Bavaria nCoV Cluster Grows To Nine in Three Countries

[niman]

The Bavaria nCoV cluster, which has it's epicenter in suburban Munich, has grown to nine victims spread over six cities (Shanghai, Stockdorf,  Fürstenfeldbruck, Starnberg, Traustein, La Gomera) in three countries (China, Germany, Spain)

Edited February 1, 2020 by niman

[niman]

Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany

TO THE EDITOR:

The novel coronavirus (2019-nCoV) from Wuhan is currently causing concern in the medical community as the virus is spreading around the world.¹ Since its identification in late December 2019, the number of cases from China that have been imported into other countries is on the rise, and the epidemiologic picture is changing on a daily basis. We are reporting a case of 2019-nCoV infection acquired outside of Asia in which transmission appears to have occurred during the incubation period in the index patient.

A 33-year-old otherwise healthy German businessman (Patient 1) became ill with a sore throat, chills, and myalgias on January 24, 2020. The following day, a fever of 39.1°C (102.4°F) developed, along with a productive cough. By the evening of the next day, he started feeling better and went back to work on January 27.

Figure 1.Timeline of Exposure to Index Patient with Asymptomatic 2019-CoV Infection in Germany.

Before the onset of symptoms, he had attended meetings with a Chinese business partner at his company near Munich on January 20 and 21. The business partner, a Shanghai resident, had visited Germany between Jan. 19 and 22. During her stay, she had been well with no signs or symptoms of infection but had become ill on her flight back to China, where she tested positive for 2019-nCoV on January 26 (index patient in Figure 1).

On January 27, she informed the company about her illness. Contact tracing was started, and the above-mentioned colleague was sent to the Division of Infectious Diseases and Tropical Medicine in Munich for further assessment. At presentation, he was afebrile and well. He reported no previous or chronic illnesses and had no history of foreign travel within 14 days before the onset of symptoms. Two nasopharyngeal swabs and one sputum sample were obtained and were found to be positive for 2019-nCoV on quantitative reverse-transcriptase–polymerase-chain-reaction (qRT-PCR) assay.² Follow-up qRT-PCR assay revealed a high viral load of 10⁸ copies per milliliter in his sputum during the following days, with the last available result on January 29.

On January 28, three additional employees at the company tested positive for 2019-nCoV (Patients 2 through 4 in Figure 1). Of these patients, only Patient 2 had contact with the index patient; the other two patients had contact only with Patient 1. In accordance with the health authorities, all the patients with confirmed 2019-nCoV infection were admitted to a Munich infectious diseases unit for clinical monitoring and isolation. So far, none of the four confirmed patients show signs of severe clinical illness.

This case of 2019-nCoV infection was diagnosed in Germany and transmitted outside of Asia. However, it is notable that the infection appears to have been transmitted during the incubation period of the index patient, in whom the illness was brief and nonspecific.³

The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak. In this context, the detection of 2019-nCoV and a high sputum viral load in a convalescent patient (Patient 1) arouse concern about prolonged shedding of 2019-nCoV after recovery. Yet, the viability of 2019-nCoV detected on qRT-PCR in this patient remains to be proved by means of viral culture.

Despite these concerns, all four patients who were seen in Munich have had mild cases and were hospitalized primarily for public health purposes. Since hospital capacities are limited — in particular, given the concurrent peak of the influenza season in the northern hemisphere — research is needed to determine whether such patients can be treated with appropriate guidance and oversight outside the hospital.

