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Initial Public Health Response and Interim Clinical Guidance for the 2019 Novel Coronavirus Outbreak — United States, December 31, 2019–February 4, 2020
Weekly / February 7, 2020 / 69(5);140–146
On February 5, 2020, this report was posted online as an MMWR Early Release.
Please note: An erratum has been published for this report. To view the erratum, please click here.
Anita Patel, PharmD1; Daniel B. Jernigan, MD1; 2019-nCoV 星空娱乐官网 Response Team (View author affiliations)
View suggested citationSummary
What is already known about this topic?
In December 2019, an outbreak of acute respiratory illness caused by a novel coronavirus (2019-nCoV) was detected in mainland China. Cases have been reported in 26 additional locations, including the United States.
What is added by this report?
Nine of the first 11 U.S. 2019-nCoV patients were exposed in Wuhan, China. 星空娱乐官网 expects more U.S. cases.
What are the implications for public health practice?
星空娱乐官网, multiple other federal agencies, state and local health departments, and other partners are implementing aggressive measures to substantially slow U.S. transmission of 2019-nCoV, including identification of U.S. cases and contacts and managing travelers arriving from mainland China to the United States. Interim guidance is available at /coronavirus/index.html and will be updated as more information becomes available.
On December 31, 2019, Chinese health officials reported a cluster of cases of acute respiratory illness in persons associated with the Hunan seafood and animal market in the city of Wuhan, Hubei Province, in central China. On January 7, 2020, Chinese health officials confirmed that a novel coronavirus (2019-nCoV) was associated with this initial cluster (1). As of February 4, 2020, a total of 20,471 confirmed cases, including 2,788 (13.6%) with severe illness,* and 425 deaths (2.1%) had been reported by the National Health Commission of China (2). Cases have also been reported in 26 locations outside of mainland China, including documentation of some person-to-person transmission and one death (2). As of February 4, 11 cases had been reported in the United States. On January 30, the World Health Organization (WHO) Director-General declared that the 2019-nCoV outbreak constitutes a Public Health Emergency of International Concern.† On January 31, the U.S. Department of Health and Human Services (HHS) Secretary declared a U.S. public health emergency to respond to 2019-nCoV.§ Also on January 31, the president of the United States signed a “Proclamation on Suspension of Entry as Immigrants and Nonimmigrants of Persons who Pose a Risk of Transmitting 2019 Novel Coronavirus,” which limits entry into the United States of persons who traveled to mainland China to U.S. citizens and lawful permanent residents and their families (3). 星空娱乐官网, multiple other federal agencies, state and local health departments, and other partners are implementing aggressive measures to slow transmission of 2019-nCoV in the United States (4,5). These measures require the identification of cases and their contacts in the United States and the appropriate assessment and care of travelers arriving from mainland China to the United States. These measures are being implemented in anticipation of additional 2019-nCoV cases in the United States. Although these measures might not prevent the eventual establishment of ongoing, widespread transmission of the virus in the United States, they are being implemented to 1) slow the spread of illness; 2) provide time to better prepare health care systems and the general public to be ready if widespread transmission with substantial associated illness occurs; and 3) better characterize 2019-nCoV infection to guide public health recommendations and the development of medical countermeasures including diagnostics, therapeutics, and vaccines. Public health authorities are monitoring the situation closely. As more is learned about this novel virus and this outbreak, 星空娱乐官网 will rapidly incorporate new knowledge into guidance for action by 星空娱乐官网 and state and local health departments.
Some coronaviruses, such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS), are the result of human-animal interactions. Preliminary investigation of 2019-nCoV also suggests a zoonotic origin (6), but the exact origin has not yet been determined. Person-to-person spread is evident (7); however, how easily the virus is transmitted between persons is currently unclear. 2019-nCoV is similar to coronaviruses that cause MERS and SARS, which are transmitted mainly by respiratory droplets. Signs and symptoms of patients with confirmed 2019-nCoV infection include fever, cough, and shortness of breath (8). Based on the incubation period of illness from MERS and SARS coronaviruses, 星空娱乐官网 believes that symptoms of 2019-nCoV infection occur within 2 to 14 days following infection. Preliminary information suggests that older adults and persons with underlying health conditions or compromised immune systems might be at higher risk for severe illness from this virus (9); however, many characteristics of this novel coronavirus and how it might affect individual persons and potentially vulnerable population subgroups, such as the elderly or those with chronic health conditions, remain unclear.
