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SARS Appears in More Asian Nations
April 11, 2003
INDONESIA AND the Philippines on Friday reported their first cases of severe acute respiratory syndrome, both of them foreigners who had traveled to Hong Kong or Singapore, bringing the number of nations with reported cases to 20.
Redoubling precautions, Hong Kong ordered members of 70 to 80 households with known victims of the disease to stay in their homes for 10 days in case they have been infected. Police were making spot inspections and violators faced fines, imprisonment or confinement in quarantine camps.
On Thursday, the U.S. State Department advised Americans not to travel to China unless necessary. It also alerted travelers to a new Chinese government policy requiring hospitalization of anyone — including foreigners — who shows SARS symptoms until the contagious phase passes.
The State Department said that under the new Chinese policy, patients will not be allowed to see family members, personal physicians or U.S. consular officials.

55 DEATHS IN CHINA
Beijing has reported four of China’s 55 deaths from SARS and 22 cases of infection. Experts believe the disease started in southern China late last year and then spread to other parts of the country and around the world.
A Chinese health official and the U.S. Consulate in Shanghai confirmed that at least seven foreign nationals, including two Americans, were being treated in that city. None of the foreigners at Shanghai’s Pulmonary Disease Hospital has been confirmed to have SARS, said an official of the Shanghai Center for Disease Control who would give only his surname, Jiang. But on Wednesday, an American teacher was pronounced dead after falling ill in the hard-hit province of Guangdong. The teacher was taken to Hong Kong for treatment in what a friend contended was an attempt by Chinese authorities to avoid the embarrassment of another foreigner’s death on the mainland.
James Salisbury, a 52-year-old English instructor at a polytechnic institute in China, already appeared dead when he was wheeled into an ambulance in the southern Chinese city of Shenzhen, according to the friend, David Westbrook, who was with Salisbury and had been in contact with doctors about his condition.
Meanwhile, researchers released more evidence suggesting SARS may be caused by a new coronavirus, a bug that ordinarily causes common colds. But scientists were checking whether some other microbe might make SARS more severe or easier to catch.

ALMOST 3,000 INFECTED
Worldwide, SARS has claimed at least 111 lives and sickened more than 2,700 people. Symptoms include fever, shortness of breath, coughing, chills and body aches. Mainland China and Hong Kong have reported the highest numbers of infections and deaths. Canada, Singapore, Vietnam, Thailand and Malaysia also have reported fatalities.
Indonesia’s first confirmed SARS case was a 47-year-old British businessman who was hospitalized Wednesday. He had visited Hong Kong and Singapore before arriving in Indonesia, said Mariani Reksoprodjo, a health ministry spokeswoman. She said the country had nine other people with SARS-like symptoms under observation.
The Philippines reported its first “probable” case in a 64-year-old foreigner who frequently travels between Manila and Hong Kong. The patient sought treatment immediately after his symptoms started and did not appear to have infected anyone else, said President Gloria Macapagal Arroyo.
Canada has seen the largest outbreak of SARS outside of Asia, with 10 people killed among more than 200 probable or suspected cases, the first a woman returning from Hong Kong. Ethnic Chinese in Canada say they’ve been stigmatized as carriers and that their businesses have suffered.
Seeking to ease concern, Prime Minister Jean Chretien dined in Toronto’s Chinatown and urged others to do the same.

IN U.S., WORKPLACE SARS
The United States has reported its first SARS case suspected to have spread in a workplace. The United States has had no deaths, but 166 suspected cases, most of them people falling ill after travel in Asia.
In Hong Kong, health officials were making daily phone calls to the 150 people affected by the territory’s new quarantine order to ask about their health. They would be visited by health workers for home medical checks, said Health Department spokeswoman Elaine Wong.The government has promised to provide the quarantined households with food and other necessities.Police were to drop by the homes unannounced to check on compliance with the order, announced Thursday as Hong Kong reported it had almost 1,000 cases and 30 deaths from SARS.The government also said it would post on the Internet a list of buildings where SARS cases had been found.