Camilla Rothe, M.D.
Mirjam Schunk, M.D.
Peter Sothmann, M.D.
Gisela Bretzel, M.D.
Guenter Froeschl, M.D.
Claudia Wallrauch, M.D.
Thorbjörn Zimmer, M.D.
Verena Thiel, M.D.
Christian Janke, M.D.
University Hospital LMU Munich, Munich, Germany
[email protected]

Wolfgang Guggemos, M.D.
Michael Seilmaier, M.D.
Klinikum München-Schwabing, Munich, Germany

Christian Drosten, M.D.
Charité Universitätsmedizin Berlin, Berlin, Germany

Patrick Vollmar, M.D.
Katrin Zwirglmaier, Ph.D.
Sabine Zange, M.D.
Roman Wölfel, M.D.
Bundeswehr Institute of Microbiology, Munich, Germany

Michael Hoelscher, M.D., Ph.D.
University Hospital LMU Munich, Munich, Germany

Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org.

This letter was published on January 30, 2020, at NEJM.org.

3 References

1. 1.Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. DOI: 10.1056/NEJMoa2001017.

   • Free Full Text
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2. 2.Corman V, Bleicker T, Brünink S, et al. Diagnostic detection of Wuhan coronavirus 2019 by real-time RT-PCR. Geneva: World Health Organization, January 13, 2020 (https://www.who.int/docs/default-source/coronaviruse/wuhan-virus-assay-v1991527e5122341d99287a1b17c111902.pdf. opens in new tab).

   • Google Scholar. opens in new tab

3. 3.Callaway E, Cyranoski D. China coronavirus: six questions scientists are asking. Nature 2020;577:605-607.

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https://www.nejm.org/doi/full/10.1056/NEJMc2001468

[niman]

press release

 

• 01/31/2020
• No. 19 / GP
• Download PDF

 

Current information on the corona virus situation in Bavaria - Bavarian Ministry of Health: A new case in the Fürstenfeldbruck district confirmed

The Bavarian Ministry of Health informed a third time late Friday evening about the current development of the new corona virus in Bavaria. A ministry spokesman said in Munich that, according to the State Office for Health and Food Safety (LGL), another coronavirus case in Bavaria had been confirmed. It is a man who lives in the Fürstenfeldbruck district. He is an employee of the company from the district of Starnberg, where the five first known coronavirus cases are employed.

There are currently seven known coronavirus cases in Bavaria (as of 7:30 p.m.). The sixth case had been confirmed on Friday afternoon. It is a child of the man from the district of Traunstein, the positive finding of which was published late Thursday evening. This man is also an employee of the company from the district of Starnberg. A test campaign for employees had taken place there on Wednesday, Thursday and Friday. Of the 128 results currently available, 127 were negative. The positive finding comes from the man in the Fürstenfeldbruck district - details will be given to the media on Saturday.

https://www.stmgp.bayern.de/presse/aktuelle-informationen-zur-coronavirus-lage-in-bayern-bayerisches-gesundheitsministerium-4/

[niman]

https://www.stmgp.bayern.de/presse/aktuelle-informationen-zur-coronavirus-lage-in-bayern-bayerisches-gesundheitsministerium-2/

The Bavarian Ministry of Health informed on Friday about the current development of the new corona virus in Bavaria. A ministry spokesman said in Munich that, according to the State Office for Health and Food Safety (LGL), another coronavirus case in Bavaria was confirmed at noon. It is a child of the man from the district of Traunstein, the positive finding of which was published late Thursday evening. The man is an employee of the company from the district of Starnberg, which also deals with the other four cases known to date.

There are a total of six coronavirus cases in Bavaria. According to doctors, all those affected are currently in a stable state of health.

Tests by other people who also work for this company showed no further positive results until midday on Friday. The Bavarian Ministry of Health will provide further details later today. The contacts identified so far should isolate themselves at home and continuously report to the health department with information on their health status.

[niman]

Confirmed the coronavirus in a German tourist in La Gomera

This is the analysis performed on one of the samples sent from La Gomera (Canary Islands). The patient is admitted and isolated in a hospital of the island.

 IN SUMMARY

 

• The affected had had direct contact with a person infected in Germany

 

 

First case of coronavirus in Spain. The National Center for Microbiology has confirmed its presence in samples sent from La Gomera (Canary Islands).

