SEVERE ACUTE RESPIRATORY SYNDROME - WORLDWIDE (02): ALERT

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Archive Number20030315.0649Published Date15-MAR-2003SubjectPRO/EDR> Severe acute

respiratory syndrome - Worldwide (02):alert

 

SEVERE ACUTE RESPIRATORY SYNDROME - WORLDWIDE (02):

ALERT***************************************A ProMED-mail

post<http://www.promedmail.org>ProMED-mail is a program of theInternational

Society for Infectious Diseases<http://www.isid.org>[1] Taiwan[2] USA

response/briefing[3] Worldwide summary alert[4] Hong Kong[5] East Asia[1]Date:

Sun, 16 Mar 2003 11:24:28 +0800 (CST) " Peter Chang, MD, MPH, ScD "

<wpc94Official report by the CDC of Taiwan: Another Suspected

Atypical Pneumonia Case in Taiwan - follow up report on 15 Mar

2003---------------------------Here in Taiwan, we have one more reported case of

atypical pneumonia, this 64-year-old woman developed fever on 8 Mar 2003 about

one week after traveling to Guandong (China) and Hong Kong. She was hospitalized

on 13 Mar 2003 due to subsequent respiratory symptoms. Chest radiogram revealed

an atypical pneumonia in the right lower lung. CDC Taiwan has reviewed the

regular surveillance system for Acute respiratory distress syndrome (ARDS) and

complicated influenza cases. So far, there was no evidence of community spread

except for the couple reported on 14 Mar 2003 [see ProMED-mail Acute respiratory

syndrome - East Asia 20030314.0630]We would appreciate any useful advice and

assistance for pathogen investigation.Peter Chang, MD, MPH, ScDAdvisor and

Coordinator for Health AffairsforTzay-Jinn Chen, M.D.,

M.P.H.Directer-General,Center for Disease Control,Department of

Health,Taiwan******[2]15 Mar 2003ProMED-mail

<promedSource: CDC Press

Release<http://www.cdc.gov/od/oc/media/pressrel/r030315.htm>Severe Acute

Respiratory SyndromeCenter for Disease Control and Prevention CDC [uSA] Issues

Health Alert About Atypical Pneumonia----------------------------Atlanta: In

response to reports of increasing numbers of cases of an atypical pneumonia that

the World Health Organization (WHO) has called Severe Acute Respiratory Syndrome

(SARS), the CDC today announced several steps to alert US health authorities at

local and state levels.CDC activated its emergency operations center on Fri, 14

Mar 2003, upon learning of several cases reported in Canada among travelers

recently returned from Southeast Asia and their family members. The federal

public health agency:Issued a health alert to hospitals and clinicians on Sat 15

Mar 2003Briefed state health officials on Sat 15 mar 2003Is investigating

illness among travelers who may have passed through the United States after

having potential exposure to the virus.Is preparing health alert cards to give

to travelers returning from Southeast Asia.Is preparing guidance to assist

public health departments, health care facilities and clinicians in monitoring

and identifying potential cases.Deployed 8 CDC scientists to assist the WHO in

the global investigation.Is analyzing specimens to identify a cause for the

illness.CDC has been working with the World Health Organization (WHO) since late

February [2003] to investigate and confirm outbreaks of this severe form of

pneumonia in Viet Nam, Hong Kong, and parts of China. No cases have been

identified to date in the United States. " The emergence of 2 clusters of this

illness on the North American continent indicates the potential for travelers

who have been in the affected areas of Southeast Asia to have been exposed to

this serious syndrome, " said Dr. Julie L. Gerberding, CDC Director. " The World

Health Organization has been leading a global effort, in which CDC is

participating, to understand the cause of this illness and how to prevent its

spread. We do know that it may progress rapidly and can be fatal. Therefore, we

are instituting measures aimed at identifying potential cases among travelers

returning to the United States and protecting the people with whom they may come

into contact. " The WHO issued a global alert about the outbreak on 12 Mar 2003,

cautioning that the severe respiratory illness may spread to hospital staff. No

link has been made between this illness and any known influenza, including the

" bird flu " (A[H5N1]) outbreak reported in Hong Kong on 19 Feb

2003.******[3]15 Mar 2003ProMED-mail <promedSource:

New York Times 16 Mar 2003 (from

website)<http://www.nytimes.com/2003/03/16/health/16INFE.html?pagewanted=all & pos\

ition=top>As a mysterious respiratory illness spread to more countries, the

World Health Organization (WHO) yesterday issued a rare health alert, declaring

the ailment " a worldwide health threat " and urging all countries to help in

seeking its cause and control.The agency said that in the last week it had

received reports of more than 150 new suspected cases of the illness, now known

as Severe Acute Respiratory Syndrome, or SARS. The syndrome has caused at least

9 deaths, the last one a nurse in Hanoi. It apparently does not respond to

antiviral and antibiotic drugs. [according to a Center for Disease Control and

Prevention (CDC) telebriefing held today, 15 Mar 2003 (available at:

