Severe acute respiratory syndrome - worldwide (07)

[Dave Farber <dave () farber net>]

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Subject: PRO/EDR> Severe acute respiratory syndrome - worldwide (07)


SEVERE ACUTE RESPIRATORY SYNDROME - WORLDWIDE (07)
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In this update:
[1] Singapore - MOH
[2] Hong Kong - MOH
[3] Worldwide update - WHO
[4] Index case, Hong Kong - newswire
[5 Index case, Hong Kong - subscriber contribution

******
[1]
Date: 18 Mar 2003
From: ProMED-mail <promed () promedmail org>
Source: Singapore Ministry of Health 18 Mar 2003 [edited]
<http://app.moh.gov.sg/new/new02.asp?id=1&mid=5480>


Update 5 on SARS cases in Singapore
-----------------------------------
Since the Ministry of Health (MOH) press release yesterday, 2 more patients
have been diagnosed with SARS. The new cases are both close contacts of the
cases. In total, 23 cases of SARS have been reported. Other than the
initial 3 cases, the additional 20 patients are all close contacts of
patients with SARS, 8 of them being hospital staff. All the patients are
stable, except for 4 patients who are in a serious condition.

The Ministry of Health would like to appeal to the public to avoid travel
to Hong Kong, Hanoi, and Guangdong province in China for the time being,
unless absolutely necessary. This would help us greatly in our efforts to
contain the number of new cases. We hope that we will continue to see a
decreasing number of cases of SARS as we have put in place the necessary
precautionary measures.

We also advise you to stay calm and continue with your daily routine.
Though SARS is infectious, there is no need for alarm as your risk of SARS
is low. The World Health Organization (WHO) has reported that the disease
is spread from person to person but only through close contact with an
infected person. There is no evidence to date that the disease spreads
through casual contact. Apart from the initial 3 cases, those who came down
with SARS in Singapore were family members and friends, and hospital staff
who had come into close contacts with the infected patients.

The Ministry would like to reiterate that you should seek immediate medical
attention if you have:
- fever (greater than 38 degrees Celsius) and respiratory symptoms
including cough, shortness of breath, or breathing difficulty;
AND
- have travelled to Hong Kong, Hanoi, or Guangdong province in China,
within 2 weeks of onset of the symptoms; or
- are a close contact of a person(s) diagnosed with SARS. (Close contact
means having cared for, having lived with, or having had direct contact
with respiratory secretions and body fluids of a person with SARS)

******
[2]
Date: 18 Mar 2003
From: ProMED-mail <promed () promedmail org>
Source: Hong Kong, SAR - Department of Health 18 Mar 2003
<http://www.info.gov.hk/dh/new/index.htm>


Latest admission figures
------------------------
The following is jointly issued by the Department of Health and the
Hospital Authority:
As at 1pm today (18 Mar 2003), the admission statistics of patients who
have been in close contacts with atypical pneumonia patients are as follows:

A. Staff of Hospitals/Clinics (numbers in brackets are those with symptoms
of pneumonia)
Staff of Prince of Wales Hospital (PWH) admitted to:
Prince of Wales Hospital 44 (36)
Kwong Wah Hospital 1 (1)
Princess Margaret Hospital (PMH) 1 (1)
Tseung Kwan O Hospital 1 (1)

Staff of Kwong Wah Hospital (KWH) admitted to:
Kwong Wah Hospital 2 (2)

Staff of Pamela Youde Nethersole Eastern Hospital (PYNEH) admitted to:
Pamela Youde Nethersole Eastern Hospital 7 (7)

Staff of Queen Elizabeth Hospital admitted to:
Queen Elizabeth Hospital 4 (1)

Staff of a Private Clinic in Mong Kok admitted to:
Princess Margaret Hospital 3 (3)
Tuen Mun Hospital 1 (0)

Staff of a private hospital on HK Island admitted to:
Pamela Youde Nethersole Eastern Hospital 3 (3)

Sub-total (A) 67 (55)

B. Medical Students (numbers in brackets are those with symptoms of
pneumonia)
Medical students Prince of Wales Hospital 17 (17)

