cor International Journal of Infectious Diseases 91 2020 264 266 Contents lists available at ScienceDirect Infectious WHO 2020b The 2019 nCoV is a CoV of group 2B with at least 70 similarity in genetic sequence to SARS CoV and has been named 2019 nCoV by the WHO SARS is a zoonosis caused by SARS CoV which rst emerged in China in 2002 before spreading to 29 countries regions in 2003 through a travel related global outbreak with 8 098 cases with a case fatality rate of 9 6 Nosocomial transmission of SARS CoV was common while the primary reservoir was bats and the intermediary source was civet cats in the wet markets in Guangdong Hui and Zumla 2019 MERS is a novel lethal zoonotic disease of humans endemic to the Middle East caused by MERS CoV Humans are thought to acquire MERS CoV infection though contact with camels or camel products with a case fatality rate close to 35 while nosocomial transmission is also a hallmark Azhar et al 2019 The recent outbreak of clusters of viral pneumonia due to a 2019 nCoV in the Wuhan market poses signi cant threats to international health and may be related to sale of wild animal as game food at the seafood market 13th January 2020 in a Chinese tourist visiting Thailand and is being treated in hospital The Chinese Health Authorities have carried out very appropriate and prompt response measures including active case nding and retrospective investigations of the current cluster of patients which have been completed The Huanan Seafood Wholesale Market has been temporarily closed to carry out investigation environmental sanitation and disinfection Public risk communication activities have been carried out to improve public awareness and adoption of self protection measures Technical guidance on novel coronavirus has been developed and will continue to be updated as additional information becomes available However many questions about the new coronavirus remain While it appears to be transmitted to humans via animals the speci c animals and other reservoirs need to be identi ed the transmission route the incubation period and characteristics of the susceptible population and survival rates At present there is however very limited clinical information of the 2019 nCoV infection and data are missing in regard to the age range animal https doi org 10 1016 j ijid 2020 01 009 1201 9712 2020 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases This is an open access article under the CC BY NC ND license http creativecommons org licenses by nc nd 4 0 Editorial The continuing 2019 nCoV epidemic threat to global health The latest 2019 novel Wuhan China The city of Wuhan in China is the focus of global attention due to an outbreak of a febrile respiratory illness due to a coronavirus 2019 nCoV In December 2019 there was an outbreak of pneumonia of unknown cause in Wuhan Hubei province in China with an epidemiological link to the Huanan Seafood Wholesale Market where there was also sale of live animals Noti cation of the WHO on 31 Dec 2019 by the Chinese Health Authorities has prompted health authorities in Hong Kong Macau and Taiwan to step up border surveillance and generated concern and fears that it could mark the emergence of a novel and serious threat to public health WHO 2020a Parr 2020 The Chinese health authorities have taken prompt public health measures including intensive surveillance epidemiolog ical investigations and closure of the market on 1 Jan 2020 SARS CoV MERS CoV avian in uenza in uenza and other common respiratory viruses were ruled out The Chinese scientists were able to isolate a 2019 nCoV from a patient within a short time on 7 Jan 2020 and perform genome sequencing of the 2019 nCoV The genetic sequence of the 2019 nCoV has become available to the WHO on 12 Jan 2020 and this has facilitated the laboratories in different countries to produce speci c diagnostic PCR tests for detecting the novel infection International Journal of journal homepage www elsevier co of novel coronaviruses onavirus outbreak in As of 10 Jan 2020 41 patients have been diagnosed to have infection by the 2019 nCoV animals The onset of illness of the 41 cases ranges from 8 December 2019 to 2 January 2020 Symptoms include fever 90 cases malaise dry cough 80 shortness of breath 20 and respiratory distress 15 The vital signs were stable in most of the cases while leucopenia and lymphopenia were common Among the 41 cases six patients have been discharged seven patients are in critical care and one died while the remaining patients are in stable condition The fatal case involved a 61 year old man with an abdominal tumour and cirrhosis who was admitted to a hospital due to respiratory failure and severe pneumonia The diagnoses included severe pneumonia acute respiratory distress syndrome septic shock and multi organ failure The 2016 nCoV infection in Wuhan appears clinically milder than SARS or MERS overall in terms of severity case fatality rate and transmissibility There is currently no clear evidence of human to human transmission At present 739 close contacts including 419 healthcare workers are being quarantined and monitored for any development of symptoms WHO 2020b Center for Health Protection and HKSAR 2020 No new cases have been detected in Wuhan since 3 January 2020 However the rst case outside China has been reported today Diseases m locate ijid D S Hui et al International Journal of Infectious Diseases 91 2020 264 266 265 source of the virus incubation period epidemic curve viral kinetics transmission route pathogenesis autopsy ndings and any treatment response to antivirals among the severe cases Once there is any clue to the source of animals being responsible for this outbreak global public health authorities should examine the trading route and source of movement of wild and domestic animals from other parts to Wuhan and consider appropriate trading restrictions or other control measures to limit The rapid identi cation and containment of a novel coronavirus virus in a short period of time is a re assuring and a commendable achievement by China s public health authorities and re ects the increasing global capacity to detect identify de ne and contain new outbreaks The latest analysis show that the Wuhan