IN RELATED DEVELOPMENTS:
- Malaysia announced it would deny visas to most Hong Kong people. On Wednesday, Malaysia said it would begin barring all tourists from China while those from other places badly hit by SARS will need to obtain health certificates before entering.
- German airline Lufthansa said Thursday it had been informed by Hong Kong health authorities that one of its passengers had been diagnosed with SARS. It said the passenger, a 48-year-old Chinese man, had traveled with Lufthansa between March 30 and April 4.
- Taiwan said medical staff would quarantine all arriving travelers found to have a fever.
- In Singapore, Manpower Minister Lee Boon Yang said that over the next month all foreign workers arriving from SARS-stricken areas will be quarantined for 10 days.
- SilkAir flew home a Singaporean in an empty plane after he was turned back in Thailand on suspicion of being infected with SARS. A battery of tests later showed the man was free of the virus.
- Australia declared itself to be free of SARS, with health authorities saying the one suspected case detected on Australian soil was a false alarm. A British tourist, who had been declared a probable SARS case but had recovered and left the country, had been suffering from influenza, test results had found, health authorities said.
Source: MSNBC.com

Posted by RaRa at 4/11/2003 08:05:00 AM | Permalink | Comments

Coronavirus Confirmed as SARS Agent
Laurie Barclay, MD
April 9, 2003 — Within just two months, investigators have found what may be the causative agent of severe acute respiratory syndrome (SARS), according to a report published online April 8 by The Lancet. A coronavirus that has never been described before was isolated from two patients and then confirmed through polymerase chain reaction (PCR) in 45 of 50 patients but in no controls. According to the commentators, the progress is truly "remarkable and unprecedented." A separate article in The Lancet also provides guidelines for management.
"This report provides evidence that a virus in the coronavirus family is the etiological agent of SARS," lead author Malik Peiris, from the University of Hong Kong, says in a news release. "However, it remains possible that other viruses act as opportunistic secondary invaders to enhance the disease progression, a hypothesis that needs to be investigated further."
The Hong Kong University SARS Study Group reviewed records and microbiological findings for 50 patients with SARS, representing more than five separate epidemiologically linked transmission clusters, and ranging in age from 23 to 74 years. Evaluation included chest radiography and double-blinded laboratory testing of nasopharyngeal aspirates and serum samples.
The most frequent symptoms were fever, chills, myalgia, and cough. Fewer than 25% of patients had upper respiratory tract symptoms, but 10% had gastrointestinal symptoms. Respiratory symptoms and auscultatory findings were milder than would be expected from chest x-ray findings.
Predictors of severity were household contact with other infected individuals, older age, lymphopenia, and liver dysfunction. In two patients, a virus belonging to the family Coronaviridae was isolated. Serological and reverse-transcriptase PCR specific for this virus was positive in 45 of 50 patients with SARS, but in no controls. Of 32 patients from whom acute and convalescent sera were available, all had rising antibody titers to this coronavirus.
Because this virus is not one of the two known human coronaviruses, nor is it exactly like any of the known animal coronaviruses, the investigators believe that it may be a new virus which may have originated from animals. Additional genetic analysis may confirm this hypothesis.
"The high incidence of altered liver function, leukopenia, severe lymphopenia, thrombocytopenia, and subsequent evolution into adult respiratory distress syndrome suggests a severe systemic inflammatory damage induced by this human pneumonia-associated coronavirus," they write. "Thus immunomodulation by steroid treatment may be important to complement the empirical antiviral treatment with ribavirin."
They describe a "window of opportunity" of around eight days from symptom onset to respiratory failure, and they note that severe complicated cases are associated with underlying disease and delayed use of ribavirin and steroid treatment. The epidemiologic data suggest that spread is by droplets or by direct and indirect contact, although airborne spread and fecal-oral transmission cannot be ruled out.
"These findings significantly strengthen the tentative etiological association reported by other investigators who have also isolated a novel coronavirus from patients with SARS," Ann Falsey and Edward Walsh, from the University of Rochester in New York, write in an accompanying commentary. "As other pathogens, such as human metapneumovirus and Chlamydia spp, are identified in SARS patients, it will be important to use control groups to determine their role in causality or as cofactors for severe disease."
They note that nearly 40% of the patients developed respiratory failure requiring assisted ventilation, and that the lack of untreated control patients prevents definite conclusions about the efficacy of treatment.
In a second commentary, William Ho, from the Hospital Authority Building in Kowloon, Hong Kong, reports that the first index case in Hong Kong was admitted on Feb. 22, 2003. As of April 6, 842 cases with 22 deaths were identified in Hong Kong. The Hospital Authority of Hong Kong and the Department of Health have implemented public health measures and hospital policies for diagnosis and management of patients with SARS, which are available online at http://www.ha.org.hk.
Algorithms consider whether a suspected case has had close or social contact with a patient with SARS, whether there are classic symptoms of fever, cough, and shortness of breath, and whether chest x-ray reveals a new pulmonary infiltrate. Management may consist of outpatient monitoring or admission to hospital or designated medical center.
Source: Medscape.com

