SARS Back In Canada?
From Patricia Doyle, PhD

Is Canada facing a renewed SARS outbreak OR is this still the same outbreak? My opinion is SARS has been with us all along.
[1] Date: 15 Aug 2003 From: ProMED-mail
Source: British Columbia Center for Disease Control/Fraser Health Authority
Press Release 14 Aug 2003
British Columbia responds to flu-like illness in nursing home
VANCOUVER August 14, 2003: Public health officials are investigating an outbreak of influenza-like illness in a North Surrey residential care facility.
The outbreak at Kinsmen Place Lodge has been actively managed by Fraser Health Authority and the BC Centre for Disease Control (BCCDC) since early July and appears to be tapering off with just a few new cases identified in the past week. Through July and early August [2003], 97 of 142 residents of the facility have been affected, with most experiencing only mild cold-like symptoms such as runny nose and cough. Of 160 staff, 46 have also shown similar symptoms. The majority of residents and staff have fully recovered.
Although health officials are aware of the deaths of 7 residents over the past 6 weeks, 4 of these deaths were unrelated. In 3 of the deaths, pneumonia was a contributing factor.
"BC has a strong network of public health surveillance and health officials take any disease outbreak very seriously," said Dr David Patrick, director of epidemiology at BCCDC. "As with any situation where a large number of patients and staff are affected by an outbreak, we are working to identify the cause."
Fraser Health Authority is working with BCCDC, the provincial health officer, and Health Canada to conclusively identify the cause. Tests performed by the National Microbiology Lab in Winnipeg have yielded a range of results for possible viruses, including positives for both human metapnuemavirus and a virus similar to the SARS coronavirus. None of these patients fits the profile of previous SARS cases in BC and Ontario earlier this year.
"These laboratory findings are surprising given the nature of the outbreak," said Patrick. "The symptoms and progression of illness are not consistent with SARS infection and there is no evidence anyone related to the outbreak has traveled to an affected area or had contact with a SARS case. While the virus looks like the SARS coronavirus, it doesn't appear to act like the SARS virus we've come to know," said Patrick.
As a precautionary measure and in addition to the infection control measures already in place, Kinsmen Place Lodge will be considered a site where transmission of SARS virus may have occurred in residents or visitors since 1 Jul 2003. "Until such time as we determine the cause through sound medical and clinical research, we are erring on the side of caution," said Dr Roland Guasparini, medical health officer for Fraser Health Authority. "Infection control procedures have been used as a standard practice during the course of this outbreak. Given these recent lab results, there are established protocols around SARS precautions that Fraser Health is familiar with and will maintain."
Since the outbreak began in early July, full precautions have been taken to limit the spread of the illness. The outbreak has been contained and the rate of transmission and number of new cases has dropped to very low levels. Kinsmen Place Lodge has had visiting and admissions restrictions in place since the outbreak was first identified. Isolation precautions were instituted around symptomatic patients and will continue. In addition, staff have been directed not to work between different facilities and ill staff have been directed not to work.
Visitors to Kinsmen Place Lodge after 1 Jul 2003 who have a cough and fever over 38 degrees Celsius have been asked to contact BC NurseLine.
Media Contact Information: Sally Greenwood Director, Communications Transplant, Renal and Public Health, PHSA Helen Carkner Director, Public Affairs Communication, Fraser Health Authority
[2] Date: 15 Aug 2003
From: ProMED-mail
Source: Yahoo news
WHO rules out SARS as mystery illness at Canadian nursing home
VANCOUVER, British Columbia: - The World Health Organization said on Friday that a pneumonia-like illness that sickened dozens of people at a British Columbia nursing home probably was not SARS. 7 people have died, 3 of them due to respiratory illness, since the unknown disease first appeared 6 weeks ago at the Kinsman Place Lodge in the Vancouver suburb of Surrey, said Dr Shaun Peck, the British Columbia deputy medical health officer.
In Geneva, WHO spokesman Iain Simpson said some tests showed the cause could be a virus that causes severe acute respiratory syndrome, known as SARS, but no other similarities exist. Simpson noted patients at the nursing home lacked the high fever, breathing difficulties, and other symptoms associated with SARS. "At the moment we don't exactly understand what is happening," Simpson said. "They have found 10 positive results for the SARS virus. We don't believe this is an outbreak of SARS but the local authorities in Vancouver are taking a very conservative approach." The illness could be a milder form of SARS than previously encountered, Simpson said. "We are waiting for more information from Canada," he said. SARS sickened almost 250 people, killing 44 of them, in two outbreaks this year in Toronto, Canada's largest city. At the nursing home, 97 out of 142 residents and 46 of 160 staff members have fallen ill in the past 6 weeks, Peck said Thursday.
Although laboratory tests showed some results for a corona virus similar to SARS, Peck and others noted few similarities between the illness and SARS. Those infected show mild, cold-like symptoms such as runny nose with no fever, said Dr David Patrick of the British Columbia Center for Disease Control. SARS patients generally develop high fever and respiratory problems.
The outbreak peaked on 29 Jul 2003 and has since tapered off, with the last person developing symptoms 3 days ago, according to Patrick. None of the affected staff members needed hospital admission, he said.