The patient is admitted and isolated in a hospital of the island. It is part of the group of five tourists who were already under observation on the island. Two of them had been in contact in Germany with a patient diagnosed with coronavirus infection.

These people were located on the afternoon of Wednesday once the Ministry of Health of the Canary Islands Government was alerted by Health that these two people were in the Canary Islands.

As foreseen in the protocol that has been explained these days, this Saturday there will be a ministerial meeting of evaluation and monitoring of the coronavirus, chaired by the minister, Salvador Illa, after which all available information on the case will be offered.

There are currently more than 75,000 cases under study in Wuhan. In Europe there are already positives in the United Kingdom, France. Germany, Italy, Sweden and Finland.

https://www.antena3.com/noticias/sociedad/confirmado-caso-coronavirus-gomera_202001315e34a9380cf2cfb788f47b07.html

[niman]

According to auto-parts supplier Webasto SE, seven of its employees -- five German and two Chinese -- have been infected with the new coronavirus, the cause of a massive pneumonia outbreak in China that the World Health Organization declared a global emergency on Thursday.

https://www.bloomberg.com/news/articles/2020-01-31/coronavirus-spreading-in-munich-shows-difficulty-halting-new-bug?utm_source=dlvr.it&utm_medium=twitter

[niman]

World

Coronavirus Spreading in Munich Shows Difficulty Halting New Bug

By 

Jason Gale

 and 

Birgit Jennen

January 30, 2020, 11:50 PM EST Updated on January 31, 2020, 2:52 PM EST

•  
  Shanghai visitor who didn’t have symptoms led to new cluster
•  
  Infections widen to seven with two additional 2019-nCoV cases

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In this article

1006204D

WEBASTO SE

Private Company

A business event in Munich set off a chain of coronavirus infections that began with an infected colleague from Shanghai who showed no symptoms during a trip to the German city. It’s the largest reported cluster of cases caused by human-to-human spread outside China.

 

 

According to auto-parts supplier Webasto SE, seven of its employees -- five German and two Chinese -- have been infected with the new coronavirus, the cause of a massive pneumonia outbreak in China that the World Health Organization declared a global emergency on Thursday.

 

 

The Schwabing hospital, where four people are being treated for coronavirus, in Munich, Germany, Jan. 29.

Photographer: Michaela Handrek-Rehle/Bloomberg

The infection appears to have been transmitted while a Shanghai-based colleague was still incubating the virus. The woman attended meetings from Jan. 19 to 22 at Webasto’s headquarters in Stockdorf, on Munich’s outskirts, with no signs or symptoms of infection, but she became unwell on her Jan. 22 flight back to China. She tested positive for the 2019-nCoV virus four days later, doctors said in the New England Journal of Medicine on Thursday.

 

 

 

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The cases show the difficulty of controlling the contagion using methods such as fever-screening at airports. Almost 10,000 people across 20 countries are confirmed to have been infected with the new virus, which was first reported in the central Chinese city of Wuhan a month ago.

 

 

Mitigation strategies for halting the spread of 2019-nCoV have been informed by experiences combating coronaviruses that cause severe acute respiratory syndrome, or SARS, and Middle East respiratory syndrome. People don’t typically transmit those infections unless they have symptoms, said Benjamin Cowie, a professor of medicine at the University of Melbourne and an epidemiologist with the Peter Doherty Institute for Infection and Immunity.

10-Year-Old Boy

Cases like the ones in Germany, and that of a 10-year-old boy in Shenzhen whose case was described last week, have complicated control measures, Cowie said in an interview Friday.

Read More: 10-Year-Old Boy Raises Fears Wuhan Virus Could Spread Undetected

“With this information suggesting that there is at least the ability to isolate or detect the virus in asymptomatic or apparently asymptomatic individuals, that’s got significant implications for epidemiological control measures,” he said. “If we’re trying to identify cases when they’re not symptomatic, that’s impossible on a clinical basis, and that then becomes a lot harder to control.”