Epidemiology of First U.S. Cases
On January 21, 2020, the first person in the United States with diagnosed 2019-nCoV infection was reported. As of February 4, a total of 293 persons from 36 states, the District of Columbia, and the U.S. Virgin Islands were under investigation based on current patient under investigation (PUI) definitions,¶ and also included those being evaluated because they are close contacts. Of these PUIs, 11 patients have confirmed 2019-nCoV infection using a real-time reverse transcription–polymerase chain reaction (RT-PCR) assay developed by 星空娱乐官网. These 11 cases were diagnosed in the following states: Arizona (one), California (six), Illinois (two), Massachusetts (one), and Washington (one) (Table). Nine cases were in travelers from Wuhan. Eight of these nine cases were identified as a result of patients seeking clinical care for symptoms and clinicians connecting with the appropriate public health systems. Two cases (one each in California and Illinois) occurred in close contacts of two confirmed cases and were diagnosed as part of routine monitoring of case contacts. All patients are being monitored closely for progressing illness. No deaths have been reported in the United States.
Public Health Response
星空娱乐官网 established a 2019-nCoV Incident Management Structure on January 7, 2020. On January 21, 星空娱乐官网 activated its Emergency Operations Center to optimize coordination for domestic and international 2019-nCoV response efforts. To date, 星空娱乐官网 has deployed teams to the U.S. jurisdictions with cases to assist with epidemiologic investigation and to work closely with state and local partners to identify and monitor close contacts and better understand the spectrum of illness, transmission, and virulence associated with this novel virus. Information learned from these investigations will help inform response actions. 星空娱乐官网 has closely monitored the global impact of this virus with staff members positioned in 星空娱乐官网 offices around the world, including mainland China, and in coordination with other countries and WHO. This coordination has included deploying 星空娱乐官网 staff members to work with WHO and providing active support to 星空娱乐官网 offices in affected countries. In addition, 星空娱乐官网 in response to the escalating risks of travel from China has issued a series of Travelers’ Health Notices for both Wuhan and the rest of China regarding the 2019-nCoV outbreak. On January 27, 星空娱乐官网 issued a Level 3 travel notice for travelers to avoid all nonessential travel to mainland China.**
U.S. quarantine stations, located at 18 major U.S. ports of entry, are part of a comprehensive regulatory system authorized under section 361 of the Public Health Service Act (42 U.S. Code Section 264), that limits the introduction of infectious diseases into the United States to prevent their spread. On January 17, consistent with existing communicable disease response protocols, 星空娱乐官网 Quarantine staff members instituted enhanced entry screening of travelers on direct and connecting flights from Wuhan, China, arriving at three major U.S. airports: Los Angeles (LAX), New York City (JFK), and San Francisco (SFO),†† which then expanded to include travelers arriving in Atlanta (ATL) and Chicago (ORD). These five airports together receive approximately 85% of all air travelers from Wuhan, China, to the United States. U.S. Customs and Border Protection officers identified travelers arriving from Wuhan and referred them to 星空娱乐官网 for health screening.§§ Any traveler from Wuhan with signs or symptoms of illness (e.g., fever, cough, or difficulty breathing) received a more comprehensive public health assessment performed by 星空娱乐官网 public health and medical officers.¶¶ All travelers from Wuhan were also provided 星空娱乐官网’s Travel Health Alert Notice (T-HAN)*** that advised them to monitor their health for 14 days and described recommended actions to take if relevant symptoms develop. As of February 1, 2020, a total of 3,099 persons on 437 flights were screened; five symptomatic travelers were referred by 星空娱乐官网 to local health care providers for further medical evaluation, and one of these persons tested positive for 2019-nCoV.
