SARS Worldwide
March 20, 2003
SEVERE ACUTE RESPIRATORY SYNDROME - WORLDWIDE (11)
***************************************
In this update:
[1] Singapore - MOH
[2] Hong Kong - MOH
[3] Worldwide update - WHO
[4] Taiwan - MOH
[5] USA - CDC
[6] Worldwide update - MMWR
[7] Worldwide update - Eurosurveillance Weekly
******
[1]
Date: 20 Mar 2003
From: ProMED-mail promed@promedmail.org
Source: Singapore Ministry of Health 20 Mar 2003 (edited)
http://app.moh.gov.sg/new/new02.asp?id=1&mid=5520
Update (7) on SARS cases in Singapore
-------------------------------------
As at 20 Mar 2003, a total of 34 people with SARS have been reported. The
3
additional patients reported today comprise 3 family members and friends
of
patients. Two patients from the initial cohort have recovered and been
discharged, but the rest of the patients are still in hospital. All the
patients are stable except for 5 who are in a serious condition.
To date, apart from the 3 initial people who had travelled to Hong Kong, a
total of 18 family and friends of cases, and 13 hospital staff have been
diagnosed with SARS. So far, all the cases of SARS have been linked to the
initial 3 cases. No new index cases have been reported and no further
cases
have occurred among health care workers after the implementation of
enhanced infection control precautions.
******
[2]
Date: 20 Mar 2003
From: ProMED-mail promed@promedmail.org
Source: Hong Kong, SAR - Department of Health 20 Mar 2003 (edited)
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 3pm today (20 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 53 (53)
Kwong Wah Hospital 3 (2)
Princess Margaret Hospital (PMH) 1 (1)
Tseung Kwan O Hospital (TKOH) 1 (1)
Staff of Kwong Wah Hospital (KWH) admitted to:
Kwong Wah Hospital 4 (4)
One of the health care workers was discharged
Staff of Pamela Youde Nethersole Eastern Hospital (PYNEH) admitted to:
Pamela Youde Nethersole Eastern Hospital 7 (7)
Staff of Queen Elizabeth Hospital (QEH) admitted to:
Queen Elizabeth Hospital 5 (2)
Staff of a Private Clinic in Mong Kok admitted to:
Princess Margaret Hospital 4 (4)
Tuen Mun Hospital 1 (0)
Staff of a private hospital on HK Island admitted to:
Pamela Youde Nethersole Eastern Hospital 3 (3)
Total 82 (77)
B. Medical students (numbers in brackets are those with symptoms of
pneumonia)
Medical students Prince of Wales Hospital 17 (17)
One of the medical students was discharged
C. Other close contacts of Index Patients (numbers in brackets are those
with symptoms of pneumonia)
Patients, patients' family members & visitors PWH, PMH, KWH, PYNEH, QEH,
TKOH & Queen Mary Hospital 74 (71)
3 of the patients were discharged
Total admissions (A + B + C) 173 (165)
5 were discharged
The Department of Health and Hospital Authority have been closely
monitoring the clinical condition of inpatients with pneumonia symptoms.
The total number of admissions is released after collating, analysing, and
confirming the clinical symptoms and test results of the patients
concerned. The total number of patients includes those who were admitted
earlier.
On the other hand, 6 patients with atypical pneumonia died recently in the
following public hospitals: Kwong Wah Hospital (2 patients); Princess
Margaret Hospital (1); Pamela Youde Nethersole Eastern Hospital (1);
Prince
of Wales Hospital (2).
The Department of Health has launched a website on atypical pneumonia to
provide health advice on the prevention of respiratory tract infection and
news on the cases. The URLs are www.info.gov.hk/dh/ap.htm(English) and
www.info.gov.hk/dh/apc.htm(Chinese).
******
[3]
Date: 20 Mar 2003
From: ProMED-mail promed@promedmail.org
Source: WHO / CSR / SARS website 20 Mar 2003
http://www.who.int/csr/don/2003_03_20/en/
A. Severe acute respiratory syndrome (SARS) multi-country outbreak -
update 5
------------------------------------
Highly specialized testing of specimens from patients ill with SARS
continues at top speed in top labs, expedited by electronic sharing of
results. The World Health Organization (WHO) is increasingly optimistic
that conclusive identification of the causative agent can be announced
soon. The development of a precise diagnostic test could follow quickly.
Collaboration in the race to find the causative agent is taking place
within the framework of a network of labs set up on Monday.
Research is now focused on the Paramyxoviridae family of viruses. This
family includes several well known viruses, such as those causing mumps,
measles, and common respiratory ailments. It also includes a subfamily of
viruses capable of infecting multiple animal species, including humans.
This subfamily was implicated in the emergence during the 1990s of new and
severe diseases in humans caused by Hendra and Nipah viruses. The virus
jumped directly from animal hosts (horses and pigs) to humans. No person
to
person transmission was documented in outbreaks caused by either virus.