C. Other Close contacts of Index Patient (numbers in brackets are those
with symptoms of pneumonia)
Family members & visitors PWH, PMH, KWH, PYNEH & Queen Mary Hospital 39 (39)

Total admissions
(A + B + C) 123 (111)

Meanwhile, the Department of Health has launched a dedicated website on
atypical pneumonia to provide health advice on the prevention of
respiratory tract infection and offer latest information on the cases. The
websites are <www.info.gov.hk/dh/ap.htm> (English) and
<www.info.gov.hk/dh/apc.htm> (Chinese). [These websites contain information
on the disease, suggested prevention measure when caring for ill family
members and a hotline telephone number to call for additional information.
- Mod.MPP]

******
[3]
Date: 18 Mar 2003
From: ProMED-mail <promed () promedmail org>
Source: WHO/CSR update 18 Mar 2003 (edited)
<http://www.who.int/csr/don/2003_03_18/en/>


SARS multi-country outbreak - update 3
--------------------------------------
Advice for travellers: Currently available findings from the outbreak of
severe acute respiratory syndrome (SARS) continue to indicate that the
overwhelming majority of cases are occurring in health care workers, and
their families, who have had direct contact with SARS patients. The number
of cases without such close contact remains small, and no data indicate
that this number is rapidly increasing. Based on current knowledge, WHO
considers that the emergency travel advice issued on Sat 15 Mar 2003
remains valid.

WHO advises that no restrictions on travel to any destination are
necessary. Persons travelling to Asia and the Far East should be aware of
the major symptoms of SARS, and of the need to report promptly to a health
care worker in the unlikely event that they fall ill during their travel or
after returning home.

For the full WHO travel advice and additional information about this
disease go to <http://www.who.int/csr/sars/en/>.

Current situation: Isolated cases of suspected SARS continue to be reported
in new countries. As of today, health authorities are investigating
reported cases in Canada, China, Taiwan (China), Germany, Hong Kong Special
Administrative Region of China, Singapore, Slovenia, Thailand, Viet Nam,
and the United Kingdom. Further details, including cumulative number of
cases and deaths, are given in the table below
<http://www.who.int/csr/sars/tablemarch18/en/>.

Cumulative number of reported suspect and probable cases from 1 Feb to 18
Mar 2003

Country / cumulative no. cases / no. deaths / local transmission
Germany / 2 / 0/ none*
Canada  / 8 / 2/ yes
China  / +
Singapore/ 23 / 0 / yes
Hong Kong SAR China/ 123 / 1** / yes
Taiwan, China/  3 / 0 / yes
Thailand / 1 / 0 / none*
Viet Nam / 57 / 1 / yes
Slovenia / 1 / 0 / none*
United Kingdom / 1 / 0 / none*
Total: 219 / 4 / not applicable

It is possible for the status of a reported case to change over time. SARS
is a diagnosis of exclusion. This means that whenever a known cause is
found that could fully account for a patient's clinical condition, this
patient should no longer be considered to be a case of SARS.

Two cases attributed to Switzerland on 17 Mar 2003 no longer fulfilled the
case definition of SARS after further clinical assessment.

+ The Chinese authorities have reported suspect and probable cases in
Guangdong province. Figures are being updated.
* No documented secondary transmission in-country. No affected areas.
**The death attributed to Hong Kong SAR of China occurred in a case
medically transferred from Viet Nam.

At present, the vast majority of cases are concentrated in Hong Kong
Special Administrative Region of China and Hanoi, Viet Nam. Singapore is
currently reporting the third largest number of cases. All reported cases
in other parts of the world are linked to travel within the past 10 days to
one of these destinations. It remains undetermined whether an outbreak of
atypical pneumonia in southern China, which began in November, is related
to the current outbreaks.

In Hanoi, 13 of the 57 patients are showing signs of clinical improvement.

Awareness of the disease is now very high throughout the world.
Surveillance is proving to be sensitive, with suspected cases rapidly
detected, reported to national authorities and WHO, and investigated
according to the standard case definition. An increase in the number of
suspected cases is to be expected in such an atmosphere of heightened
awareness.

In areas where person to person transmission has been documented, cases
have occurred almost exclusively in health care workers or in people in
very close contact with patients, such as family members. Currently
available data indicate that transmission of the infectious agent requires
direct and close contact. There is no evidence of transmission following
casual contact.

