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Early Transmission Patterns of Coronavirus Disease 2019 (COVID-19) in Travellers from Wuhan to Thailand, January 2020

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Early Transmission Patterns of Coronavirus Disease 2019 (COVID-19) in Travellers from Wuhan to Thailand, January 2020 Rapid communication Early transmission patterns of coronavirus disease 2019 (COVID-19) in travellers from Wuhan to Thailand, January 2020 Pilailuk Okada¹ , Rome Buathong² , Siripaporn Phuygun¹ , Thanutsapa Thanadachakul¹ , Sittiporn Parnmen¹ , Warawan Wongboot¹ , Sunthareeya Waicharoen¹ , Supaporn Wacharapluesadee³ , Sumonmal Uttayamakul² , Apichart Vachiraphan2 , Malinee Chittaganpitch¹ , Nanthawan Mekha¹ , Noppavan Janejai¹ , Sopon Iamsirithaworn² , Raphael TC Lee⁴ , Sebastian Maurer- Stroh4,5 1. Department of Medical Sciences, Ministry of Public Health, Thailand 2. Department of Disease Control, Ministry of Public Health, Thailand 3. Thai Red Cross Emerging Infectious Diseases - Health Science Centre, Chulalongkorn University, Thailand 4. Bioinformatics Institute, Agency for Science Technology and Research, Singapore 5. Department of Biological Sciences, National University of Singapore, Singapore Correspondence: Pilailuk Okada ([email protected]) Citation style for this article: Okada Pilailuk , Buathong Rome , Phuygun Siripaporn , Thanadachakul Thanutsapa , Parnmen Sittiporn , Wongboot Warawan , Waicharoen Sunthareeya , Wacharapluesadee Supaporn , Uttayamakul Sumonmal , Vachiraphan Apichart , Chittaganpitch Malinee , Mekha Nanthawan , Janejai Noppavan , Iamsirithaworn Sopon , Lee Raphael TC , Maurer-Stroh Sebastian . Early transmission patterns of coronavirus disease 2019 (COVID-19) in travellers from Wuhan to Thailand, January 2020. Euro Surveill. 2020;25(8):pii=2000097. https://doi.org/10.2807/1560-7917.ES.2020.25.8.2000097 Article submitted on 06 Feb 2020 / accepted on 27 Feb 2020 / published on 27 Feb 2020 We report two cases of coronavirus disease 2019 arrival gate was 38.6 °C by thermoscanner, and con- (COVID-19) in travellers from Wuhan, China to firmed with a tympanic thermometer. After being inter- Thailand. Both were independent introductions on viewed by quarantine officers, she was transferred to separate flights, discovered with thermoscanners Bamrasnaradura Infectious Disease Institute (BIDI) and confirmed with RT-PCR and genome sequencing. Hospital, Nonthaburi, for isolation and laboratory inves- Both cases do not seem directly linked to the Huanan tigations. She reported a runny nose and sore throat Seafood Market in Hubei but the viral genomes are but no dyspnea or diarrhoea. Upon admission, her vital identical to four other sequences from Wuhan, sug- signs were normal except for elevated blood pressure. gesting early spread within the city already in the first Her physical examination was unremarkable including week of January. inconspicuous lung sounds. Her complete blood count suggested a viral infection from relatively decreased In late December 2019, an outbreak with an initially neutrophil (48%; norm: 35–75%) to lymphocyte (40%; undiagnosed pneumonia was reported in the city of norm: 20–59%) ratio [8]. The chest X-ray (CXR) results Wuhan, Hubei Province, China, and linked to the Huanan on 8 January were compatible with pneumonia with Seafood Market [1,2]. The causative pathogen was mild thickening lung marking at both lower lungs pos- identified as a novel betacoronavirus within the severe sibly because of crowded lung rather than infiltration. acute respiratory syndrome (SARS) coronavirus (CoV) It also showed borderline cardiomegaly. Repeat CXR family, recently termed SARS-CoV-2 [3-7]. In response after 7 days showed no remarkable changes. to the outbreak, several countries including Thailand, established thermal screening at the airport for travel- In the interview, the patient explicitly stated that she lers from Wuhan since 3 January. On 8 January and 13 had not visited the Huanan Seafood Market but she January, suspected cases of infection with SARS-CoV-2 was living near another local market, which she visited were identified at Bangkok Suvarnabhumi airport. We daily until illness onset. This market was at ca 7.5 km report the investigation, basic clinical characteristics distance from the Huanan Seafood Market. The patient and viral genomes derived from these cases. also reported that she had not purchased live animals and or visited stalls with live animals. She did not visit Case 1 Jinyintai Hospital or other hospitals in Wuhan. However, A woman in her early 60s from Wuhan developed a she visited local dispensaries in Wuhan to obtain medi- fever with chills, sore throat and headache on 5 January cation. She also reported no contact with persons with 2020. She went to a local health facility in China and respiratory symptoms. received undisclosed medication. On 8 January 2020, she took a direct ca 4 h flight to Thailand from