key: cord-0713392-wks9pkpd authors: Kim, Il-Hwan; Jang, Jun Hyeong; Jo, Su-Kyoung; No, Jin Sun; Seo, Seung-Hee; Kim, Jun-Young; Jung, Sang-Oun; Kim, Jeong-Min; Lee, Sang-Eun; Park, Hye-Kyung; Kim, Eun-Jin; Jeon, Jun Ho; Choi, Myung-Min; Ryu, Boyeong; Jang, Yoon Suk; Kim, Hwami; Lee, Jin; Shin, Seung-Hwan; Kim, Hee Kyoung; Kim, Eun-Kyoung; Park, Ye Eun; Yoo, Cheon-Kwon; Lee, Sang-Won; Han, Myung-Guk; Rhie, Gi-Eun; Kang, Byung Hak title: 2019 Tabletop Exercise for Laboratory Diagnosis and Analyses of Unknown Disease Outbreaks by the Korea Centers for Disease Control and Prevention date: 2020-10-03 journal: Osong Public Health Res Perspect DOI: 10.24171/j.phrp.2020.11.5.03 sha: 85aafe0fe0161b0518504d19e3029deff9ed0ca2 doc_id: 713392 cord_uid: wks9pkpd OBJECTIVES: The Korea Centers for Disease Control and Prevention has published “A Guideline for Unknown Disease Outbreaks (UDO).” The aim of this report was to introduce tabletop exercises (TTX) to prepare for UDO in the future. METHODS: The UDO Laboratory Analyses Task Force in Korea Centers for Disease Control and Prevention in April 2018, assigned unknown diseases into 5 syndromes, designed an algorithm for diagnosis, and made a panel list for diagnosis by exclusion. Using the guidelines and laboratory analyses for UDO, TTX were introduced. RESULTS: Since September 9(th), 2018, the UDO Laboratory Analyses Task Force has been preparing TTX based on a scenario of an outbreak caused by a novel coronavirus. In December 2019, through TTX, individual missions, epidemiological investigations, sample treatments, diagnosis by exclusions, and next generation sequencing analysis were discussed, and a novel coronavirus was identified as the causal pathogen. CONCLUSION: Guideline and laboratory analyses for UDO successfully applied in TTX. Conclusions drawn from TTX could be applied effectively in the analyses for the initial response to COVID-19, an ongoing epidemic of 2019 – 2020. Therefore, TTX should continuously be conducted for the response and preparation against UDO. With the recent increase in the occurrence of emerging and variant infectious diseases, the risk of infectious disease outbreaks have increased. During the past 2 decades, around 20 different types of infectious diseases have emerged including severe acute respiratory syndrome (SARS; 2002) [1] , influenza A caused by the H1N1 virus (2009) [2] , Dabie bandavirus causing severe fever with thrombocytopenia syndrome (SFTS) (2009) [3] , Middle East respiratory syndrome (MERS) (2012) [4] , and febrile illness caused by the Alongshan virus (2017) [5] . Emerging infectious diseases will continue to occur in future and Coronavirus disease 2019 (COVID-19) is the latest infectious disease to cause a pandemic [6] . The term "unknown disease outbreaks" is described by the world health organization (WHO) as a cluster of outbreaks or diseases of unknown etiology [7] . The CDC, in the US have stated that an "unexplained respiratory disease outbreak" is a case where the causal pathogen of the respiratory disease cannot be determined [8] . The KCDC defines "unknown disease outbreaks" as "cases where an unidentified pathogen (cause) is spatially and temporally associated with a disease (including severe cases and death), leading to outbreaks" [9] . In 2019, the KCDC published a guideline in response to UDO. The guideline focused on the response to the occurrence or predicted occurrence of an infectious disease or a disease of unknown etiology. According to the guidelines, a health professional or the director of a medical institution may request an epidemiological investigation from the director of the KCDC in cases of UDO. The KCDC runs a surveillance system, which includes a patient based surveillance system such as the Emergency Department syndrome monitoring system, patient monitoring system (for severe acute respiratory infection and influenzalike illness), laboratory based monitoring system (influenza and respiratory viruses), and acute respiratory infectious network. A case based monitoring system is also in operation using the 1339 call-line or press release. When a request is made by local government for an epidemiological investigation for UDO, such Regarding the laboratory diagnosis system for an unknown disease, the laboratory diagnosis algorithm for syndromes or the WHO guidelines on clinical sample collection should be referred to according to the given case [10] . If the cause of the unknown disease is pathogenic infection, the patient and follow-up management of the exposed individuals is carried out. If the unknown disease has been identified as noninfectious, the task is transferred to the relevant department or institution. The Unknown Disease Outbreak Laboratory Analyses Task were admitted to, began to show similar symptoms. On December 17 th , 2019, TTX (using the cases presented) Without prior experience of UDO, TTX reported in this study were conducted to address any weaknesses in the response process by providing an opportunity to examine and practice in advance the requirements in an actual case. The training results were effectively and appropriately utilized to respond and to identify the causal pathogen of COVID-19. Thus, TTX serve as an extremely useful practice for optimizing responses to UDO that may occur in future. Therefore, TTX should continue to be used to provide training to ensure preparedness against various emerging infectious diseases in future. The authors have no conflicts of interest to declare. Coronavirus as a possible cause of severe acute respiratory syndrome Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 influenza. Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection Severe fever with thrombocytopenia syndrome, an emerging tick-borne zoonosis Isolation of a novel coronavirus form a man with pneumonia in Saudi Arabia A new segmented virus associated with human febrile illness in China The proximal origin of SARS-CoV-2 Unexplained respiratory disease outbreak Disease outbreak of unknown etiology Guideline for preparedness and response of unknown disease outbreak Guideline for the collection of clinical specimens during field investigation of outbreaks We wish to thank the KCDC EIS officers and committee members for laboratory analyses of UDO. This work was funded by the KCDC (no.: 4800-4837-301).