Status:
Resolved
Health alert:
AL20004
Date Issued:
31 Jan 2020 - (update to Alert issued 29 January 2020)
Issued by:
Dr Brett Sutton, Chief Health Officer
Issued to:
Clinicians and patients

Key messages

  • A novel coronavirus (2019-nCoV) outbreak has been identified, focused on Hubei Province in mainland China. Please see the departmental website for regular updates:
  • The department is advising all people who have visited Hubei province in mainland China to stay at home and avoid public settings until 14 days after leaving Hubei Province. Anyone who has been in close contact with a confirmed case of 2019-nCoV should also stay at home and avoid public settings until 14 days after their last contact. 
  • The department has confirmed three cases of novel coronavirus in Victoria, including one man in his 50s notified on 25 January; a man in his 60s confirmed on 28 January and a woman in her 40s on 30 January.
  • The second confirmed case attended a restaurant dinner at the House of Delight restaurant in Glen Waverley between 1730 and 1900 on 26 January 2020. Anyone who was at the restaurant at that time should contact the department on 1300 651 160. There are no other locations of concern.
  • The second confirmed case left Wuhan City to Melbourne (via Guangzhou), arriving on flight CZ643 at 6.50am 21 January 2020. The patient was not ill during the flight and is not considered to have been infectious on the flight. The Department of Health and Human Services will not be contacting passengers on the flight, in accordance with nationally agreed guidelines. 
  • Queensland Health has confirmed a case diagnosed in Queensland who was in Melbourne prior to being diagnosed. This case travelled on Tiger Airways flight TT566 From Melbourne to Gold Coast on 27 January 2020. Passengers on this flight are being contacted by the department. If you were on that flight you should contact the department on 1300 651 160 for advice.
  • The department has updated guidelines to health services and general practitioners, with modifications to the case definition and exclusions recommendations.
  • Health professionals should be alert for patients who have travelled to Hubei province, mainland China within 14 days of onset of illness and who present with fever and respiratory symptoms. 
  • Please ensure a surgical mask is placed on the patient as soon as they are identified and place them in a negative pressure room or single room. Notify the Department of Health and Human Services on 1300 651 160.
  • Take a travel history in patients with respiratory symptoms. See below for a detailed case definition to inform testing.
  • The Department of Foreign Affairs and Trade have updated a Smartraveller travel advisory for Hubei province to level 4 – ‘do not travel’ and for China overall to level 3 – ‘reconsider your need to travel’.
  • A public information hotline is serviced by Nurse-on-Call - 1800 675 398.

What is the issue?

A novel coronavirus (2019-nCoV) outbreak has been identified associated with Hubei Province, China.  As of 29 January 2020, health authorities in China have reported more than 8000 cases and over 170 deaths. Confirmed cases have been identified in mainland China, as well as Hong Kong, Macau, Taiwan, Thailand, Japan, Malaysia, South Korea, Vietnam, Cambodia, Sri Lanka, Singapore, Nepal, France, USA and Canada. 

The World Health Organisation declared on 30 January 2020 that the outbreak of 2019-nCoV constitutes a Public Health Emergency of International Concern.
Most confirmed cases have a history of travel to Hubei Province or have links to the Province. There is some evidence of human-to-human transmission outside of Hubei Province. 

The 2019 novel coronavirus (2019-nCoV) identified in this outbreak has not previously been identified in people. Coronaviruses are a large and diverse family of viruses that include viruses that are known to cause illness of variable severity in humans, including the common cold, severe acute respiratory syndrome (SARS-CoV) and Middle East Respiratory Syndrome (MERS-CoV). They are also found in animals such as camels and bats.

Novel coronavirus 2019 is now a notifiable condition under the Public Health and Wellbeing Regulations 2019 and is required to be notified by medical practitioners and pathology services as soon as practicable.

Who is at risk?

The situation is evolving rapidly as we find out more about this new virus.

Anyone who has travelled to Hubei Province, mainland China or is a close or casual contact of a confirmed case of the novel coronavirus (2019-nCoV) is at risk of infection. See below and the website for a full case definition.

Anyone person who is unwell and presents with a letter, email or other correspondence from a state or territory public health or communicable disease unit informing them they are a contact should be treated as a suspected case.

Anyone who attended the House of Delight restaurant in Glen Waverley between 1730 and 1900 on 26 January 2020, or who was on Tiger Airways flight TT566 From Melbourne to Gold Coast on 27 January 2020 should contact the department on 1300 651 160. 