WHO has today established a cooperative network of clinicians for SARS
diagnosis and treatment. The network brings together, via two daily
teleconferences, clinicians in the most heavily affected Asian countries
and in Europe and North America. Clinicians participate on the basis of
either first-hand experience in the management of SARS cases or leading
expertise in the diagnosis and management of unusual infectious diseases.
Participants are pooling data on cases and sharing x-ray pictures. Chest
x-rays are, at present, one of the main tools for distinguishing between
suspected and probable cases. Treatment guidelines, including criteria for
safe discharge of patients from hospitals, are also being established on
the basis of shared experiences.
Pending definitive identification of the causative agent, efforts to cure
cases are based on a trial-and-error approach. WHO is providing support,
in
the form of protective equipment and supplies, to help the most heavily
affected hospitals prevent further spread within hospital settings, where
the overwhelming majority of new infections have occurred.
If a paramyxovirus is confirmed to be the cause, WHO will be in a much
better position to recommend a treatment. The antiviral drug, ribavirin,
may be responsible for some degree of clinical improvement observed in
critically ill patients in Hong Kong Special Administrative Region of
China. Intensive and good supportive care have also been associated with
improved prospects of recovery.
As of 20 Mar 2003, 306 suspected and probable cases, including 10 deaths,
have been reported from 11 countries. These figures represent an
additional
42 cases and one death compared with the previous day. Increases were
reported in Canada (1), Hong Kong (23), Singapore (3), Taiwan, China (1),
the United Kingdom (1), and Viet Nam (6). Switzerland, reporting 7
suspected cases, was added to the list.
Press reports have referred to 2 suspected cases of SARS, one in an
airline
crew member and a second in a passenger, travelling on separate flights
from Hong Kong and Taipei to Viet Nam. Both suspected cases have been
investigated and are now ruled out as cases of SARS.
WHO has welcomed a report from the Hong Kong Department of Health,
released
yesterday, that may have identified the "index" case in the outbreak in
the
Prince of Wales Hospital in Hong Kong. In an outstanding example of
detective work, epidemiologists have determined that 7 people who
contracted SARS recently stayed in or visited the Metropole hotel in
Kowloon last month. The 7 people investigated include 3 visitors from
Singapore, 2 from Canada, one China mainland visitor, and a local Hong
Kong
resident.
The investigation revealed that all 7 stayed in or visited the same floor
of the hotel between 12 Feb 2003 and 2 Mar 2003. The local Hong Kong
resident is believed to be the index case, who subsequently infected other
early cases in the outbreak. He had visited an acquaintance staying at the
hotel from 15 to 23 Feb 2003. The visitor from mainland China, who became
sick a week before staying at the hotel, is considered the original source
of the infection. No further cases have been linked to the hotel.
WHO is underscoring the need for continued vigilance. Experience with
other
emerging diseases makes it clear that, should the causative agent turn out
to be a virus, the new disease could establish endemicity, especially in
light of abundantly documented human-to-human transmission. The world must
protect itself against the widespread establishment of another new
infectious disease.
WHO's concern is now increasingly focused on preparation to assist
vulnerable countries in the likely event that cases continue to spread. Up
to now, all imported cases have occurred in countries well equipped and
well prepared to institute WHO-recommended precautions, including
isolation
and barrier nursing practices, for preventing spread to others, whether
health care workers or family members. In view of the rapid spread of this
disease to new countries via exposed air travellers, any country with an
international airport is potentially at risk.
This focus on preparedness underscores the need for a concerted effort to
defend global public health security. In an era of close
interconnectedness
and rapid air travel, an outbreak anywhere in the world is a potential
threat to health everywhere.
International collaboration -– on the part of the medical and research
communities, multinational teams in the field, and health authorities
around the world –- in the reporting, investigation, and management of
this
outbreak has been outstanding.
B. Cumulative number of reported suspect and probable cases
http://www.who.int/csr/sarscountry/2003_03_20/en/
From: 1 Feb 2003 To: 20 Mar 2003, 13:00 GMT+1
Country: Cumulative No. case(s) / no. deaths / local transmission
Canada: 9 / 2 / yes
China: +
Germany 1 / 0 / none*
Hong Kong SAR China: 173 / 6** / yes
Singapore: 34 / 0 / yes
Slovenia: 1 / 0 / none*
Spain: 1 / 0 / to be determined
Switzerland: 7 / 0 / to be determined
Taiwan, China: 4 / 0 / yes
Thailand: 1 / 0 / none*
United Kingdom: 2 / 0 / to be determined
United States: 11 / 0 / to be determined
Viet Nam: 62 / 2 / yes
Total: 306 / 10
Notes:
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.
+The Chinese authorities have reported suspect and probable cases in
Guangdong province. Figures are being updated.
Cumulative number of cases includes number of deaths.
* No documented secondary transmission in-country. No affected areas.
**One death attributed to Hong Kong Special Administrative Region of China
occurred in a case medically transferred from Viet Nam.