CoV cluster with the SARS CoV 10 Novel coronavirus China 01 HU WHO phylogenetic tree Archive Number 20200112 6885385 This outbreak brings back memories of the novel coronavirus outbreak in China the severe acute respiratory syndrome SARS in China in 2003 caused by a novel SARS CoV coronavirus World Health Organization 2019a SARS CoV rapidly spread from southern China in 2003 and infected more than 3000 people killing 774 by 2004 and then disappeared never to be seen again However The Middle East Respiratory Syndrome MERS Corona virus MERS CoV World Health Organization 2019b a lethal zoonotic pathogen that was rst identi ed in humans in the Kingdom of Saudi Arabia KSA in 2012 continues to emerge and re emerge through intermittent sporadic cases community clusters and nosocomial outbreaks Between 2012 and December 2019 a total of 2465 laboratory con rmed cases of MERS CoV infection including 850deaths 34 4 mortality werereportedfrom27countriestoWHO the majority of which were reported by KSA 2073 cases 772 deaths Whilst several important aspects of MERS CoV epidemiology virology mode of transmission pathogenesis diagnosis clinical features have been de ned there remain many unanswered questions including source transmission and epidemic potential The Wuhan outbreak is a stark reminder of the continuing threat of zoonotic diseases to global health security More signi cant and better targeted investments are required for a more concerted and collaborative global effort learning from experiences from all geographical regions through a ONE HUMAN ENIVRONMENTAL ANIMAL HEALTH global consortium to reduce the global threat of zoonotic diseases Zumla et al 2016 Sharingexperience andlearning from all geographical regions and across disciplines will be key to sustaining and further developing the progress being made Author declarations All authors have a specialist interest in emerging and re emerging pathogens FN RK OD GI TDMc CD and AZ are members of the Pan African Network on Emerging and Re emerging Infections PANDORA ID NET funded by the European and Developing Countries Clinical Trials Partnership the EU Horizon 2020 Framework Programme for Research and Innovation AZ is a National Institutes of Health Research senior investigator All authors declare no con icts of interest References Azhar EI Hui DSC Memish ZA Drosten C Zumla A The Middle East Respiratory Syndrome MERS Infect Dis Clin North Am 2019 33 4 891 905 Center for Health Protection HKSAR Press Release 11 Jan Accessed 12 Jan 2020 Available at 2020 https www info gov hk gia general 202001 11 P2020011100233 htm Hui DSC Zumla A Severe acute respiratory syndrome historical epidemiologic and clinical features Infect Dis Clin North Am 2019 33 4 869 89 Parr J Pneumonia in China lack of information raises concerns among Hong Kong health workers BMJ 2020 368 m56 doi http dx doi org 10 1136 bmj m56 Published 8 January 2020 WHO Emergencies preparedness response Pneumonia of unknown origin China Disease outbreak news 5 January Accessed 12 Jan 2020 Available at https www who int csr don 05 january 2020 pneumonia of unkown cause china en WHO Emergencies preparedness response Pneumonia of unknown origin China Disease outbreak news 12 January Accessed 12 Jan 2020 Available at https www who int csr don 12 january 2020 novel coronavirus china en World Health Organization SARS Severe Acute Respiratory Syndrome 2019 accessed 12th January 2020 https www who int ith diseases sars en World Health Organization MERS situation update 2019 accessed August 20 2019 http applications emro who int docs EMROPub 2019 MERA ap r EN 23513 pdf ua 1 Zumla A Dar O Kock R et al Taking forward a One Health approach for turning the tide against the Middle East respiratory syndrome coronavirus and other zoonotic pathogens with epidemic potential Int J Infect Dis 2016 47 5 9 ProMED Novel coronavirus China 01 HU WHO phylogenetic tree Archive Number 20200112 6885385 Accessed 13 Jan 2020 https www ecohealth alliance org 2020 01 phylogenetic analysis shows novel wuhan coronavirus clusters with sars David S Hui Department of Medicine Therapeutics Chinese University of Hong Kong Prince of Wales Hospital Shatin New Territories Hong Kong China Esam I Azhar Special Infectious Agents Unit King Fahd Medical Research Center and Department of Medical Laboratory Technology Faculty of Applied Medical Sciences King Abdulaziz University Jeddah Saudi Arabia Tariq A Madani Department of Medicine Faculty of Medicine King Abdulaziz University Jeddah Saudi Arabia Francine Ntoumi Fondation Congolaise pour la Recherche M dicale Brazzaville Republic of Congo Richard Kock The Royal Veterinary College University of London Hawkshead Lane North Mymms Hat eld Hertfordshire UK Osman Dar Chatham House Centre on Global Health Security Royal Institute of International Affairs London UK Giuseppe Ippolito Lazzaro Spallanzani National Institute for Infectious Diseases IRCCS Rome Italy Timothy D Mchugh Center for Clinical Microbiology Division of Infection and Immunity University College London United Kingdom Ziad A Memish a b c a Infectious Diseases Division Department of Medicine and Research Department Prince Mohamed Bin Abdulaziz Hospital Ministry of Health Riyadh Saudi Arabia b College of Medicine Alfaisal University Riyadh Saudi Arabia c Hubert Department of Global Health Rollins School of Public Health Emory University Atlanta GA USA Christian Drosten a b c a Charit Universit tsmedizin Berlin Corporate Member of Freie Universit t Berlin Humboldt Universit t zu Berlin Germany b Berlin Institute of Health Institute of Virology Berlin Germany c German Centre for Infection Research associated partner Charit Berlin Germany Alimuddin Zumla Center for Clinical Microbiology Division of Infection and Immunity University College London and NIHR Biomedical Research Centre UCL Hospitals NHS Foundation Trust London United Kingdom Eskild Petersen a b a Directorate General for Disease Surveillance and Control Ministry of Health Muscat Oman b Institute for Clinical Medicine Faculty of Health Science University of Aarhus Aarhus Denmark Corresponding author E mail address dschui cuhk edu hk D Hui 266 D S Hui et al International Journal of Infectious Diseases 91 2020 264 266