical conditions, had been hospitalised in United Arab Emirates and transferred to a hospital in Germany for specific clinical care where subsequent diagnosis of nCoV infection was confirmed. Despite intensive care treatment the patient died on 26 March [4]. Contact tracing and investigations are underway by German public health authorities.

Since the start of reporting, six cases have been diagnosed and cared for in Europe ( Table 1). Three cases (2 in Germany and 1 in UK) came to Europe as part of transfer for care from countries in the Arabian Peninsula where they acquired their infection.  A fourth case became unwell while in the Arabian Peninsula, but may have acquired his infection in either Pakistan or the Arabian Peninsula, before travelling to the UK. Extensive contact tracing has been undertaken around the first two UK cases and first German case, by respective national public health authorities [5-7]. To date, this has revealed two cases occurring though human-to-human transmission in the UK. Testing of other persons as recommended by WHO and ECDC has not revealed additional cases [5-9].

Though the number of nCoV infections has increased this last month, most reported cases continue to be associated with the Arabian Peninsula, where contact tracing and epidemiological investigations by Public Health Authorities continue in order to identify the possible source of infection.

The ECDC update of the rapid risk assessment for the EU provided on 19 February and its recommendations remain valid [10]. ECDC has published today a Public Health Development highlighting recent updated surveillance and clinical guidance from WHO and providing ECDC advice in their application by EU Member States [11,12].



1. WHO. Novel coronavirus infection – update 6 March 2013

2. WHO. Novel coronavirus infection – update 12 March 2013  

3. WHO. Novel coronavirus infection – update 23 March 2013

4. RKI. Aktualisierung der Risikoeinschätzung des RKI zu Erkrankungsfällen durch das neuartige Coronavirus (hCoV-EMC) 26 March 2013  

5. Health Protection Agency (HPA) UK - Investigation and public health management of possible cases of severe acute respiratory illness associated with a novel virus. February  version 19/02/2013.

6. Pebody RG, Chand MA, Thomas HL, Green HK, Boddington NL, Carvalho C et al. The United Kingdom public health response to an imported laboratory confirmed case of a novel coronavirus in September 2012. Euro Surveill. 2012;17(40):pii=20292. Available at:

7. Buchholz U, Müller MA, Nitsche A, Sanewski A, Wevering N, Bauer-Balci T, Bonin F, Drosten C, Schweiger B, Wolff T, Muth D, Meyer B, Buda S, Krause G, Schaade L, Haas W. Contact investigation of a case of human novel coronavirus infection treated in a German hospital, October-November 2012. Euro Surveill. 2013;18(8):pii=20406. Available online:

8. Palm D, Pereyaslov D, Vaz J, Broberg E, Zeller H, Gross D, Brown CS, Struelens MJ, on behalf of the Joint ECDC-WHO Regional Office for Europe Novel Coronavirus Laboratory Survey participants; ECDC National Microbiology Focal Points, WHO European Region EuroFlu Network and European Network for Diagnostics of "Imported" Viral Diseases (ENIVD). Laboratory capability for molecular detection and confirmation of novel coronavirus in Europe, November 2012. Euro Surveill. 2012;17(49):pii=20335. Available online:

9. Health Protection Agency  Novel coronavirus 20 March 2013 in HPA Weekly National Influenza Report. Summary of UK surveillance of influenza and other seasonal respiratory illnesses 21 March 2013 – Week 12 report (up to week 11 data)

10. ECDC Risk Assessment severe respiratory disease associated with a novel coronavirus 19 February 2013

11. ECDC Public Health Development on Updated guidance on novel coronavirus by WHO 

12. WHO Interim surveillance recommendations for human infection with novel coronavirus - 18 March 2013


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