Journal Article

A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster

Tsoi, Hoi-Wah, Cheng, Vincent Chi-Chung, Ip, Jonathan Daniel, Cai, Jian-Piao, Chan, Jasper Fuk-Woo, Chan, Wan-Mui, Yuen, Kwok-Yung, Kok, Kin-Hang, Liu, Jieling, Chu, Hin, Xing, Fanfan, Poon, Vincent Kwok-Man, To, Kelvin Kai-Wang, Yang, Jin, Chan, Kwok-Hung, Hui, Christopher Kim-Ming, Yip, Cyril Chik-Yan, Poon, Rosana Wing-Shan, Yuan, Shuofeng, Lo, Simon Kam-Fai, Chen, Honglin

2020

Overview

An ongoing outbreak of pneumonia associated with a novel coronavirus was reported in Wuhan city, Hubei province, China. Affected patients were geographically linked with a local wet market as a potential source. No data on person-to-person or nosocomial transmission have been published to date. In this study, we report the epidemiological, clinical, laboratory, radiological, and microbiological findings of five patients in a family cluster who presented with unexplained pneumonia after returning to Shenzhen, Guangdong province, China, after a visit to Wuhan, and an additional family member who did not travel to Wuhan. Phylogenetic analysis of genetic sequences from these patients were done. From Jan 10, 2020, we enrolled a family of six patients who travelled to Wuhan from Shenzhen between Dec 29, 2019 and Jan 4, 2020. Of six family members who travelled to Wuhan, five were identified as infected with the novel coronavirus. Additionally, one family member, who did not travel to Wuhan, became infected with the virus after several days of contact with four of the family members. None of the family members had contacts with Wuhan markets or animals, although two had visited a Wuhan hospital. Five family members (aged 36–66 years) presented with fever, upper or lower respiratory tract symptoms, or diarrhoea, or a combination of these 3–6 days after exposure. They presented to our hospital (The University of Hong Kong-Shenzhen Hospital, Shenzhen) 6–10 days after symptom onset. They and one asymptomatic child (aged 10 years) had radiological ground-glass lung opacities. Older patients (aged >60 years) had more systemic symptoms, extensive radiological ground-glass lung changes, lymphopenia, thrombocytopenia, and increased C-reactive protein and lactate dehydrogenase levels. The nasopharyngeal or throat swabs of these six patients were negative for known respiratory microbes by point-of-care multiplex RT-PCR, but five patients (four adults and the child) were RT-PCR positive for genes encoding the internal RNA-dependent RNA polymerase and surface Spike protein of this novel coronavirus, which were confirmed by Sanger sequencing. Phylogenetic analysis of these five patients' RT-PCR amplicons and two full genomes by next-generation sequencing showed that this is a novel coronavirus, which is closest to the bat severe acute respiatory syndrome (SARS)-related coronaviruses found in Chinese horseshoe bats. Our findings are consistent with person-to-person transmission of this novel coronavirus in hospital and family settings, and the reports of infected travellers in other geographical regions. The Shaw Foundation Hong Kong, Michael Seak-Kan Tong, Respiratory Viral Research Foundation Limited, Hui Ming, Hui Hoy and Chow Sin Lan Charity Fund Limited, Marina Man-Wai Lee, the Hong Kong Hainan Commercial Association South China Microbiology Research Fund, Sanming Project of Medicine (Shenzhen), and High Level-Hospital Program (Guangdong Health Commission).

• Publisher: Elsevier Ltd,Elsevier Limited
• Subject: Adult / Aged / Animals / Asymptomatic / Betacoronavirus - classification / Betacoronavirus - genetics / Bioinformatics / C-reactive protein / China - epidemiology / Clinical Laboratory Techniques / Clusters / Coronaviridae / Coronavirus Infections - diagnosis / Coronavirus Infections - epidemiology / Coronavirus Infections - transmission / Coronaviruses / COVID-19 / COVID-19 Testing / Diarrhea / Disease transmission / DNA-directed RNA polymerase / Epidemiology / Family Health / Fever / Gene sequencing / Genetic analysis / Genome, Viral / Genomes / Glass / Hospitals / Humans / Influenza / L-Lactate dehydrogenase / Laboratories / Lactate dehydrogenase / Lactic acid / Lungs / Lymphopenia / Microbiology / Middle Aged / Next-generation sequencing / Nosocomial infections / Patients / Pharynx / Phylogenetics / Phylogeny / Pneumonia / Pneumonia, Viral - diagnosis / Pneumonia, Viral - epidemiology / Pneumonia, Viral - transmission / Polymerase chain reaction / Proteins / Radiography, Thoracic / Respiratory diseases / Respiratory syncytial virus / Respiratory tract / Ribonucleic acid / RNA / RNA polymerase / RNA-directed RNA polymerase / SARS-CoV-2 / Spike protein / Thrombocytopenia / Tomography, X-Ray Computed / Travel / Travellers / Urine / Viruses / Whole Genome Sequencing - methods