<http://www.cdc.gov/od/oc/media/transcripts/t030315.htm>) Dr. Gerberding's

response about efficacy of antimicrobials was: " ...there is no consistent

utilization of antibiotics or antiviral therapy in the areas that have had the

most cases, and so we have no real information to help tell us whether or not

anything is having a clinical impact. At best we could just provide anecdotal

suggestions and no data or advice. " , hence a conclusion that there is no

response to antiviral and antibiotics maybe premature. - Mod. MPP]Reported cases

have come from Canada and 6 countries in Asia — Hong Kong and elsewhere in

China, Indonesia, the Philippines, Singapore, Thailand and Vietnam, the health

organization said. There have been no reports of the illness in the United

States. But yesterday [today - 15 Mar 2003], an ill passenger and 2 companions

who traveled from New York City were removed from a flight after it arrived in

Frankfurt and put in isolation in a German hospital.The ill passenger is a

doctor from Singapore who treated one of the earliest cases there, and who flew

to a medical meeting in New York City, said Dick Thompson, a WHO spokesman. The

doctor may have gone to a hospital in New York — the agency is not certain which

one — before flying back to Singapore via Frankfurt with his wife and another

doctor. Before boarding the flight, the doctor called a colleague in Singapore

to describe his symptoms, and the colleague notified WHO.The cause has not been

identified, and scientists do not know whether it is a virus or even an

infectious agent. Although health officials have suspected avian influenza,

which has infected a small number of people sporadically in Hong Kong since

1997, laboratory tests have not detected that rare strain, known as influenza

A(H5N1). As a result, laboratory scientists are focusing on the possibility of a

previously unknown infectious agent.Dr. Julie L. Gerberding, director of CDC,

said in a news conference yesterday [today - 15 Mar 2003] that it appeared to

take direct and sustained contact to transmit the illness from an affected

individual to other people. " There is no evidence to suggest that this can be

spread through brief contact or assemblages of large numbers of people, " she

said.Asked whether this might be an instance of bioterrorism, she replied, " We

are keeping an open mind. " In an emergency advisory issued yesterday, WHO said

that " there is presently no indication to restrict travel to any

destination. " But Dr. Gerberding said, " We are advising persons planning

nonessential or elective travel to affected areas that they may wish to postpone

their trip until further notice. " Updated information will be posted on the

centers' Web site, .WHO and American officials urged all travelers to be aware

of the main signs. In addition to the breathing problems, the illness can cause

a dry cough and other flulike symptoms that are thought to develop 2 to 7 days

after exposure. They usually start with a sudden onset of high fever and go on

to include muscle aches, headache, sore throat and shortness of breath.Standard

lab tests often show low numbers of white blood cells and platelets, which help

blood to clot.The health agency said any passenger or airline crew member who

developed such symptoms should immediately seek medical attention and ensure

that information about their recent travel was passed on to the health care

staff. " Any traveler who develops these symptoms is advised not to undertake

further travel until they have recovered, " it said.If a passenger became ill on

a flight, the agency asked airlines to alert the airport of destination and to

refer any ill passengers to airport health officials. " There are currently no

indications to restrict the onward travel of well passengers, but all passengers

and crew should be advised to seek medical attention if they develop " symptoms,

the agency said.In another rare step, the CDC activated its emergency operations

center in Atlanta, including sophisticated communications technology, to enhance

its ability to coordinate information from other countries and to investigate

any suspect cases in this country.The CDC has used the operations center only

twice before, for the mosquito-borne West Nile fever epidemic last year and the

anthrax attacks in 2001. The last time it issued a global health alert was in

1993, to enhance measures to control tuberculosis. WHO officials said they could

not recall the last time an emergency global travel advisory was issued.The CDC

and New York City health officials are now investigating the travel histories of

the passengers now in a German hospital as well as one of the 8 cases suspected

to be the new syndrome in Toronto and Vancouver, British Columbia [Canada].Two

hours before the plane landed, the WHO notified German health officials, who had

the plane moved to a separate runway where the doctor, his wife and a colleague

disembarked and were taken to a nearby hospital. German health officials advised

the other passengers to monitor their health and gave them a telephone number to

call if they developed any symptoms. Officials did not release any information

on his condition.Mr. Thompson, the spokesman for the WHO, said the cases in

Toronto involved a family who returned home after flying to Hong Kong. A woman,

died shortly after her return. Five other family members who had not been to

Hong Kong have since become ill; 4 are still in the hospital while the fifth,

[the fatal case's] son, died on 13 Mar 2003, according to Toronto Public Health

officials.Toronto health officials said they were aware of 2 other cases in

Vancouver, both people who had recently traveled to Hong Kong. CDC officials are

aiding in the investigation because [the fatal case's] daughter, who is being

treated in Toronto, had flown to Atlanta recently, Mr. Thompson said.So far,

laboratory scientists have not been able to identify a known or novel infectious

agent, said Dr. David L. Heymann, a WHO official.Japanese officials said their

tests showed that the influenza virus was not the cause of the illness. But Dr.

