- [1] WHO update
- http://www.who.int/csr/don/2004_04_23/en/
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- China Reports Additional SARS Cases - Update
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- The Chinese Ministry of Health has today reported an
additional 3 cases of SARS, including one death. This brings the current
number of persons with a clinical illness compatible with SARS in China
to 4.
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- Chinese authorities have reported a diagnosis of clinically
confirmed SARS coronavirus infection in 2 of these persons. These are the
20-year-old nurse in Beijing, reported yesterday, who remains in intensive
care, and a 26-year-old female laboratory researcher, from Anhui Province.
During 2 weeks in March 2004, the researcher worked at the Chinese National
Institute of Virology in Beijing, which is part of China's Center for Disease
Control. This institute is known to be engaged in research involving the
SARS coronavirus. She developed symptoms on 25 Mar and was attended, while
in a Beijing hospital, by the nurse. Her mother also provided bedside care.
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- The mother became ill in Anhui on 8 Apr and died on 19
Apr. Her clinical symptoms were compatible with SARS, and health authorities
have retrospectively diagnosed her as a suspected SARS case.
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- The 4th person is a 31-year-old male laboratory researcher
who also worked at the Beijing virology institute. He developed symptoms
on 17 Apr and was hospitalized in isolation on 22 Apr. Health authorities
have diagnosed him as a suspected SARS case.
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- In line with WHO definitions of SARS coronavirus infections,
WHO has classified 2 of these persons, the 20-year-old nurse and the 26-year-old
laboratory researcher, as probable cases of SARS. The 2 additional persons
remain under investigation; further laboratory tests are being conducted
by Chinese authorities.
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- According to WHO guidelines for the global surveillance
of SARS, classification as a confirmed case requires independent verification
of results by an external international reference laboratory. Such procedures
are considered necessary in view of the implications that confirmed SARS
cases can have for international public health.
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- WHO is working closely with Chinese health authorities
to confirm the status and full extent of this cluster, and to prevent further
spread. The situation is considered potentially serious because of the
multiple opportunities for exposures. To date, more than 300 contacts have
been identified and placed under medical observation.
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- --
- ProMED-mail
- promed@promedmail.org
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- ******
- [2] China measures taken
- Date: 24 Apr 2004
- From: ProMED-mail
- Source: New York Times [edited]
- http://www.nytimes.com/2004/04/24/international/asia/24SARS.html
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- The Chinese government began screening travelers at airports
and train stations on Friday and closed its main SARS laboratory after
what appeared to be a safety breach at the lab led to 4 confirmed [cases
are still pending confirmation from an independent international laboratory]
and suspected cases, including a death, in a new outbreak.
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- Officials are hurriedly trying to determine how widely
the disease has spread. At least 260 people who came into close contact
with the patients are being observed, and at least 5 others with fevers
have been isolated.
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- There is also concern about the recent travels of one
of the patients [the index case], a 26-year-old medical graduate student,
who studied at the SARS lab. She traveled on at least 3 trains; 2 of the
trips came after she had developed a fever and other symptoms. [Her] mother,
who cared for her and traveled with her, fell ill with pneumonia symptoms
this month and died Monday.
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- This is the 3rd outbreak from a laboratory accident in
the past year; the others were in Singapore and Taiwan. Dr. Alfred Sommer,
an epidemiologist and dean of the Johns Hopkins Bloomberg School of Public
Health in Baltimore, said Friday, "The good news is this is not a
new emergence of yet another strain of virus that we do not know anything
about, or how to contain," like SARS, severe acute respiratory syndrome,
was when first detected in 2003. "The bad news is that this is the
3rd laboratory release of this virus, which keeps taking people by surprise,"
he added.
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- Chinese officials, who were harshly criticized for their
mismanagement of the original SARS outbreak, appeared to be responding
swiftly. Efforts were under way to find people who had come into contact
with the SARS patients. Officials also closed the Institute of Virology
at China's Centers for Disease Control in Beijing, where the infections
originated, according to a statement on the Ministry of Health Web site.
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- The director of Beijing's health bureau, Jin Dapeng,
said Friday that the chain of transmission had been identified and that
authorities had the situation under "effective control." The
pattern of the outbreak, however, has raised questions about how a safety
breach could have occurred at the laboratory and whether medical officials
moved quickly enough to isolate [the index case] after she exhibited symptoms.
The 4 patients were cared for in different hospitals but not initially
isolated. Another student working in the lab, developed symptoms more than
3 weeks later and is now listed as suspected of having SARS.
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- Dr. Julie Hall, the SARS team leader for the Beijing
office of the World Health Organization, said health officials held a meeting
on Friday with the Chinese Ministry of Health. She said the ministry had
asked for their help in trying to determine what went wrong and to limit
exposures.