On January 24, 2020, travel bans began to be instituted by the Chinese government, resulting in restricted travel in and out of Hubei Province, including the city of Wuhan, and fewer travelers undergoing entry screening in the United States. In response to the escalating risks associated with travel from mainland China, on January 31, 2020, the Presidential Proclamation further refined the border health strategy to temporarily suspend entry, undergo additional screening, or possible quarantine for individuals that have visited China (excluding Hong Kong, Macau, and Taiwan) in the past 14 days. These enhanced entry screening efforts are taking place at 11 airports at which all air travelers from China are being directed.
Laboratory and Diagnostic Support
Chinese health officials posted the full 2019-nCoV genome sequence on January 10, 2020, to inform the development of specific diagnostic tests for this emergent coronavirus (1). Within a week, 星空娱乐官网 developed a Clinical Laboratory Improvement Amendments–approved real-time RT-PCR test that can diagnose 2019-nCoV respiratory samples from clinical specimens. On January 24, 星空娱乐官网 publicly posted the assay protocol for this test (/coronavirus/2019-nCoV/lab/index.html). On January 4, 2020, the Food and Drug Administration issued an Emergency Use Authorization to enable emergency use of 星空娱乐官网’s 2019-nCoV Real-Time RT-PCR Diagnostic Panel. To date, this test has been limited to use at 星空娱乐官网 laboratories. This authorization allows the use of the test at any 星空娱乐官网-qualified lab across the country. 星空娱乐官网 is working closely with FDA and public health partners, including the American Public Health Laboratories, to rapidly share these tests domestically and internationally through 星空娱乐官网’s International Reagent Resource (). In addition, 星空娱乐官网 uploaded the genome of the virus from the first reported cases in the United States to GenBank, the National Institutes of Health genetic sequence database of publicly available DNA sequences (). 星空娱乐官网 also is growing the virus in cell culture, which is necessary for further studies, including for additional genetic characterization. Once isolated, the virus will be made available through BEI Resources () to assist research efforts.
Clinical and Infection Control Guidance
Additional information about 2019-nCoV is needed to better understand transmission, disease severity, and risk to the general population. Although 星空娱乐官网 and partners are actively learning about 2019-nCoV, initial 星空娱乐官网 guidance is based on guidance for management and prevention of respiratory illnesses including influenza, MERS, and SARS. No vaccine or specific treatment for 2019-nCoV infection is currently available. At present, medical care for patients with 2019-nCoV is supportive.
On January 31, 星空娱乐官网 published its third Health Advisory with interim guidance for clinicians and public health practitioners.††† In addition, 星空娱乐官网 issued a Clinical Action Alert through its Clinician Outreach and Communication Activity network on January 31.§§§ Interim guidance for health care professionals is available at /coronavirus/2019-nCoV/hcp/clinical-criteria.html. Health care providers should identify patients who might have been exposed and who have signs or symptoms related to 2019-nCoV infection, isolate these patients, and inform public health departments. This includes obtaining a detailed travel history for patients being evaluated with fever and lower respiratory tract illness. Criteria to guide evaluation and testing of PUIs for 2019-nCoV include 1) fever or signs or symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) in any person, including health care workers, who has had close contact¶¶¶ with a patient with laboratory-confirmed 2019-nCoV infection within 14 days of symptom onset; 2) fever and signs or symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) in any person with a history of travel from Hubei Province, China, within 14 days of symptom onset; or 3) fever and signs or symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) requiring hospitalization in any person with a history of travel from mainland China within 14 days of symptom onset. Additional nonhospitalized PUIs may be tested based on consultation with state and local public health officials. Clinicians should evaluate PUIs for other possible causes of illness (e.g., influenza and respiratory syncytial virus) as clinically indicated.