[3] Date: Fri, 15 Aug 2003 07:45:54 +1200 (NZST) From: Mark Collins
and Kaz Matsuki
BC nursing home hit by SARS-like virus, dozens of patients, staff infected
VANCOUVER (CP): Federal and BC health authorities are looking into the deaths of 7 people and the infection of dozens of others at a BC nursing home hit by a mysterious, "SARS-like" respiratory virus. While stressing this was not another outbreak of SARS, which killed more than 40 people in the Toronto area this year, officials said they were treating like the deadly form of pneumonia until they learn more about it.
The illness struck Kinsman Place Lodge in suburban Surrey, infecting 97 out of 142 residents and 46 of 160 staff members over the last 6 weeks, Dr Shaun Peck, BC deputy medical health officer, said on Thursday.
"There have been 7 deaths, although only 3 of them have been directly associated with a respiratory illness," Peck told a news briefing. Officials said nursing homes such as the Kinsman Place Lodge normally can average 4 to 5 deaths a month. Preliminary tests from the National Microbiology Laboratory in Winnipeg show the disease "appears to be a SARS-like virus," said Peck. "Although clinically it is not an illness that we associate with SARS, we felt obliged to let everybody know about it."
Staff and residents infected by the illness showed only mild, cold-like symptoms such as runny nose with no fever, said Dr David Patrick of the BC Centre for Disease Control. "This is not a typical SARS picture," he said. He said 2 of the deaths being probed were patients already in palliative care, 2 were from vascular causes and 3 others had pneumonia as a contributing factor along with an underlying illness. Lab tests produced some positive results for a SARS-like corona virus, said Patrick.
"These findings around a SARS-like virus from the lab are unexpected," he said. "The outbreak hasn't behaved at all like SARS as manifested in Hong Kong, Toronto, Singapore, Vancouver, et cetera, in the past." Peck said this could be the SARS virus behaving less aggressively or a closely related, less virulent virus previously unknown, or a SARS virus weakened through genetic alternation. "All these possibilities remain and they need to be clarified," he said.
Scientists at Winnipeg and the US Centers for Disease Control and Prevention in Atlanta will try to identify the virus and compare it with the known SARS virus. "In the meantime though and until this is clear, we're playing it safe," said Peck. The outbreak was initially treated as influenza -- common in nursing homes -- but tests for the flu virus proved negative, said Dr Roland Guasparini, chief medical officer for the Fraser Health Authority. Early tests for SARS also came back negative, he said. But when the new results came in, precautions were stepped up, he said.
"Based on these preliminary lab findings ... we're going to consider this long-term care facility as a site where transmission of SARS may have occurred in residents or visitors since 1 Jul 2003," said Guasparini. He noted there was no evidence the illness had been transmitted outside the nursing home.
Guasparini said one patient remained isolated in hospital with pneumonia and staff who were exposed are being tracked for possible quarantine and observation. "We're going to adopt a very careful public-health approach to this, as we did in the past, when we were investigating the cases of SARS and suspect SARS that we had," he said.
Guasparini said the public should take normal precautions against the new illness, such as reducing contact with others if one has cold symptoms and maintaining hygiene. Visitors to the stricken nursing home who develop a fever of more than 38 degrees, along with a cough, should telephone a local public health hotline. Those who become seriously ill should contact their doctors.
Symptoms shown by the nursing-home residents included cough, sore throat, joint pain, muscle pain and extreme fatigue. The nursing home had a sign at the front door Thursday warning visitors the facility was dealing with a "respiratory outbreak," and recommending people do not enter.
[byline: Emily Yearwood-Lee]
-- ProMED-mail <>
[The description of the illness is that of a mild respiratory illness. According to the numbers provided, there were 97 out of 142 residents (clinical attack rate 68 per cent) and 46 of 160 staff members (attack rate 29 per cent) with 3 deaths (overall case fatality rate 2 per cent with a case fatality rate of 3 per cent among residents). The attack rates are very high, and the case fatality rate very low, especially among the residents -- remembering that the case fatality rate among the elderly in the SARS outbreak in both Hong Kong and Singapore was about 50 per cent or higher). There is much room for speculation, including a change of the virus to a less virulent form. There is also the possibility that as a result of increased surveillance for respiratory illness, and the increase in laboratory studies now conducted on outbreaks of respiratory illness, that we will be identifying many "new pathogens" that we did not know about in the past... a corollary of "seek and ye shall find". We await further word on the virological studies related to this outbreak. - Mod.MPP
The results of the virological investigations provide no convincing evidence so far that the SARS coronavirus responsible for the outbreak originating in Guangdong Province in China is the etiologic agent in this outbreak in British Columbia. Indeed there is no clear indication that a single virus pathogen is involved. Many respiratory viruses are virtually ubiquitous in the human population and can be responsible simultaneously for respiratory illness in vulnerable groups such as those at risk in the British Columbia outbreak. Nor is it surprising that a SARS-like coronavirus has been detected, since 2 other human coronaviruses are established respiratory pathogens, and others may exist. Characterization of the SARS coronavirus indicates it is more similar to the group 2 coronaviruses (J Mol Biol 2003; 33: 991-1004), than to the group 1 coronaviruses. It will be interesting to see whether this putative SARS-like coronavirus exhibits a similar relationship. - Mod.CP]
Patricia A. Doyle, PhD Please visit my "Emerging Diseases" message board at:
Zhan le Devlesa tai sastimasa Go with God and in Good Health




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