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- At World Health Organization headquarters in Geneva,
a spokesman for the United Nations agency said that under its rules it
could not call the cases confirmed until scientists in a laboratory in
its network outside of China had tested specimens from the patients. Until
then, the agency is considering as "probable" the 2 cases that
China has called "confirmed." The agency said it is classifying
the other 2 cases as "under investigation."
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- Early Friday evening, the Chinese Ministry of Health
issued a detailed chronology that appeared to trace the outbreak to some
sort of mishap in the lab. [The index case], a medical graduate student
in Anhui Province, began study at the lab on 7 Mar 2004. She and the other
[post doctoral student case] both studied in a laboratory that handled
samples of the SARS virus, according to Dr. Hall.
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- The Health Ministry said that [the index case's] stint
at the lab ended 22 Mar 2004 and that the next day she returned by train
to Anhui Province. On 25 Mar 2004, she developed a fever. At some point,
she returned by train to Beijing for treatment. On 29 Mar 2004, she was
admitted to Jiangong Hospital as a pneumonia patient.
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- At the hospital, one of [the nurses who cared for her],
the woman identified Thursday by Chinese officials as suspected of having
SARS. On Friday, officials reclassified [this case] as a confirmed SARS
patient.
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- For reasons that are not clear, [the index case] was
discharged from Jiangong on 2 Apr 2004 and returned by train with her mother
to a hospital in Anhui. There, she was transferred to a second hospital.
The person apparently most often by [her] side during her illness was her
mother. She had started caring for her daughter on 31 Mar 2004 and developed
a fever on 8 Apr 2004. She was hospitalized as a pneumonia patient at the
same hospital as her daughter. On Monday, [the index case's mother] died.
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- The official New China News Agency reported that [the
index case] tested positive for SARS antibodies on Wednesday. Health officials
from Beijing went to Anhui and tested her again. She again tested positive
on Friday and was deemed a confirmed SARS patient. Dr. Hall, said she "died
of pneumonia of an unknown cause that is likely to be SARS."
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- Meanwhile, [the other graduate student] developed a fever
on 17 Apr 2004 and was hospitalized Thursday. He is now classified as suspected
of having SARS.
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- Dr. Hall said the timetable raised questions about why
[the index case] was not promptly isolated when she first developed a fever,
particularly because physicians should have known she had studied in a
SARS laboratory. "Those alarm bells appear not to have gone off,"
she said.
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- Byline: Jim Yardley and Lawrence K. Altman]
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- --
- ProMED-mail
- <promed@promedmail.org>
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- ******
- [3] USA response
- Date: 23 Apr 2004
- From: ProMED-mail <promed@promedmail.org>
- Source: CDC Health Alert Network [edited]
- <http://www.cdc.gov/ncidod/sars/han/han_China042304.htm>
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- CDC is recommending that U.S. physicians maintain a greater
index of suspicion for SARS in patients who 1) require hospitalization
for radiographically confirmed pneumonia or acute respiratory distress
syndrome (ARDS) and 2) who have a history of travel to mainland China (or
close contact with an ill person with a history of recent travel to mainland
China) in the 10 days before onset of symptoms . When such patients are
identified, they should be considered at high risk for SARS-CoV infection,
and the following actions should be taken:
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- Patients should immediately be placed in appropriate
isolation precautions for SARS (i.e., contact and airborne precautions
along with eye protection).
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- Patients should promptly be reported to the state or
local health department. Health departments should immediately report any
SARS-CoV positive test result to CDC. Health departments should also inform
CDC of other cases or clusters of pneumonia that are of particular concern
by calling 770-488-7100.
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- Patients should promptly be tested for evidence of SARS-CoV
infection as part of the diagnostic evaluation (see Appendix 2, "Guidelines
for Collecting Specimens from Potential SARS Patients," in the CDC
document, "In the Absence of SARS-CoV Transmission Worldwide: Guidance
for Surveillance, Clinical and Laboratory Evaluation, and Reporting"
at <http://www.cdc.gov/ncidod/sars/absenceofsars.htm>
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- The health department should identify, evaluate, and
monitor relevant contacts of the patient, as indicated. In particular,
the health status of household contacts or persons who provided care to
symptomatic patients should be assessed.
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- Health care providers are reminded to obtain a travel
history for patients presenting with acute respiratory illness. In addition,
this new case of possible SARS provides a reminder to all healthcare settings,
especially physician offices, outpatient clinics, and emergency departments,
of the importance of implementing infection control precautions at the
point of 1st contact with patients who have symptoms of a respiratory infection.
These include respiratory hygiene/cough etiquette, hand hygiene, and droplet
precautions (i.e., masks for close patient contact). For additional information,
see " Respiratory Hygiene/Cough Etiquette in Healthcare Settings."