星空娱乐官网 currently recommends a cautious approach to the examination of PUIs. These patients should be asked to wear a surgical mask as soon as they are identified, and directed to a separate area, if possible, separated by at least 6 ft (2 m) from other persons. Patients should be evaluated in a private room with the door closed, ideally an airborne infection isolation room, if available. Health care personnel entering the room should use standard precautions, contact precautions, airborne precautions, and eye protection (e.g., goggles or a face shield).
Clinicians should immediately notify the health care facility’s infection control personnel and local health department. The health department will determine whether the patient needs to be considered a PUI for 2019-nCoV and be tested for infection. If directed by the health department, to increase the likelihood of detecting 2019-nCoV infection, 星空娱乐官网 recommends collecting and testing both upper and lower respiratory tract specimens.**** Additional specimen types (e.g., stool or urine) may be collected and stored. Specimens should be collected as soon as possible once a PUI is identified regardless of time since symptom onset.
For persons who might have 2019-nCoV infection and their close contacts, information and guidance on how to reduce the risk for transmitting and acquiring infection is available at /coronavirus/2019-ncov/hcp/guidance-prevent-spread.html. Close contacts should immediately call their health care providers if they develop symptoms. In addition, 星空娱乐官网 is working closely with state and local health partners to develop and disseminate information to the public on general prevention of respiratory illness, including the 2019-nCoV. This includes everyday preventive actions such as washing your hands, covering your cough, and staying home when you are ill. Additional information and resources for this outbreak are available on the 星空娱乐官网 website (/coronavirus/2019-ncov/index.html).
Discussion
The 2019-nCoV has impacted multiple countries, caused severe illness, and sustained person-to-person transmission making it a concerning and serious public health threat. It is unclear how this virus will impact the U.S. over time. For the general population, who are unlikely to be exposed to this virus at the current time, the immediate health risk from 2019-nCoV is considered low. 星空娱乐官网, multiple other federal agencies, state and local health departments, and other partners are implementing aggressive measures to slow U.S. transmission of 2019-nCoV (4,5). These measures require the identification of cases and contacts in the United States and the effective management of the estimated 14,000 travelers arriving from mainland China to the United States each day (3). These measures are being implemented based on the assumption that there will be more U.S. 2019-nCoV cases occurring with potential chains of transmission, with the understanding that these measures might not prevent the eventual establishment of ongoing, widespread transmission of the virus in the United States.
It is important for public health agencies, health care providers, and the public to be aware of this new 2019-nCoV so that coordinated, timely, and effective actions can help prevent additional cases or poor health outcomes. The critical role that the U.S. health care system plays in halting or significantly slowing U.S. transmission of 2019-nCoV is already evident: eight of the first 11 U.S. cases were detected by clinicians collaborating with public health to test persons at risk. The early recognition of cases in the United States reduces transmission risk and increases understanding of the virus, including its transmission and severity, to inform national and global response actions.
2019-nCoV symptoms are similar to those of influenza (e.g., fever, cough, or sore throat), and the outbreak is occurring during a time of year when respiratory illnesses from influenza, respiratory syncytial virus, and other respiratory viruses are highly prevalent. To prevent influenza, all persons aged ≥6 months should receive an annual influenza vaccine, and vaccination is still available and effective in helping to prevent influenza (10). Reducing the number of persons in the United States with seasonal influenza will reduce possible confusion with 2019-nCoV infection and possible additional risk to patients with seasonal influenza. Public health authorities are monitoring the situation closely. As more is learned about this novel virus and this outbreak, 星空娱乐官网 will rapidly incorporate new knowledge into guidance for action.
Acknowledgments
Arizona Department of Health Services; Maricopa County Department of Public Health; California Department of Public Health; Los Angeles County Department of Public Health; Orange County Health Department; San Benito County Public Health Services Department; Santa Clara County Public Health Department; Illinois Department of Public Health; Chicago Department of Public Health; Cook County Department of Public Health; DuPage County Health Department; Massachusetts Department of Public Health; Washington State Department of Health; Snohomish Health District.
