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WHO Suggests Broader Betacornavirus Testing
Recombinomics Commentary 22:00
November 23, 2012

it is prudent to consider that the virus is likely more widely distributed than just the two countries which have identified cases. Member States should consider testing of patients with unexplained pneumonias for the new coronavirus even in the absence of travel or other associations with the two affected countries. In addition, any clusters of SARI or SARI in health care workers should be thoroughly investigated regardless of where in the world they occur.

The above comments are from the last WHO update on the novel betacornavirus (SARS-CoV like), which announces four more confirmed cases and two more suspect cases, which include two additional fatalities.  Four of the cases (two confirmed and two suspect) are from the same family, strongly supporting human to human transmission.

Although details on this cluster have not been released, the four member familial cluster reveals significant developments.  Although media reports continue to cite a lack of evidence supporting human transmission, the likelihood of four new cases, including two fatal cases, are due to a common source is remote.  Earlier reports had also cited symptomatic contacts with the second confirmed case (first in Qatar) which tested negative.  One of the symptomatic family members in the current cluster also tested negative, raising serious concerns about the surveillance and testing.

The first two cases were identified with a pan-coronavirus PCR test, which likely has a low sensitivity based on recent sequence data from the first two confirmed cases.  A new PCR test has been developed, using two regions from the novel betacoronavirus, which should increase sensitivity.  It is unclear if the new cases were confirmed with the new test, or with the earlier pan-coronavirus PCR test, but the negative data on the symptomatic family member raises ongoing testing concerns.

The WHO suggestion for increasing testing of symptomatic cases in countries with no previous case recognizes the likelihood of human transmission as well as an absence of confirmed cases due to limited testing.

More detail on the current cluster, including testing methods and sequences would be useful.

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