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- The reported possible cases of SARS in China represent
an evolving situation, and CDC will distribute updates as additional information
is learned. For more about SARS and the current U.S. SARS control guidelines,
please visit the CDC SARS website.
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- --
- ProMED-mail
- promed@promedmail.org
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- ******
- [5] Canada response (Health Canada)
- Date: 24 Apr 2004
- From: ProMED-mail
- Source: Health Canada [edited]
- http://www.hc-sc.gc.ca/english/protection/warnings/sars/cases_china.html
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- Health Canada has alerted health care officials to the
importance of collecting a travel history from people with severe respiratory
illness. As per the Department's guidelines, Health Canada recommends that
health professionals be alert for severe respiratory illness (fever, cough,
difficulty breathing and evidence of pneumonia or acute respiratory distress
syndrome) in patients who have a history of travel to China or in patients
having close contact with a symptomatic person with a history of travel
to China in the 10 days before symptoms appeared.
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- We continue to provide ongoing, up-to-date information
from Health Canada to our provincial and territorial partners on SARS,
influenza, avian influenza, and other emerging severe respiratory illnesses.
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- Health Canada continues to maintain Quarantine Services
at the Toronto, Vancouver, Montreal (Mirabel, Pierre Elliot Trudeau), Calgary,
Edmonton, Halifax and Ottawa international airports. Quarantine Officers
on site at these airports provide health assessments for international
travellers who are identified to be ill. Health Canada has advised Quarantine
Officers of the SARS situation in China and has asked them to increase
vigilance of any reported passengers with respiratory illness. They have
been advised to be especially alert to reports of travellers on flights
from Beijing who appear to be ill from a respiratory illness. We also continue
to provide infectious disease brochures with information on SARS at the
airports.
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- --
- ProMED-mail
- <promed@promedmail.org>
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- ******
- [5] European Union response (Eurosurveillance e-alert)
- Date: 24 Apr 2004
- From: ProMED-mail
- Source: Eurosurveillance e-alert 23 Apr 2003 [edited]
- http://www.eurosurveillance.org
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- The European Commission Directorate General for Public
Health and Consumer Protection (DG SANCO, <http://europa.eu.int/comm/health/index_en.htm>)
has previously issued several technical guidance documents outlining the
communication procedures if a probable case of SARS is detected within
European Union countries. This document also includes case definitions
(see <http://europa.eu.int/comm/health/ph_threats/com/sars/com_procedure.pdf>).
An early warning, regarding the current Beijing suspect case of SARS, has
been sent to national public health bodies through the European Union's
Early Warning and Response System.
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- The United Kingdom (UK) Health Protection Agency (HPA)
recently issued interim guidance (algorithm) for identification of possible
cases of SARS and avian influenza (<http://www.hpa.org.uk/infections/topics_az/avianinfluenza/pdfs/Algorithm140
404.pdf>). The HPA has urged clinicians and health professionals in
the UK to remain vigilant and report any unusual clusters of severe respiratory
illness in people returning from China.
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- --
- ProMED-mail
- promed@promedmail.org
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- ******
- [6] South Korea
- Date: 24 Apr 2004
- Source: Yahoo News, Asia [edited]
- http://asia.news.yahoo.com/040424/ap/d8256gu00.html
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- South Korea heightens health checks against travelers
from China amid new SARS scare
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- Health inspections of travelers from Beijing and Shanghai
were intensified Saturday at South Korean airports and seaports after China
reported new SARS cases.
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- The National Institute of Health ordered quarantine offices
to check temperatures of all travelers from the 2 Chinese cities, and asked
them to fill out health questionnaires upon arrival.
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- The institute also ordered anyone showing symptoms of
severe acute respiratory syndrome, such as a high fever, be reported immediately.
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- --
- ProMED-mail
- promed@promedmail.org
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- [In the past 24 hours there have been no reports of additional
cases other than those reported in the ProMED-mail posting of yesterday
SARS - worldwide (18): China (cases) 20040423.1125. This current posting
contains more detailed information from WHO and newswires on the chronology
of events surrounding the cases with implications for potential spread
due to delay in recognition of the disease in the index and other cases.
We've included information from several countries on heightened surveillance
activities that are now being taken in order to more quickly identify possible
spread of disease outside of China. One hopes that with heightened surveillance,
transmission of the SARS CoV will be interrupted rapidly. - Mod.MPP]
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- Patricia A. Doyle, PhD
- Please visit my "Emerging Diseases" message
board at: http://www.clickitnews.com/ubbthreads/postlist.php?Cat=&Board=emergingdiseases
- Zhan le Devlesa tai sastimasa
- Go with God and in Good Health
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