2019-nCoV 星空娱乐官网 Response Team
Fatuma Abdirizak, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Glen Abedi, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Sharad Aggarwal, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Denise Albina, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Elizabeth Allen, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Lauren Andersen, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Jade Anderson, Center for Preparedness and Response, 星空娱乐官网; Megan Anderson, Center for Preparedness and Response, 星空娱乐官网; Tara Anderson, Center for State, Tribal, Local and Territorial Support, 星空娱乐官网; Kayla Anderson, National Center on Birth Defects and Developmental Disabilities, 星空娱乐官网; Ana Cecilia Bardossy, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Vaughn Barry, National Center for Injury Prevention and Control, 星空娱乐官网; Karlyn Beer, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Michael Bell, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Sherri Berger, Office of the Director, 星空娱乐官网; Joseph Bertulfo, Office of the Director, 星空娱乐官网; Holly Biggs, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Jennifer Bornemann, Office of the Director, 星空娱乐官网; Josh Bornstein, Office of the Director, 星空娱乐官网; Willie Bower, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Joseph Bresee, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Clive Brown, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Alicia Budd, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Jennifer Buigut, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Stephen Burke, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Rachel Burke, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Erin Burns, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Jay Butler, Office of the Deputy Director of Infectious Disease, 星空娱乐官网; Russell Cantrell, Center for State, Tribal, Local and Territorial Support, 星空娱乐官网; Cristina Cardemil, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Jordan Cates, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Marty Cetron, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Kevin Chatham-Stephens, National Center on Birth Defects and Developmental Disabilities, 星空娱乐官网; Kevin Chatham-Stevens, National Center on Birth Defects and Developmental Disabilities, 星空娱乐官网; Nora Chea, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Bryan Christensen, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Victoria Chu, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Kevin Clarke, Center for Global Health, 星空娱乐官网; Angela Cleveland, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Nicole Cohen, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Max Cohen, Center for State, Tribal, Local and Territorial Support, 星空娱乐官网; Amanda Cohn, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Jennifer Collins, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Erin Conners, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Aaron Curns, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Rebecca Dahl, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Walter Daley, Center for Preparedness and Response, 星空娱乐官网; Vishal Dasari, Center for State, Tribal, Local and Territorial Support, 星空娱乐官网; Elizabeth Davlantes, Center for State, Tribal, Local and Territorial Support, 星空娱乐官网; Patrick Dawson, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Lisa Delaney, National Institute for Occupational Safety and Health, 星空娱乐官网; Matthew Donahue, Center for State, Tribal, Local and Territorial Support, 星空娱乐官网; Chad Dowell, National Institute for Occupational Safety and Health, 星空娱乐官网; Jonathan Dyal, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; William Edens, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Rachel Eidex, , National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Lauren Epstein, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Mary Evans, National Center for Injury Prevention and Control, 星空娱乐官网; Ryan Fagan, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Kevin Farris, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Leora Feldstein, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; LeAnne Fox, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Mark Frank, Center for Preparedness and Response, 星空娱乐官网; Brandi Freeman, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Alicia Fry, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; James Fuller, Center for Global Health, 星空娱乐官网; Romeo Galang, National Center for Chronic Disease Prevention and Promotion, 星空娱乐官网; Sue Gerber, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Runa Gokhale, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Sue Goldstein, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Sue Gorman, Center for Preparedness and Response, 星空娱乐官网; William Gregg, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; William Greim, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Steven Grube, Office of the Director, 星空娱乐官网; Aron Hall, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Amber Haynes, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Sherrasa Hill, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Jennifer Hornsby-Myers, National Institute for Occupational Safety and Health, 星空娱乐官网; Jennifer Hunter, , National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Christopher Ionta, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Cheryl Isenhour, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Max Jacobs, Center for State, Tribal, Local and Territorial Support, 星空娱乐官网; Kara Jacobs Slifka, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Daniel Jernigan, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Michael Jhung, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Jamie Jones-Wormley, Center for Preparedness and Response, 星空娱乐官网; Anita Kambhampati, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Shifaq Kamili, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Pamela Kennedy, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Charlotte Kent, Center