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      Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia

      , M.Med., , Ph.D., , Ph.D., , M.P.H., , M.Med., , Ph.D., , M.Med., , Ph.D., , Ph.D., , Ph.D., , Ph.D., , M.Med., , M.Sc., , M.P.H., , M.Sc., , M.P.H., , B.Med., , M.Sc., , M.Sc., , M.Med., , M.Sc., , M.Med., , M.Med., , M.P.H., , M.Med., , M.D., , M.Med., , M.Sc., , M.Med., , B.Med., , M.P.H., , M.P.H., , M.Med., , M.Med., , M.P.H., , M.Med., , M.Med., , M.P.H., , Ph.D., , Ph.D., , D.Phil., , Ph.D., , M.Sc., , M.D., , M.Med.

      The New England Journal of Medicine

      Massachusetts Medical Society

      Keyword part (code): 18Keyword part (keyword): Infectious DiseaseKeyword part (code): 18_1Keyword part (keyword): Infectious Disease GeneralKeyword part (code): 18_6Keyword part (keyword): Viral InfectionsKeyword part (code): 18_9Keyword part (keyword): Global Health , 18, Infectious Disease, Keyword part (code): 18_1Keyword part (keyword): Infectious Disease GeneralKeyword part (code): 18_6Keyword part (keyword): Viral InfectionsKeyword part (code): 18_9Keyword part (keyword): Global Health , 18_1, Infectious Disease General, 18_6, Viral Infections, 18_9, Global Health

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          Abstract

          Background

          The initial cases of novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) occurred in Wuhan, Hubei Province, China, in December 2019 and January 2020. We analyzed data on the first 425 confirmed cases in Wuhan to determine the epidemiologic characteristics of NCIP.

          Methods

          We collected information on demographic characteristics, exposure history, and illness timelines of laboratory-confirmed cases of NCIP that had been reported by January 22, 2020. We described characteristics of the cases and estimated the key epidemiologic time-delay distributions. In the early period of exponential growth, we estimated the epidemic doubling time and the basic reproductive number.

          Results

          Among the first 425 patients with confirmed NCIP, the median age was 59 years and 56% were male. The majority of cases (55%) with onset before January 1, 2020, were linked to the Huanan Seafood Wholesale Market, as compared with 8.6% of the subsequent cases. The mean incubation period was 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days. In its early stages, the epidemic doubled in size every 7.4 days. With a mean serial interval of 7.5 days (95% CI, 5.3 to 19), the basic reproductive number was estimated to be 2.2 (95% CI, 1.4 to 3.9).

          Conclusions

          On the basis of this information, there is evidence that human-to-human transmission has occurred among close contacts since the middle of December 2019. Considerable efforts to reduce transmission will be required to control outbreaks if similar dynamics apply elsewhere. Measures to prevent or reduce transmission should be implemented in populations at risk. (Funded by the Ministry of Science and Technology of China and others.)

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          Most cited references 4

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          How to maintain surveillance for novel influenza A H1N1 when there are too many cases to count.

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            Dynamically Modeling SARS and Other Newly Emerging Respiratory Illnesses

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                Author and article information

                Journal
                N Engl J Med
                N. Engl. J. Med
                nejm
                The New England Journal of Medicine
                Massachusetts Medical Society
                0028-4793
                1533-4406
                26 March 2020
                : 382
                : 13
                : 1199-1207
                Affiliations
                From the Chinese Center for Disease Control and Prevention, Beijing (Q.L., X.W., L.Z., R.R., N.X., C.L., D.L., J.Z., W.T., L.J., Q.W., R.W., Y.Z., G. Shi, G.F.G., Z.F.), the Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei (X.G., Y.T., X.X., Y.W., Q.C., M.L., C.C., R.Y., S.Z., Y. Luo, B.Y.), the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, University of Hong Kong, Hong Kong (P.W., K.S.M.L., E.H.Y.L., J.Y.W., T.T.Y.L., J.T.W., B.J.C., G.M.L.), the Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing (T.L., R.Y., S.Z., H. Liu, Y. Liu, G. Shao, H. Li, Z.T.), the Jingzhou Center for Disease Control and Prevention, Jingzhou, Hubei (T.L.), the Chengdu Center for Disease Control and Prevention, Chengdu, Sichuan (H. Liu); the Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan (Y. Liu), the Anyang Municipal Center for Disease Control and Prevention, Anyang, Henan (G. Shao), the Panjin Center for Disease Control and Prevention, Panjin, Liaoning (H. Li), the Guizhou Center for Disease Control and Prevention, Guiyang, Guizhou (Z.T.), the Jiading District Center for Disease Control and Prevention, Shanghai (Y.Y.), the Nanchang Center for Disease Control and Prevention, Nanchang, Jiangxi (Z.D.), the Inner Mongolia Comprehensive Center for Disease Control and Prevention, Hohhot, Inner Mongolia (B.L.), and the Baoshan District Center for Disease Control and Prevention, Shanghai (Z.M.) — all in China.
                Author notes
                Address reprint requests to Dr. Feng at the Chinese Center for Disease Control and Prevention, No. 155 Changbai Rd., Changping District, Beijing, China, or at fengzj@ 123456chinacdc.cn ; to Dr. G.M. Leung or Dr. Cowling at the School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, 21 Sassoon Rd., Pokfulam, Hong Kong, China, or at gmleung@ 123456hku.hk or bcowling@ 123456hku.hk , respectively; or to Dr. B. Yang at the Hubei Center for Disease Control and Prevention, No. 35 Zhuodaoquan North Rd., Hongshan District, Wuhan, Hubei, China, or at 49205957@ 123456qq.com .

                Drs. Q. Li, X. Guan, P. Wu, and X. Wang and Drs. B. Cowling, B. Yang, M. Leung, and Z. Feng contributed equally to this article.

                Article
                NJ202003263821306
                10.1056/NEJMoa2001316
                7121484
                31995857
                Copyright © 2020 Massachusetts Medical Society. All rights reserved.

                This article is made available via the PMC Open Access Subset for unrestricted re-use, except commercial resale, and analyses in any form or by any means with acknowledgment of the original source. These permissions are granted for the duration of the Covid-19 pandemic or until revoked in writing. Upon expiration of these permissions, PMC is granted a license to make this article available via PMC and Europe PMC, subject to existing copyright protections.

                Product
                Funding
                Funded by: Ministry of Science and Technology, FundRef http://dx.doi.org/10.13039/501100003711;
                Award ID: KJYJ-2013-01-02
                Funded by: National Natural Science Foundation of China, FundRef http://dx.doi.org/10.13039/501100001809;
                Award ID: 71934002
                Funded by: National Institute of Allergy and Infectious Diseases, FundRef http://dx.doi.org/10.13039/100000060;
                Award ID: HHSN272201400006C
                Funded by: Health and Medical Research Fund, FundRef http://dx.doi.org/10.13039/501100005847;
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