Due to heightened awareness, cases are now being quickly identified and
immediately isolated. No cases of secondary transmission are occurring
following the detection and proper management of imported cases.

Protective measures and strict barrier nursing procedures are now in place
in hospitals in all areas where cases have been reported. In areas where
person to person transmission has occurred, these measures are expected to
decrease transmission to health staff and families of patients. Strict
protective measures in countries managing imported cases are likewise
expected to reduce the risk that the disease will spread to others within
these countries.

Efforts are under way to expedite identification of the causative agent,
improve diagnostic precision, and develop a diagnostic test. A network of
11 highly qualified laboratories in 10 countries was established yesterday
and has begun data sharing and regular reporting today.

Many countries have activated well designed national preparedness plans for
dealing with an emerging infectious disease. The global surveillance
system, which WHO coordinates, is working well in the ways needed to
prevent the outbreak from becoming a global epidemic.

******
[4]
Date: 18 Mar 2003
From: ProMED-mail <promed () promedmail org>
Source: CNN 18 Mar 2003 13:40 GMT [edited]
<http://www.cnn.com/2003/HEALTH/03/18/mystery.disease.patient.ap/index.html>


HONG KONG (AP): A pneumonia patient believed to have spread a mysterious
respiratory illness to dozens of hospital workers in Hong Kong traveled to
mainland China before he became ill. Dr Leung Ping-chung, who has been
working throughout the pneumonia outbreak at Hong Kong's hardest-hit
hospital, told the Associated Press the patient believed to have spread the
illness was a man aged in his 40s who had visited Hainan island and other
parts of southern China. Leung said the patient, who has not been
identified by name, is "still very sick" in the hospital.

Health authorities are trying to determine whether disease outbreaks in
Hong Kong, Vietnam and elsewhere are linked to an illness in mainland
China's southern Guangdong province that recently sickened 305 people and
killed 5.

On Monday, Hong Kong's health chief, Dr Yeoh Eng-kiong, said that officials
had identified the "index patient" who apparently has spread the disease to
68 people, mainly medical workers, at the Prince of Wales Hospital, but
declined to provide any details about the patient.

******
[5]
Date: 17 Mar 2003
From: Date: Mon, 17 Mar 2003 00:47:20 -0800 (PST)
From: John Herbert <j_a_herbert () yahoo com>


There was a death of a Hong Kong man who visited mainland [China] and fell
ill, admitted to hospital on 22 Feb 2003. He died 11 days later at Kwong
Wah hospital on 4 Mar 2003. He had atypical pneumonia symptoms and his
sister was also taken ill too, although little information is available.
Later, we have the "official" HK outbreak reported at Kwong Wah Hospital,
HK.

To put you in the picture a little, the Hong Kong/China border is busy,
comprising 5 crossing points and built and staffed to handle more than 200
000 people a day plus countless container lorries.

Every day, thousands (I don't have a precise figure must be near 5000)
cross the border, many people would consider a day trip to China as normal
activity:
- border is open 24 hrs a day.
- thousands of people live in China and cross for work in Hong Kong.
- hundreds more cross the border twice a day, whether it is Chinese kids
coming here for schooling in Hong Kong, or businessman going over for
dinner and entertainment, or day shoppers or traders; the border creates
great opportunities for trade and 2 way infection everyday.

-- 
John Herbert (Hong Kong)
Consulting Engineer
<j_a_herbert () yahoo com>

ProMED-mail
<promed () promedmail org>

[ProMED-mail would like to thank the following subscribers for submission
of information on this unfolding outbreak: Marianne Hopp
<mjhopp12 () yahoo com>, Pablo Nart <p.nart () virgin com, Annike
Andresen"<pegasus55 () email dk>, Dr Muruga Vadivale
<Muruga.Vadivale () aventis com>, H Larry Penning <hlpenning () yahoo com>, Lizz
Kopecny <ekopecny () mail usyd edu au>, Joe Parrish
<JoeParrish () compuserve com>, Gerhard Mosbach <info () meil de>, Chris Griot
<Christian.Griot () ivi admin ch>. If we have inadvertently omitted your name,
please accept our apologies and our continued thanks for keeping us updated.