for Surveillance Epidemiology and Laboratory Services, 星空娱乐官网; Marie Killerby, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Lindsay Kim, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Hannah Kirking, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Lisa Koonin, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Ram Koppaka, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Christine Kosmos, Center for Preparedness and Response, 星空娱乐官网; David Kuhar, National Center for Emerging and Zoonotic Infectious Diseases 星空娱乐官网; Wendi Kuhnert-Tallman, Deputy Director for Infectious Diseases, 星空娱乐官网; Stephanie Kujawski, National Center for Immunization and Respiratory Diseases 星空娱乐官网; Archana Kumar, , National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Alexander Landon, Office of the Director, 星空娱乐官网; Leslie Lee, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Jessica Leung, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Stephen Lindstrom, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Ruth Link-Gelles, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Joana Lively, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Xiaoyan Lu, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Brian Lynch, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Lakshmi Malapati, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Samantha Mandel, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Brian Manns, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Nina Marano, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Mariel Marlow, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Barbara Marston, Center for Global Health, 星空娱乐官网; Nancy McClung, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Liz McClure, Center for Global Health, 星空娱乐官网; Emily McDonald, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Oliva McGovern, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Nancy Messonnier, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Claire Midgley, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Danielle Moulia, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Janna Murray, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Kate Noelte, Center for Preparedness and Response, 星空娱乐官网; Michelle Noonan-Smith, Office of the Director, 星空娱乐官网; Kristen Nordlund, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Emily Norton, National Institute for Occupational Safety and Health, 星空娱乐官网; Sara Oliver, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Mark Pallansch, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Umesh Parashar, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Anita Patel, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Manisha Patel, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Kristen Pettrone, National Center for Health Statistics, 星空娱乐官网; Taran Pierce, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Harald Pietz, Center for Preparedness and Response, 星空娱乐官网; Satish Pillai, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Lewis Radonovich, National Institute for Occupational Safety and Health, 星空娱乐官网; Sarah Reagan-Steiner, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Amy Reel, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Heather Reese, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Brian Rha, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Philip Ricks, Center for Global Health, 星空娱乐官网; Melissa Rolfes, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Shahrokh Roohi, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Lauren Roper, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Lisa Rotz, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Janell Routh, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Senthil Kumar Sakthivel, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Luisa Sarmiento, National Institute for Occupational Safety and Health, 星空娱乐官网; Jessica Schindelar, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Eileen Schneider, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Anne Schuchat, Office of the Director, 星空娱乐官网; Sarah Scott, Center for State, Tribal, Local and Territorial Support, 星空娱乐官网; Varun Shetty, Center for State, Tribal, Local and Territorial Support, 星空娱乐官网; Caitlin Shockey, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Jill Shugart, National Institute for Occupational Safety and Health, 星空娱乐官网; Mark Stenger, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention 星空娱乐官网; Matthew Stuckey, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Brittany Sunshine, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Tamara Sykes, Office of the Director, 星空娱乐官网; Jonathan Trapp, Office of the Director, 星空娱乐官网; Timothy Uyeki, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Grace Vahey, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Amy Valderrama, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Julie Villanueva, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Tunicia Walker, Center for Preparedness and Response, 星空娱乐官网; Megan Wallace, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Lijuan Wang, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; John Watson, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Angie Weber, National Institute for Occupational Safety and Health, 星空娱乐官网; Cindy Weinbaum, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; William Weldon, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Caroline Westnedge, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Brett Whitaker, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Michael Whitaker, National Center for Immunization and Respiratory Diseases, 星空娱乐官网; Alcia Williams, Office of the Director, 星空娱乐官网; Holly Williams, Office of the Director, 星空娱乐官网; Ian Willams, National Center for Emerging and Zoonotic Infectious Diseases, 星空娱乐官网; Karen Wong, Center for Surveillance, Epidemiology and Laboratory Services, 星空娱乐官网; Amy Xie, Center for State, Tribal, Local and Territorial Support, 星空娱乐官网; Anna Yousef, National Center for Immunization and Respiratory Diseases, 星空娱乐官网.
