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Emergency Preparedness and Response

Outbreak of Pneumonia of Unknown Etiology (PUE) in
Wuhan, China

Distributed via the CDC Health Alert Network
January 8, 2020, 1615 ET (04:15 PM ET)
The Centers for Disease Control and Prevention (CDC) is closely monitoring a reported cluster of pneumonia of unknown
etiology (PUE) with possible epidemiologic links to a large wholesale sh and live animal market in Wuhan City, Hubei
Province, China. An outbreak investigation by local o cials is ongoing in China; the World Health Organization (WHO) is the
lead international public health agency. Currently, there are no known U.S. cases nor have cases been reported in countries
other than China. CDC has established an Incident Management Structure to optimize domestic and international
coordination if additional public health actions are required.
This HAN Advisory informs state and local health departments and health care providers about this outbreak and requests
that health care providers ask patients with severe respiratory disease about travel history to Wuhan City. Wuhan City is a
major transportation hub about 700 miles south of Beijing with a population of more than 11 million people.
According to a report from the Wuhan Municipal Health Commission, as of January 5, 2020, the national authorities in China
have reported 59 patients with PUE to WHO. The patients had symptom onset dates from December 12 through December
29, 2019. Patients involved in the cluster reportedly have had fever, dyspnea, and bilateral lung in ltrates on chest
radiograph. Of the 59 cases, seven are critically ill, and the remaining patients are in stable condition. No deaths have been
reported and no health care providers have been reported to be ill. The Wuhan Municipal Health Commission has not
reported human-to-human transmission.
Reports indicate that some of the patients were vendors at the Wuhan South China Seafood City (South China Seafood
Wholesale Market) where, in addition to seafood, chickens, bats, marmots, and other wild animals are sold, suggesting a
possible zoonotic origin to the outbreak. The market has been closed for cleaning and disinfection. Local authorities have
reported negative laboratory test results for seasonal in uenza, avian in uenza, adenovirus, severe acute respiratory
syndrome-associated coronavirus (SARS-CoV), and Middle East respiratory syndrome coronavirus (MERS-CoV) among patients
associated with this cluster. Additional laboratory testing is ongoing to determine the source of the outbreak. Health
authorities are monitoring more than 150 contacts of patients for illness.
CDC has issued a level 1 travel notice (“practice usual precautions”) for this destination.
( On January 5, 2020, WHO posted an update on this situation,
including an early risk assessment, which is available at:  .
Recommendations for Health Care Providers
1. Providers should consider pneumonia related to the cluster for patients with severe respiratory symptoms who traveled
to Wuhan since December 1, 2019 and had onset of illness within two weeks of returning, and who do not have another
known diagnosis that would explain their illness. Providers should notify infection control personnel and local and state
health departments immediately if any patients meet these criteria. State health departments should notify CDC after
identifying a case under investigation by calling CDC’s Emergency Operations Center at (770) 488-7100.

2. Multiple respiratory tract specimens should be collected from persons with infections suspected to be associated with
this cluster, including nasopharyngeal, nasal, and throat swabs. Patients with severe respiratory disease also should have
lower respiratory tract specimens collected, if possible. Consider saving urine, stool, serum, and respiratory pathology
specimens if available.
3. Although the etiology and transmissibility have yet to be determined, and to date, no human-to-human transmission has
been reported and no health care providers have been reported ill, CDC currently recommends a cautious approach to
symptomatic patients with a history of travel to Wuhan City. Such patients should be asked to wear a surgical mask as
soon as they are identi ed and be evaluated in a private room with the door closed. Personnel entering the room to
evaluate the patient should use contact precautions and wear an N95 disposable facepiece respirator. For patients
admitted for inpatient care, contact and airborne isolation precautions, in addition to standard precautions, are
recommended until further information becomes available. For additional information see:
This guidance will be updated as more information becomes available.
For More Information
CDC’s Emergency Operations Center: 770-488-7100

The Centers for Disease Control and Prevention (CDC) protects people’s health and safety by preventing and controlling
diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes
healthy living through strong partnerships with local, national and international organizations.

HAN Message Types

Health Alert: Conveys the highest level of importance; warrants immediate action or attention.
Health Advisory: Provides important information for a speci c incident or situation; may not require immediate action.
Health Update: Provides updated information regarding an incident or situation; unlikely to require immediate action.
Info Service: Provides general information that is not necessarily considered to be of an emergent nature.

This message was distributed to state and local health o cers, state and local epidemiologists, state and local laboratory
directors, public information o cers, HAN coordinators, and clinician organizations.
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Page last reviewed: January 8, 2020