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New coronavirus infections reinforce need for effective public health response

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Holly Korschun

The recent detection of two cases of infection with a novel coronavirus provides new opportunities to improve global response strategies to zoonotic viral infections, using lessons from past outbreaks, say Larry J. Anderson, MD, and Ralph S. Baric in an editorial in the October 18 issue of the New England Journal of Medicine.

Anderson is a professor of pediatrics (infectious diseases) and Marcus Chair of Infectious Diseases at Emory University School of Medicine, and Baric is associate research professor, Microbiology and Immunology, School of Medicine, University of North Carolina School of Medicine.

Their editorial is in response to an article in the same issue of the journal, entitled "Isolation of a Novel Coronavirus from a Man in Saudi Arabia," by Zaki,

A previously unidentified coronavirus strain was detected in a patient who died in Saudi Arabia in June 2012 of acute pneumonia and renal failure, and in a patient in Qatar who developed severe pneumonia. In previous studies, similar coronaviruses have only been detected in bats.

The 2003 outbreak of severe acute respiratory syndrome (SARS) was also caused by a novel coronavirus that likely originated from bats. That global outbreak caused approximately 8,000 cases and nearly 800 deaths in four months.

"It is likely that novel zoonotic virus infections causing serious disease and death in humans will increasingly test our ability to respond appropriately," say the authors. "Changes in commercial and social practices, the environment, and  travel will continually provide new opportunities for zoonotic pathogens to infect humans. In addition, ever more sophisticated tools to detect novel pathogens will increase the chance we identify sporadic introductions that do not cause widespread disease."

The current cases were quickly identified as being unusual, and diagnostic tools of pan-coronavirus PCR and sequence studies detected the virus in both infections. Serologic studies in the Saudi Arabian case showed the virus had not circulated significantly in the community.

At this point the public health risk from the new coronavirus is uncertain because there has been no human-to-human transmission or virus transmission to health care workers. In the future this may be an increasingly common scenario in which new pathogens are identified but it is unclear whether they have the potential for human-to-human transmission.

The global community has learned a number of lessons from past outbreaks, the authors note, including the need to quickly identify the infectious agent and the mode of transmission, the need to control infection from the animal host, and the need for ongoing surveillance supplemented with epidemiologic and laboratory investigations to fine tune response efforts and allow for the development of therapies and preventions.

Effective future response strategies will depend on careful and thorough local investigation, assessing the risk of human-to-human transmission, cooperation with the veterinary health community, laboratory studies to detect the pathogen and develop diagnostic assays, and informing the global community in a timely fashion, say the authors.

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