Symptoms and transmission

Reported symptoms include fever and respiratory symptoms such as cough, shortness of breath and breathing difficulties. Sore throat and headache have also been reported. Recent information on the transmission of the virus suggests that cases may be infectious up to 48 hours before the onset of symptoms.

The following case definitions are now in place in Victoria:

Confirmed case
A person tested for 2019-nCoV at the Victorian Infectious Diseases Reference Laboratory and found to have 2019-nCoV infection.

Suspected case

Both clinical and epidemiological criteria need to be met for a person to be classified as a suspected case.

 

Clinical criteria:

Acute respiratory infection (shortness of breath or cough or sore throat) with or without fever

 

AND

 

Epidemiological criteria:

A history of being in Hubei province, China, including Wuhan City, in the 14 days prior to symptom onset

OR

Close contact within 14 days of symptom onset with any of the following:

  • a confirmed or suspected case of 2019-nCoV;

  • a healthcare facility in mainland China, Hong Kong or Macau (where limited hospital-associated infections have been reported).

Note: a patient with severe acute respiratory infection (SARI) and a history of travel to any part of China in the 14 days prior to symptom onset, after discussion with the department, may be classified as a suspected case and tested for novel coronavirus. As per the World Health Organization definition SARI is an illness with fever AND cough AND admission to hospital. A casual contact with compatible symptoms, after discussion with the department, may be classified as a suspected case and tested for novel coronavirus.

Recommendations

Advice for clinicians

Clinicians are asked to be alert for patients of any age presenting with respiratory symptoms who meet the suspected case definition above. Please ensure that patients presenting with compatible symptoms, especially  pneumonia, are asked about travel specific to Hubei province, China. 

If you have a patient who meets the suspected case definition above:

  • Place a surgical mask on the patient.
  • Undertake an assessment in a private room with the door closed if negative pressure ventilation is not available.
  • Apply droplet and contact precautions (single-use face mask, eye protection, gown and gloves). If available, Airborne Precautions can be applied as well by wearing a P2 respirator (N95 mask) instead of a single use face mask during any assessment.
  • Notify the Department of Health and Human Services immediately on 1300 651 160, who will assist with conducting a public health risk assessment and short epidemiological questionnaire for suspected cases.
  • Undertake testing in your hospital or with your primary pathology service for alternative causes as soon as possible, in particular for respiratory viruses using a multiplex PCR if available.
  • After discussion with the Department, you may be advised to take: Undertake an assessment in a private room with the door closed if negative pressure ventilation is not available.
    • Respiratory specimens – combined nasopharyngeal and throat swabs in ambulatory patients and sputum (if produced) and/or endotracheal aspirate or bronchoalveolar lavage
    • Blood (serum) - these samples are to be sent for novel coronavirus testing at the Victorian Infectious Diseases Reference Laboratory.

Advice for travellers

The department has updated its recommendations and is now advising all people who have visited Hubei province in China to stay at home and avoid public settings until 14 days after they leave Hubei. Likewise, anyone who has been in close contact with a confirmed case of 2019-nCoV should also stay at home and avoid public settings until 14 days after their last contact. In line with this updated advice, students and teachers who have travelled to Hubei Province in China should not attend school or university until 14 days after leaving Hubei.

Students and teachers who have travelled to other parts of China are not required to stay away from school or university unless the following applies:

  • The person is a confirmed case of novel coronavirus, or
  • The person is a close contact with a confirmed case of novel coronavirus in past 14 days.

If you traveled to Hubei province and feel sick, you should:

  • Avoid contact with others, except for seeking medical care.
  • Don’t travel while sick.
  • Seek medical care right away. Before you go to a doctor’s office or emergency department, call ahead and tell the doctor about your recent travel and your symptoms. 
  • Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.

More information

Clinical information

https://www.dhhs.vic.gov.au/information-health-services-novel-coronavirus

https://www.who.int/china/news/detail/09-01-2020-who-statement-regarding-cluster-of-pneumonia-cases-in-wuhan-china

Consumer information

https://www.dhhs.vic.gov.au/information-public-novel-coronavirus

https://www.who.int/health-topics/coronavirus

https://www.smartraveller.gov.au/destinations/asia/china

Contacts

For more information please contact the Communicable Disease Prevention and Control section at the Department of Health and Human Services on 1300 651 160 (24 hours).

A public information hotline is serviced by Nurse-on-Call - 1800 675 398.