Wuhan, Clinical specimens collected on admission included with five family members, as part of a tour group of 16 the upper respiratory tract secretions and sputum. (including the case). Her measured temperature at the These specimens tested positive on 12 January for the www.eurosurveillance.org 1 Figure 1 Phylogenetic trees of Thai sequences in context of all coronavirus families (A) and structural mapping of mutations in the spike glycoprotein between SARS CoV (PDB:6CG [12]) and the current SARS-CoV-2 using YASARA [20] (B) A. B. 100 Bovine respiratory coronavirus AH187/NC 012948/1-30969 100 Bovine coronavirus/NC 003045/1-31028 100 Bovine respiratory coronavirus bovine/US/OH-440-TC/1996/NC 012949/1-30953 100 Human enteric coronavirus strain 4408/NC 012950/1-30953 100 Human coronavirus OC43/NC 005147/1-30738 100 Porcine hemagglutinating encephalomyelitis virus/NC 007732/1-30480 Equine coronavirus/NC 010327/1-30992 100 Rabbit coronavirus HKU14/NC 017083/1-31100 Rat coronavirus Parker/NC 012936/1-31250 100 Murine hepatitis virus strain A59/NC 001846/1-31357 100 100 Murine hepatitis virus strain JHM/NC 006852/1-31526 94 Human coronavirus HKU1/NC 006577/1-29926 Bat coronavirus HKU9-1/NC 009021/1-29114 100 Human betacoronavirus 2c EMC 2012/JX869059/1-30118 100 Bat coronavirus HKU5-1/NC 009020/1-30482 100 Bat coronavirus HKU4-1/NC 009019/1-30286 100 Bat coronavirus BtCoV/133/2005/NC 008315/1-30307 100 100 Bat coronavirus BM48-31/BGR/2008/NC 014470/1-29276 SARS coronavirus/NC 004718/1-29751 100 100 MG772933.1 Bat SARS-like coronavirus isolate bat-SL-CoVZC45/1-29802 100 MG772934.1 Bat SARS-like coronavirus isolate bat-SL-CoVZXC21/1-29732 100 BetaCoV/Nonthaburi/61/2020|EPI ISL 403962/1-29848 100 BetaCoV/Nonthaburi/74/2020|EPI ISL 403963/1-29859 Feline infectious peritonitis virus/NC 002306/1-29355 49 Human coronavirus NL63/NC 005831/1-27553 100 Human coronavirus 229E/NC 002645/1-27317 Bat coronavirus HKU2/NC 009988/1-27165 52 100 Scotophilus bat coronavirus 512/NC 009657/1-28203 81 Porcine epidemic diarrhea virus/NC 003436/1-28033 85 Bat coronavirus HKU8/NC 010438/1-28773 Bat coronavirus 1B/NC 010436/1-28476 100 100 Bat coronavirus 1A/NC 010437/1-28326 100 Turkey coronavirus/NC 010800/1-27657 100 Avian infectious bronchitis virus/NC 001451/1-27608 Beluga Whale coronavirus SW1/NC 010646/1-31686 44 Night-heron coronavirus HKU19/NC 016994/1-26077 Wigeon coronavirus HKU20/NC 016995/1-26227 Common-moorhen coronavirus HKU21/NC 016996/1-26223 100 Thrush coronavirus HKU12-600/NC 011549/1-26396 49 White-eye coronavirus HKU16/NC 016991/1-26041 100 100 Munia coronavirus HKU13-3514/NC 011550/1-26552 100 Magpie-robin coronavirus HKU18/NC 016993/1-26689 100 Sparrow coronavirus HKU17/NC 016992/1-26083 100 Porcine coronavirus HKU15/NC 016990/1-25437 CoV: coronavirus; MERS: Middle East respiratory syndrome coronavirus; SARS: severe acute respiratory syndrome. Panel A: blue: SARS-CoV-2; red: SARS; purple: MERS; green: common cold. Panel B: cyan: ACE2 human host receptor; grey: CoV spike glycoprotein trimer (PDB:6ACG); red: mutations between SARS-CoV vs SARS-CoV-2. The phylogenetic tree was created from whole genome alignment with MAFFT using the neighbour-joining method with maximum composite likelihood (MCL) model, uniform site rates and 500 bootstrap tests using MEGA X. CoV family by using a conventional nested RT-PCR [9]. thermoscanner detected a fever of 38.0 °C that was Genomic sequencing analysis included Sanger and confirmed with a tympanic thermometer. The patient next generation sequencing were performed by the reported a sore throat, that her fever onset date was 13 Emerging Infectious Diseases Health Science Center, January and that she had a cough for an undetermined the Thai Red Cross Society and the Thai National period. The patient was hospitalised at BIDI. Upon Institute of Health, Department of Medical Sciences admission, she reported mild tachypnoea, and her and the sequence shared via the Global Initiative CXR was compatible with pneumonia. Similar to case on Sharing All Influenza Data (GISAID) EpiCoV data- 1, the first CXR taken on 13 January, showed thickening base (EPI_ISL_403962). The sequencing protocol and interstitial lung marking at both lower lung fields and details are provided in the Supplementary Materials. both perihilar regions because of interstitial infiltra- The patient recovered after testing negative for SARS- tion or crowded lung marking, mild cardiomegaly and CoV-2, and returned to China without signs and symp- dilated aorta. Follow-up CXR on 17 January additionally toms on 18 January 2020. showed recent hazy with reticular opacities at left mid- dle lung field. The patient was not in severe condition Case 2 but stable. A woman in her mid-70s from Wuhan landed at Suvarnabhumi airport on 13 January. She travelled In the patient interview, she reported that she did not to Thailand with three family members as part of visit the Huanan Seafood
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