key: cord-1055974-tolwbvwg authors: Olsen, Sonja J.; Chen, Meng-Yu; Liu, Yu-Lun; Witschi, Mark; Ardoin, Alexis; Calba, Clémentine; Mathieu, Pauline; Masserey, Virginie; Maraglino, Francesco; Marro, Stefano; Penttinen, Pasi; Robesyn, Emmanuel; Pukkila, Jukka title: Early Introduction of Severe Acute Respiratory Syndrome Coronavirus 2 into Europe date: 2020-07-03 journal: Emerg Infect Dis DOI: 10.3201/eid2607.200359 sha: 07188fecadaedb05156e72e0ef7173b6b8fd7e9e doc_id: 1055974 cord_uid: tolwbvwg Early infections with severe acute respiratory syndrome coronavirus 2 in Europe were detected in travelers from Wuhan, China, in January 2020. In 1 tour group, 5 of 30 members were ill; 3 cases were laboratory confirmed. In addition, a healthcare worker was infected. This event documents early importation and subsequent spread of the virus in Europe. Early infections with severe acute respiratory syndrome coronavirus 2 in Europe were detected in travelers from Wuhan, China, in January 2020. In 1 tour group, 5 of 30 members were ill; 3 cases were laboratory confirmed. In addition, a healthcare worker was infected. This event documents early importation and subsequent spread of the virus in Europe. the patients or any personal protective equipment for the physician. Also present was another member of the group who translated. While in Paris, the 3 ill persons bought surgical face masks and began wearing them on January 21 (mother and daughter) and on January 22 (tour guide). The tour group departed on January 24 from Paris to Guangzhou, China (arrival on January 25), because Wuhan ceased air traffic on January 23. The tour guide subsequently continued from Guangzhou to Taipei on January 25, where she arrived on January 25 and was hospitalized. After returning to China, 2 additional tour members, including the tour leader, reported illness and were hospitalized in Hubei and Jiangsu Provinces, where they showed positive test results for SARS-CoV-2. Five (17%) of the 30 tour members were ill; 3 had laboratory-confirmed infection, and 2 were never tested. Because of prolonged and overlapping exposure of the group, it is impossible to determine the exact source of all infections. The source for the physician could have been the ill suspected case-patients, whose infections were never confirmed, or the then-presymptomatic person who translated (contact was 2 days before illness onset). The tour group was a fairly contained group that did not have much prolonged contact with others. Other than the 3 ill persons, the group members did not wear masks during the tour. As part of the investigation, the countries the tour visited identified low-risk (<15 min, >1-2 m) and high-risk (>15 min, <1-2 m) contacts (8) . Most transport was made by using 1 bus, except for 1 section of travel by train in Switzerland. The bus driver, from Slovakia, was a high-risk contact; he returned to Slovakia after the tour and denied having any symptoms in the 14 days after last contact with the tour group. In Italy, because seat numbers on the flight from Wuhan to Rome, during which 1 tour group member had a cough, were not reported in the passengers list, authorities contacted and informed all passengers (n = 176) and crew members (n = 17). The information provided was to watch for development of symptoms and call if any developed. No other high-risk contacts of the symptomatic group member in Italy were identified. In Switzerland, health authorities identified 0 high-risk and 3 low-risk contacts, (1 restaurant owner and 2 shop clerks). These 3 persons were told to watch for development of symptoms and call if any developed. None were reported. In France, the group visited several tourist attractions and used public transportation; contacts in the shops and hotel were interviewed and defined as low-risk contacts. Only 1 high-risk contact was identified. This person was the physician. The physician was not wearing a mask during the consultation because he had not been informed of the risk of COVID-19. He became ill on January 28 and stopped seeing patients. He went to a designated referral hospital on January 29 and showed a positive PCR result for SARS-CoV-2 for 12 days; he has since 1568 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 26, No. 7, July 2020 Authorities in China were notified of symptomatic persons on the flight from Paris to Guangzhou. However, we were unable to confirm whether any contact tracing was performed. As of February 10, the tour guide remained hospitalized, but had a normal chest radiograph and was clinically well. She remains in isolation because of a virus-positive sputum test result 19 days after illness onset. The other 3 tour members who were ill reportedly experienced mild illness, and all are now well. Because the first 2 symptomatic persons were never tested, we cannot conclude that they were the source of infection. However, given that the virus was not circulating in France, the source was most likely in the tour group. It is also possible that additional transmission resulting in mild illness occurred, particularly in the tour group, but was not identified. This event represents early introduction of SARS-CoV-2 into Europe, before implementation of extensive travel restrictions in Wuhan on January 23, and could explain additional chains of transmission in France, where the disease has now spread widely. The event was characterized by clinically mild illness in 6 persons; 2 showed documented prolonged virus shedding. Excluding members of the tour group, 1 of 40 high-risk and 0 of 216 low-risk contacts became ill. The 1 high-risk exposure event was short but entailed close contact during a clinical examination. Assuming this was the sole exposure, the incubation time was 5 days, which is consistent with reported data. This event represented a coordinated international effort and highlights the effectiveness of working through the established mechanisms of the European Union Early Warning and Response System and the International Health Regulations. This effort will be key to the effective implementation of the current global containment strategy. Members China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (CO-VID-19) in China Real-time tentative assessment of the epidemiological characteristics of novel coronavirus infections in Wuhan, China, as at 22 Estimates of the reproduction number for seasonal, pandemic, and zoonotic influenza: a systematic review of the literature Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: a data-driven analysis in the early phase of the outbreak Novel coronavirus (2019-nCoV) early-stage importation risk to Europe Investigation Team. First cases of coronavirus disease 2019 (COVID-19) in France: surveillance, investigations and control measures We thank the Taiwanese tour guide and the French physician for providing extensive details for this study and Catherine Smallwood, Dorit Nitzan, and the European Centre for Disease Prevention Technical Group for COVID-19 for providing assistance. Dr. Olsen is a technical officer at the World Health Organization Regional Office for Europe, Copenhagen, Denmark. Her primary research interest is the epidemiology of influenza and other respiratory diseases. World Hepatitis Day, July 28 ® Viral hepatitis -a group of infectious diseases known as hepatitis A, B, C, D, and E -affects millions of people worldwide, causing acute and chronic liver disease and killing close to 1.4 million people every year. Hepatitis remains largely ignored or unknown. Transmission of this virus can be prevented through better awareness and services that improve vaccinations, promote blood and injection safety, and reduce harm. On World Hepatitis Day, July 28, CDC, along with WHO and partners focus on the prevention of viral hepatitis to raise awareness among the general public and infected patients, but also to urgently promote improved access to hepatitis services, particularly prevention interventions, by policymakers.