Posted by RaRa at 4/09/2003 04:58:00 PM | Permalink | Comments

SARS Death Toll Hits 100
April 7, 2003 09:45 p.m. EST
(CBS) China disclosed Monday that a deadly respiratory illness had struck in more of its provinces than previously reported, while experts in the south looked into whether the disease came from animals on farms or in the wild. The worldwide death toll reached 100.
In nearby Hong Kong, officials said they were preparing for a worst-case scenario of 3,000 cases of severe acute respiratory syndrome, or SARS, amid fears its health system could be stretched beyond its limits. There are 700 cases there and officials say its hospitals can currently handle 1,500 cases.
On Monday, Hong Kong health officials announced that a 78-year-old woman had died — the 100th death reported in Asia and North America. More than 2,300 people have been sickened worldwide. China and Canada both reported one new fatality in the last day, and two deaths were reported Monday in Singapore.
Canada's ninth death occurred April 1 at a Toronto hospital, but was only confirmed as SARS on Sunday. The victim initially was given a different cause of death but officials took another look at the case when a relative was found to be a possible SARS victim, officials said Sunday.
In the interim, reports Chris Mavrides of CBS Radio affiliate CFRB-AM, the victim's family has contracted the illness and may have spread it to others.
"We're not yet out of the woods," Dr. Colin D'Cunha, the Ontario chief medical officer of health, said. Like most of the other Canadian cases, this one has a link to a particular Toronto hospital, said D'Cunha: Scarborough Grace Hospital east of Toronto, which has now been declared the "hot zone" for the disease. Canada has 170 cases of SARS, all in Toronto.
China and Hong have been the hardest hit by SARS, with 53 and 23 deaths respectively in each nation. Symptoms include high fever, aches, dry cough and shortness of breath. No cure has been found.
Also Monday, the Beijing office of the Geneva-based International Labor Organization was sealed, and an employee of the diplomatic office building said it was disinfected after a Finnish official of the agency fell ill with severe acute respiratory syndrome, or SARS, in Beijing. The official died Sunday. Chinese officials had reported 43 SARS deaths in the southern province of Guangdong, where experts suspect the illness originated, with fatalities also coming in Beijing and the Guangxi region.
On Monday, Chinese state television reported that there were also one SARS death each in the provinces of Shanxi in the north, Sichuan in the west and Hunan in central China — the first fatalities in those areas and an indication the disease was more widespread geographically than previously acknowledged. The new disclosures come after mounting criticism at home and abroad that China's communist government was too slow to release information about SARS.
In New Delhi, World Health Organization director-general Gro Harlem Brundt said Sunday that "it would have been much better if the Chinese government had been more open in the early stages."
Meanwhile, World Health Organization experts who are searching Guangdong for clues to how SARS spreads and why it kills were looking into whether it might have come from animals. The team hasn't yet found clear evidence to support that widely discussed possibility, but its members met with local animal-health officials and discussed both farm animals and wildlife, including pigs, ducks, bats, rodents, chickens and other birds, said team leader, Dr. Robert Breiman. Experts have linked SARS to a new form of coronavirus, other forms of which usually are found in animals. That link "may suggest that it originates from animals," Breiman said. However, he said, "the discussions today were inconclusive, so we really don't have clues."
The team, in Guangdong since Thursday, also is meeting with doctors and scientists, visiting hospitals and reviewing medical records.
On Sunday, the Health Ministry reported six additional SARS deaths that raised China's death toll to 52. That included Pekka Aro, the 53-year-old International Labor Organization official who died Sunday in a Beijing hospital, but the ministry didn't give any details about the other deaths. The ILO office was closed Monday and smelled of disinfectant. A woman at the front desk of the diplomatic office building said government health workers started cleaning it Friday after the Finnish official was confirmed to have SARS.
The visa office of the New Zealand Embassy, located in the same building, was closed Monday as a precaution, said a New Zealand diplomat, Moana George. She said the embassy was discussing with the building management how to ensure any possible infection wouldn't spread through the building.
Also Monday, the Straits Times newspaper in Singapore reported that Prime Minister Goh Chok Tong has called off an official trip to Beijing this week on the advice of his doctors. The report said Goh was going ahead with a visit to India that began Monday.
Meanwhile, Vietnamese officials said they were considering barring visitors from countries with the mysterious flu-like disease.
Japan reported six new possible cases and ordered local authorities to draw up emergency plans for coping with the outbreak.
Source: CBSnews.com

Posted by RaRa at 4/07/2003 09:27:00 AM | Permalink | Comments