An analysis by U.S. researchers of screening travelers found the strategy will, at best, detect less than half of infected travelers. Those who are incubating their infection may feel healthy enough to travel but show no detectable symptoms, they said in a Jan. 28 study.

Need for Reassessment?

“The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak,” Camilla Rothe and colleagues at the University Hospital LMU Munich, who investigated the cluster in Germany, said in a letter to the New England Journal of Medicine.

The first four cases in Germany had “mild” symptoms and were hospitalized primarily for public health purposes, the doctors said. They queried “whether such patients can be treated with appropriate guidance and oversight outside the hospital.”

Pedestrians wearing protective masks walk along a street near the Bund in Shanghai, Jan. 30.

Photographer: Qilai Shen/Bloomberg

The first of the German cases occurred in an otherwise healthy 33-year-old businessman, who became ill with a sore throat, chills, and muscle ache on Jan. 24. He had a fever and a cough the next day, but by the evening of the following day, he started feeling better and went back to work on Jan. 27, the same day his China-based colleague told company officials that she was ill.

Swabs of the back of the man’s nose and throat, and a sputum sample tested positive for 2019-nCoV. Follow-up tests found he still harbored high levels of the virus in his sputum on Jan. 29, a day after three other employees tested positive, including two who hadn’t been in contact with the colleague from China.

Patients with confirmed 2019-nCoV were isolated in a Munich infectious diseases unit. All seven people attended various meetings together in Stockdorf, the company said in a statement Friday.

Employees Spurned

Some 122 staffers have returned negative tests for the coronavirus, with a few test results still pending, according to the company.

Webasto, which has about 13,000 workers in 50 different locations, said it will keep its headquarters closed until next Monday. The company is preparing for employees to return to work Tuesday, Feb. 4, amid reports that its workforce is being subjected to discriminating behavior.

“We are receiving an increasing number of reports from employees that they and their families are being turned away from institutions, companies or businesses when it becomes known that they work for Webasto,” Chairman Holger Engelmann said. “We understand that the current situation is unsettling and also frightening for people, but it cannot be that normal everyday life is no longer possible for people who do not belong to the risk group. This is an enormous burden for the families of our employees.”

Read more: Here’s How the Fight Against China Coronavirus Works: QuickTake

— With assistance by Tim Loh, and Sybilla Gross

(Adds additional workers infected in second paragraph; company comments from 14th.)

[niman]

Virus detail
Virus name:	BetaCoV/Germany/BavPat1/2020
Accession ID:	EPI_ISL_406862
Type:	betacoronavirus
Passage details/history:	Original
Sample information
Collection date:	2020-01-28
Location:	Germany / Bavaria / Munich
Host:	Human
Additional location information:
Gender:	male
Patient age:	NA
Patient status:	hospitalized
Specimen source:	Sputum
Additional host information:
Outbreak:	Bavaria cluster patient 1
Last vaccinated:
Treatment:
Sequencing technology:	Illumina MiSeq, Nanopore MinION
Assembly method:	Geneious v9
Coverage:
Institute information
Originating lab:	Charité Universitätsmedizin Berlin, Institute of Virology; Institut für Mikrobiologie der Bundeswehr, Munich
Address:	Institute of Virology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; Institut für Mikrobiologie der Bundeswehr, Neuherbergstraße 11, 80937 Munich, Germany
Sample ID given by the sample provider:
Submitting lab:	Charité Universitätsmedizin Berlin, Institute of Virology
Address:	Charitéplatz 1, 10117 Berlin, Germany
Sample ID given by the submitting laboratory:	ChVir929
Authors:	Victor M Corman, Julia Schneider, Talitha Veith, Barbara Mühlemann, Markus Antwerpen, Christian Drosten, Roman Wölfel
Submitter information
Submitter:	Barbara Muehlemann
Submission Date:	2020-01-31
Address:	Institute of Virology, Charité Universitätsmedizin Berlin

FASTA

>BetaCoV/Germany/BavPat1/2020|EPI_ISL_406862