A novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), associated with severe respiratory illness emerged in Wuhan, China, in late 2019 (1). Epidemiologic data indicate that the virus can cause a wide spectrum of clinical disease (mild-to-severe illness), including death (2-4), and spreads through direct contact and droplets.Estimates are 5-6 days (range 2-14 days) for the incubation period and 2.2-3.6 for the reproduction rate; this rate is higher than those for seasonal and pandemic influenza (5,6). Extensive control efforts are now in place as part of a global containment strategy to minimize exportation from China and rapidly identify and stop international spread.In the World Health Organization European Region, Rome, Paris, London, Istanbul, and Moscow have direct flights to Wuhan, China, and the risk for importation was considered high (7). SARS-CoV-2 was reported to have been introduced into Europe by a person from France who had traveled to Wuhan, China, for work, became ill on January 16, and returned ill to France on January 22 (8). We report a cluster of illness in a tour group from Wuhan that predates this case detection and led to subsequent transmission in Europe.
The StudyA 55-year-old woman (Taiwanese tour guide) who resided in Wuhan came to airport health authorities in Taipei on January 25, 2020, complaining of a cough since January 22. She was transported to a designated hospital and showed a PCR-positive result for SARS-CoV-2 on January 26. She indicated that she had led a group of tourists from Wuhan to Europe on January 16-24. Further interviews with her and discussions with the rest of the group through social media yielded detailed information.A group of 30 persons departed Wuhan on January 16, 2020, for a 9-day tour in Italy, Switzerland, and France (Table; Figure). During the flight on January 16 from Wuhan to Rome, 1 tour member was mildly ill and coughing. Her daughter became ill during the tour on January 21.On January 23, while in Paris, the mother and daughter decided to seek medical care. They called the Chinese embassy, who told them to call the emergency hotline (at SAMU Centre 15 Hospital, Paris, France) dedicated to evaluation of suspected 2019 novel coronavirus disease (COVID-19) cases in France (8). The emergency hotline routed the call to the 24-hour ambulatory service, but no information about suspicion of COVID-19 was given. A physician came to their hotel room and gave them a diagnosis of the common cold. The interaction lasted »20 min, including a 15-minute face-to-face examination, without protective masks for