Heymann said samples from more victims needed to be tested, because it can take

weeks for the immune system to produce influenza antibodies, the proteins that

are formed to fight invading microbes. " We have not ruled out influenza

definitively, " Dr. Heymann said.Tests of victims' samples have found no evidence

of mycoplasma or similar microbes that are the usual causes of atypical

pneumonia. Additional tests have shown no evidence of Ebola or any of the other

viruses that cause hemorrhagic fevers, hantavirus and bacteria.In Hong Kong, an

American businessman died on Thursday after passing through Hong Kong and

falling ill in Hanoi, where 30 doctors and other medical personnel have fallen

ill at the hospital where the businessman was initially treated.[by: Lawrence K.

Altman and Keith Bradsher]-- ProMED-mail<promed*****[4]Sat

15 Mar 2003 " Pablo Nart " <p.nartSource: Reuters News online,

Sat 15 Mar 2003

[edited]<http://www.reuters.com/newsArticle.jhtml?type=worldNews & storyID=2384910\

>Hong Kong: Total of Affected Medical Personnel Increases to

47-----------------------------HONG KONG: Four

Hong Kong medical workers were admitted to hospital on Saturday with symptoms of

a flu-like virus that has already killed one person and infected dozens,

sparking a rash of travel cancellations to the territory. The 4 admitted on Sat

15 Mar 2003 brought the total of Hong Kong medical workers suffering the same

symptoms to 47. Thirty-seven have since developed signs of severe pneumonia, up

from 29 on Friday [14 Mar 2003].Forty-one people in Hanoi are being treated for

the illness, 2 of them in critical condition. [according to another newswire

report, one of these cases died during the course of today - Mod.MPP] An

outbreak of severe pneumonia in China's southern Guangdong province in February

infected 305 people, killing 5, but it is not known if there is any link.

Singapore and Taiwan issued travel warnings when a few of their residents

contracted pneumonia after trips to Hong Kong or mainland China. Vietnamese

immigration officials are now monitoring visitors for signs of infection.[by Tan

Ee Lyn and Vicki Kwong]--ProMED-mail<promed*****[5]Sat 15

Mar 2003H.L. Penning <hlpenningSource: Straits Times

Interactive, Agence France-Presse, Sat 15 Mar 2003

[edited]<http://straitstimes.asia1.com.sg>East Asia: Pneumonia Outbreak

Worsens----In Taiwan a 64-year-old woman and a

married couple were confirmed to have contracted the disease and were in

hospital, said Mr Chen Tsai Chin, head of the Taiwan Health Department's Centre

for Disease Control (CDC). In Hong Kong, 47 people are now under observation

in 6 different Hong Kong hospitals with 37 of them showing symptoms of

pneumonia.In Vietnam's capital Hanoi 6 more people were struck down with the

illness, a hospital spokesman said. The new cases brought the number of

infections in the capital to 40. Thirty employees of the Hanoi French Hospital

remained under treatment, with 2 people, including a French doctor, in a

critical condition, a hospital official said.Singapore's Ministry of Health said

on Fri 14 Mar 2003 that it had been notified of 6 persons admitted to hospital

for pneumonia, in addition to who had earlier been confined after visiting Hong

Kong. [more recent newswires put the number of cases reported from Singapore at

16 - Mod.MPP]-- H.L. Penning<hlpenning[As the newswires have been

flooded with multiple versions of the various press releases during the course

of today, this posting is an attempt to synthesize the information available at

this point. If the articles seem to be less than concise, it reflects the less

than concise understanding of what is going on. At present the etiology of this

outbreak remains unknown, and the investigations are somewhat preliminary in

terms of an understanding of the precise epidemiology of this syndrome.

Subscribers are recommended to follow the URL links provided below for more

details, especially to the official websites such as the World Health

Organization (WHO) <http://www.who.int/en/>, the Centers for Disease Control and

Prevention (CDC) of the USA <http://www.cdc.gov/ncidod/sars/>, the Department

of Health Hong Kong SAR <http://www.info.gov.hk/dh/new/index.htm>, and the

Singapore Ministry of Health <http://app.moh.gov.sg/>. - Mod.MPP][see

also:Severe Acute Respiratory Syndrome - Worldwide 20030315.0637Acute

respiratory syndrome - Canada (Ontario) 20030314.0631Acute respiratory syndrome

- East Asia 20030314.0630Acute respiratory syndrome - China (HK), VietNam (03)

20030313.0624Acute respiratory syndrome - China (HK), VietNam

(02)20030313.0623Acute respiratory syndrome - China (HK), VietNam

20030312.0602,Undiagnosed illness - Vietnam (Hanoi): RFI 20030311.0595Influenza,

H5N1 human case - China (Hong Kong) (05) 20030228.0500Pneumonia - China

(Guangdong) (07) 20030221.0452Pneumonia - China (Guangdong) (02)

20030211.0369Pneumonia - China (Guangdong) (03) 20030214.0390Pneumonia - China

(Guangdong) (04) 20030219.0427Pneumonia - China (Guangdong) (05)

20030220.0446Pneumonia - China (Guangdong) (06) 20030220.0447Pneumonia - China

(Guangdong): RFI

20030210.0357]......................mpp/cp/mpp*#################################\

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