Corresponding author: Anita Patel, APatel7@cdc.gov, 770-488-7100.
All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.
* Includes any of the following: dyspnea, respiratory rate >30 breaths per minute, hypoxemia, or chest x-ray with multilobar infiltrates or >50% progression of pulmonary infiltration within 24–48 hours per WHO. .
† .
§ .
¶ Criteria to guide evaluation and testing of patients under investigation for 2019-nCoV include 1) fever or signs or symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) in any person, including a health care worker, who has had close contact with a patient with laboratory-confirmed 2019-nCoV infection within 14 days of symptom onset; 2) fever and signs or symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) in any person with a history of travel from Hubei Province, China, within 14 days of symptom onset; or 3) fever and signs or symptoms of lower respiratory tract illness (e.g., cough or shortness of breath) requiring hospitalization in any person with a history of travel from mainland China within 14 days of symptom onset. More information is available at and .
** .
†† /media/releases/2020/p0117-coronavirus-screening.html.
§§ 星空娱乐官网’s initial health screening includes a measurement of each traveler’s temperature with a handheld noncontact thermometer, observation of these travelers for visible signs of respiratory illness (e.g., cough or difficulty breathing), and review of symptoms through a self-administered questionnaire.
¶¶ The more comprehensive public health assessment determines, based on the traveler’s illness and exposure, whether the traveler should be taken to a hospital for further medical evaluation and care, which might include testing for 2019-nCoV.
*** /coronavirus/2019-ncov/travelers/communication-resources.html.
††† .
§§§ .
¶¶¶ Close contact is defined as 1) being within approximately 6 ft (2 m) of a 2019-nCoV patient for a prolonged period while not wearing recommended personal protective equipment (PPE) (e.g., gowns, gloves, National Institute for Occupational Safety and Health–certified disposable N95 respirator, and eye protection); close contact can occur while caring for, living with, visiting, or sharing a health care waiting area or room with a 2019-nCoV patient; or 2) having direct contact with infectious secretions of a 2019-nCoV patient (e.g., being coughed on) while not wearing recommended PPE.
**** /coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html.
References
- World Health Organization. Novel coronavirus (2019-nCoV). Situation report 1. Geneva, Switzerland: World Health Organization; 2020.
- World Health Organization. Novel coronavirus(2019-nCoV). Situation report 15. Geneva, Switzerland: World Health Organization; 2020.
- Office of the President. Proclamation on suspension of entry as immigrants and nonimmigrants of persons who pose a risk of transmitting 2019 novel coronavirus. Washington, DC: Office of the President; 2020.
- Holloway R, Rasmussen SA, Zaza S, Cox NJ, Jernigan DB. Updated preparedness and response framework for influenza pandemics. MMWR Recomm Rep 2014;63(No. RR-6).
- Reed C, Biggerstaff M, Finelli L, et al. Novel framework for assessing epidemiologic effects of influenza epidemics and pandemics. Emerg Infect Dis 2013;19:85–91.
- Lu R, Zhao X, Li J, et al. Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020. Epub January 29, 2020.
- Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020.Epub January 29, 2020.
- Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020. Epub January 30, 2020.
- Hunag C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020. Epub January 24, 2020.
- Grohskopf LA, Alyanak E, Broder KR, Walter EB, Fry AM, Jernigan DB. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices—United States, 2019–20 influenza season. MMWR Recomm Rep 2019;68(No. RR-3).
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Abbreviations: F = female; M = male.
Suggested citation for this article: Patel A, Jernigan DB. Initial Public Health Response and Interim Clinical Guidance for the 2019 Novel Coronavirus Outbreak — United States, December 31, 2019–February 4, 2020. MMWR Morb Mortal Wkly Rep 2020;69:140–146. DOI: .
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