As we have mentioned in prior postings, the newswires are filled with
articles on SARS. Numerous reports of suspected cases  are followed only
hours later by reports which say that the original suspected cases have
been ruled out after further evaluation. (for example, the suspected cases
in Leipzig Germany that we reported yesterday have been ruled out as cases
today). Given this, we are choosing to be very cautious in our selection of
newswire reports for posting to avoid contributing to rumor mongering. At
this point, in the absence of a definitive etiology for SARS, suspected and
probable cases are defined based on clinical and epidemiologic criteria.
Many of the newswire reports we have reviewed may be said to have, as a
functional case definition, anyone with a respiratory illness who has been
in areas identified as having cases of SARS (see [3] Worldwide update - WHO
above), and once evaluated by the formal sector are found not to meet the
case definitions established by WHO (see
<http://www.who.int/csr/sars/casedefinition/en/>).

In [3] Worldwide update - WHO, there is mention that "isolated cases of
suspected SARS continue to be reported in new countries. As of today,
health authorities are investigating reported cases in Canada, China,
Taiwan (China), Germany, Hong Kong SAR of China, Singapore, Slovenia,
Thailand, Viet Nam, and the United Kingdom." Newswire reports also mention
suspected cases in the USA, Sweden, and Austria. Additional countries are
likely to be added to the list as the heightened alert brings cases to the
attention of the authorities. In this era of rapid transport and extensive
travel, we live in a global village and should not be surprised to have
cases among travellers who may have had close contact with SARS cases in
countries where transmission has been identified.

In [4] above, it is interesting that there was travel to southern China
preceded the onset of illness. [5] also mentions an early case with a
history of travel to southern China, and an interesting description of the
communications between southern China and Hong Kong SAR of China. We await
more information on the outbreak of a SARS-like illness in Guangdong China
when it becomes available.

On the positive note, it does not appear that casual contact with cases is
a significant mode of transmission as the overwhelming majority of cases
continue to be in people with known close contact with other cases. Also it
appears that barrier nursing precautions (see WHO Hospital Infection
Control Guidance <http://www.who.int/csr/sars/infectioncontrol/en/>) in
hospitals may be reducing transmission in this setting. Most of the current
increase in cases among health care workers occurred among people exposed
before the global recommendation for respiratory precautions was made. (The
Centers for Disease Control and Prevention (CDC) posted updated interim
domestic infection control guidance in the health care and community
setting for patients with suspected SARS on 18 Mar 2003 and can be found at
<http://www.cdc.gov/ncidod/sars/infectioncontrol.htm>). - Mod.MPP]

[see also:
Severe acute respiratory syndrome - worldwide (06)         20030318.0677
Severe acute respiratory syndrome - Worldwide (05)         20030317.0669
Severe acute respiratory syndrome - Worldwide (04):comment 20030317.0664
Severe acute respiratory syndrome - Worldwide: alert (03)  20030316.0660
Severe acute respiratory syndrome - Worldwide (02):alert   20030315.0649
Severe Acute Respiratory Syndrome - Worldwide              20030315.0637
Acute respiratory syndrome - Canada (Ontario)              20030314.0631
Acute respiratory syndrome - East Asia                     20030314.0630
Acute respiratory syndrome - China (HK), VietNam (03)      20030313.0624
Acute respiratory syndrome - China (HK), VietNam (02)      20030313.0623
Acute respiratory syndrome - China (HK), VietNam           20030312.0602
Undiagnosed illness - Vietnam (Hanoi): RFI                 20030311.0595
Influenza, H5N1 human case - China (Hong Kong) (05)        20030228.0500
Pneumonia - China (Guangdong) (07)                         20030221.0452
Pneumonia - China (Guangdong) (06)                         20030220.0447
Pneumonia - China (Guangdong) (05)                         20030220.0446
Pneumonia - China (Guangdong) (04)                         20030219.0427
Pneumonia - China (Guangdong) (03)                         20030214.0390
Pneumonia - China (Guangdong) (02)                         20030211.0369
Pneumonia - China (Guangdong): RFI                         20030210.0357]

.......................mpp/sh

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