Highlights and conclusions from the technical consultative meeting on novel coronavirus infection, Cairo,Egypt, 14-16 January 2013

The emergence of a novel strain of coronavirus in the Arabian Peninsula raised a global health concern in 2012, partly because the majority of human infections were fatal and partly due to its presumed animal origin. An urgent meeting of scientific and public health experts was convened by WHO in January 2013 in view of the limited knowledge available on the epidemiological and natural history of infection with this novel virus. The meeting reviewed current evidence and identified critical knowledge gaps to improve better understanding of the public health risk associated with the virus so as to improve preparedness and to safeguard and protect global health

Enhanced surveillance and investigation of coronavirus: what is required?

Following the discovery in September 2012 of 2 patients, both with links to the Eastern Mediterranean Region, with serious respiratory illness due to novel coronavirus, all countries have instigated surveillance and laboratory activities to detect further cases, with intensive case contact investigations undertaken on laboratory confirmation of cases. A total of 30 cases, of whom 18 have died, and at least 3 clusters have been detected to date [1 cluster among health-care workers and another 2 clusters among family members]. To date, transmission studies have shown a low risk of onward human transmission, with clinical presentation remaining severe for the majority. Many questions remain including the zoonotic source and geographical extent of infection. Surveillance has been extended to include clusters of cases or health-care workers with severe, undiagnosed respiratory illness regardless of travel history. Environmental studies, on-going surveillance and linked case-contact investigations will provide a critical role in answering some of these issues

The early response to a novel coronavirus in the Middle East

The detection of a novel coronavirus in patients from the Arabian Peninsula in late 2012 raised serious concerns of a possible international outbreak. Ministries of health of the three affected countries invited missions from the World Health Organization to participate in a review of data and capacity to detect and respond to further cases. Recommendations were made for investigations to answer critical questions about human-to human transmission and the geographic extent of the virus. Additional recommendations were made to improve surveillance capacity by acquiring the capacity to test for the virus and enhance syndromic surveillance. Available evidence continues to suggest an unknown animal reservoir for the virus with sporadic zoonotic transmission as the primary epidemiological pattern of transmission. Human-to-human transmission, while it can occur, does not appear to be sustained in the community

Incidence of traumatic injection neuropathy among children in Pakistan

We used acute flaccid paralysis surveillance data collected between 1 January 2001 and 31 December 2003 from the Pakistan Polio Eradication Initiative to describe the epidemiological characteristics and disease burden of traumatic injection neuropathy among children aged under 15 years. Of the 5627 acute flaccid paralysis cases reported, 456 were identified as traumatic injection neuropathy by case review. The condition was more common in younger children who were also more likely to have persistent paralysis. We estimate that the annual incidence of traumatic injection neuropathy rate in Pakistan is 7.1 per 1 000 000 in children under 3 years old

Characteristics of districts in Pakistan with persistent transmission of wild poliovirus, 2000-2001

We sought to identify factors associated with being a reservoir district for wild poliovirus in Pakistan. Differences between reservoir and non-reservoir districts were identified using acute flaccid paralysis surveillance data, population census statistics and data from a survey of district health officials [DHOs]. Of the 11 poliovirus reservoir districts identified, population density was significantly higher [median 550 persons/km2] than the non-reservoirs [median 175 persons/km2]. DHOs from reservoir districts more often reported that planning was affected by refugees and they had more frequent DHO transfers compared with non-reservoir districts. Multivariate analysis confirmed that reservoirs more often had high population density and frequent DHO transfers. Assessment of district-level and management characteristics can supplement surveillance methods to further improve health programmes