MESSAGE ABOUT SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
Last updated: 4/29/04
As of April 29, 2004, the Chinese Ministry of Health has reported diagnostic confirmation of SARS infection in two patients previously under investigation in Beijing. Confirmation is based on the results of laboratory tests, clinical symptoms, and a history of close contact with a known case. Both patients are relatives - the mother and an aunt - of a 20-year-old nurse who treated what is thought to be the index case in the outbreak. The nurse subsequently developed respiratory symptoms and was hospitalized on April 7. She was visited the next day by family members, including the mother and aunt. The 44-year-old mother is now in critical condition. The 36-year-old aunt, who was diagnosed with bilateral pneumonia earlier this week, remains in stable condition.
As of April 29, 2004, the number of SARS cases either clincally confirmed or under investigation is nine: seven in Beijing and two (including the single fatality) in Anhui Province. Of the nine reported cases in China so far, four are classified by Chinese health authorities as "confirmed" and five are listed as "suspected." According to World Health Organization (WHO) guidelines for the global surveillance of SARS, classification as a confirmed case at the start of an outbreak requires independent verification of results by an external international reference laboratory. Such procedures are considered by WHO to be necessary, in view of the implications that confirmed SARS cases can have for international public health. Chinese authorities have heightened surveillance and reporting for SARS-like illness in health care facilities and have sent investigative teams to Anhui Province. As of 4/26/04, close to 1,000 contacts of these cases are under medical observation, including 640 in Beijing and 353 in Anhui.
Results of investigations to date point to laboratory research at the National Institute of Virology in Beijing as the likely source of the outbreak. The institute has been engaged in research with the SARS coronavirus (SARS-CoV), including the development of a vaccine. Two of the recently reported cases were conducting research at the laboratory: a 26-year-old female postgraduate student from Anhui Province, and a 31-year-old man. The dates of symptom onset in the two cases are widely separated (23 days), suggesting that more than one opportunity for exposure may have occurred in the laboratory from mid-March through early April, according to the WHO. Authorities have closed the virology institute and placed its more than 200 employees under medical observation. Numerous environmental samples from the laboratory have been taken to help assess possible sources of contamination, and these samples will be shared with WHO.
WHO is concerned about additional opportunities for exposure that may have already occurred. Some patients were treated or assessed in several different hospitals before a suspicion of SARS led to the introduction of adequate precautionary measures, including isolation of patients and strict procedures for infection control. One patient travelled a long distance twice by train within China while symptomatic.
To date, all diagnosed cases and cases under investigation have been linked to chains of transmission involving close personal contact with an identified case. There is no evidence of wider transmission in the community.
Canada is now distributing SARS Health Alert Notices (i.e. health information cards describing SARS) at major ports of entry to arriving passengers from China. The U.S. Centers for Disease Control and Prevention (CDC) is prepared to respond at U.S. ports of entry, including the distribution of SARS Health Alert Notices, if there is an increase in SARS-CoV activity. CDC is closely monitoring the situation in China and neighboring countries and remains in close contact with international partners to determine the timing and type of response required.
For more information, see WHO and CDC links below.
Previously this year, there were three confirmed and one probable SARS cases, all resolved, reported from Guangdong, China:
On January 5, 2004, the Chinese Ministry of Health and the World Health Organization (WHO) announced laboratory confirmation of SARS in a 32-year-old male television producer in Guangdong Province, China. This patient had onset of illness on December 16, 2003, was hospitalized, and had since recovered.
On January 7, 2004, a 40-year-old director of a hospital, and practicing physician, from Guangzhou, Guangdong Province developed symptoms of SARS. He was admitted to a hospital in Guangdong with pneumonia on January 16 and placed in respiratory isolation on the suspicion of SARS. He has made a full recovery and was discharged home on January 30.
On January 8th, suspect SARS was reported in a 20-year-old woman who works in a restaurant also in Guangdong, China. This patient had onset of fever on December 26, 2003; she was also hospitalized, but has been discharged and has recovered. Laboratory tests confirmed SARS in this patient on January 17.
On January 12, we learned of another suspect SARS case in a 35-year-old male shopkeeper in Guangdong who had onset of fever on December 31; he was discharged from the hospital on January 21. This fourth patient awaits confirmatory SARS laboratory test results.
Contacts, including health care workers, of these patients have been followed and, thus far, no illness has been reported among them. There is no known epidemiological link between these patients. The source of infection in these individuals has not been determined, although a possible animal source is being investigated in the case of the 20-year-old woman. The WHO and the federal Centers for Disease Control and Prevention (CDC) have not issued any new travel alerts or advisories at this time.
Marin County Department of Health and Human Services is closely following developments on SARS and conducting appropriate surveillance. We are working closely with the California Department of Health Services, which
is in frequent contact with the CDC. State and local health agencies, the CDC, and the WHO continue to investigate this illness.
In 2003, Marin County reported two possible SARS cases. The first was reported 3/25/03 and the second was reported 4/19/03. Both have recovered, and final tests were negative for both. The two cases are not linked. Both cases
involved travel to areas in Asia designated by the CDC as areas where community transmission of SARS has occurred.
For the Public - More Information:
For Clinicians:
Clinician References:
- CDC website
- CDC Clinician Hotline: English 877-554-4625
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