C. Affected Areas - Severe Acute Respiratory Syndrome (SARS) as of 20 Mar
2003 http://www.who.int/csr/sarsareas/2003_03_20/en/
Country: Area
-------------
Canada: Toronto
Singapore: Singapore
China: Guangdong Province, Hong Kong Special Administrative Region of
China, Taiwan Province
Viet Nam: Hanoi
An "affected area" is defined as a region at the first administrative
level
where the country is reporting local transmission of SARS.
******
[3]
Date: Thu, 20 Mar 2003 19:22:47 +0800 (CST)
From: Prof Peter WS Chang wpc94@yahoo.com
Source: Taiwan, Center for Disease Control
The Department of Health, Taiwan, here reports the 4th case of probable
SARS. This 32 year old male had a trip to Gaungdong, China, and Hong Kong
from 4 to 6 Mar 2003. On 13 Mar 2003, he suffered from high fever,
headache, and cough with sputum. He visited a regional hospital in Chia-yi
County in Taiwan, and his chest radiograph disclosed pulmonary infiltrates
over the left lower lobe. He was immediately hospitalized and under the
suspicion of SARS.
All necessary sampling for pathogen studies and isolation procedures have
been undertaken for this individual. CDC in Taiwan has implemented the
surveillance system for SARS. A 24 hour 0-800 toll-free hotline and timely
updated website http://www.cdc.gov.tw/atyp/have been established. So
far, there has been no evidence of community spread except the second case
who is the wife of the first reported case. However, a few suspected
individuals have been reported to the CDC, Taiwan, to this day and further
confirmation is undertaken.
As of March 20, 4 cases of SARS were identified in Taiwan, in 3 families
and currently treated in 3 hospitals. With respect to results of lab
diagnosis, specimen tests for influenza virus type A,BB, BH5, BH7, BH9,
parainfluenza virus, adenovirus, respiratory syncytial virus, Herpes
virus,
and Nipah virus are all negative.
(Additional comment by Prof Peter WS Chang MD, PMP, ScD: "Director Dr Chen
of the Taiwan Center for Disease Control has just submitted this update of
SARS case report in Taiwan and other related information. As I am aware,
the doctors in Taiwan have observed viral particles under the electron
microscope at March 18th, same as reported in Germany and Hong Kong. They
are working on the molecular confirmation at these hours. However, it is
still not clear the paramyxovirus are the real etiology for the SARS, even
it is in the specimen. It can be an associate factor, though. Also, it
needs more study on the immunity of these patients and the exploration/
understanding on the mechanisms for this epidemic. The answers remained to
be worked out by collaborative efforts in the region in the coming days.")
[The nomenclature used in this report for the influenza viral testing is
not the conventional nomenclature. There are no accepted H and N antigenic
type designations for influenza B viruses. The B viruses do not exhibit as
much antigenic variation as the A viruses and influenza B viruses have no
animal reservoirs. The H5, H7 and H9 designations presumably refer to
avian
influenza viruses, but rather than speculate it is better to request
further clarification of this. With respect to the other viruses, it is
crucial to know the nature of the diagnostic tests employed in order to
fully interpret these results. More information on the specifics of the
testing conducted would be appreciated. - Mods.MPP/CP]
--
Professor Peter WS Chang, MD, MPH, ScD
for Director Dr Chen
Center for Disease Control
Department of Health
Taiwan
******
[4]
Date: 20 Mar 2003
From: ProMED-mail promed@promedmail.org
Source: CDC SARS website [accessed most recently 20 Mar 2003 12:30 PM EST]
http://www.cdc.gov/ncidod/sars/
Suspected cases of SARS under investigation in the United States
http://www.cdc.gov/od/oc/media/sars.htm
This information in this table will be updated Monday through Friday.
These
data were reported to the World Health Organization on March 18, 2003.
Numbers of suspected cases are expected to fluctuate as additional
information becomes available.
State: Suspected cases under investigation*
Arizona 1
California 1
Colorado 1
Hawaii 2
New Jersey 1
New Mexico 1
North Carolina 1
Tennessee 1
Virginia 1
Wisconsin 1
Total: suspected cases under investigation 11
*Case definition can be found at:
http://www.cdc.gov/ncidod/sars/casedefinition.htm
United States Department of Health and Human Services
Centers for Disease Control and Prevention
Office of Communication
Division of Media Relations
--
******
[6]
Date: 20 Mar 2003
From: ProMED-mail promed@promedmail.org
Source: CDC. MMWR Morb Mortal Wkly Rep 2003; 52(11): 226-8 (21 Mar)
(edited)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5211a5.htm
Outbreak of severe acute respiratory syndrome -- worldwide, 2003
---------------------------------------------
Since late February 2003, the US Centers for Disease Control and
Prevention
(CDC) have been supporting the World Health Organization (WHO) in the
investigation of a multicountry outbreak of atypical pneumonia of unknown
etiology. The illness is being referred to as severe acute respiratory
syndrome (SARS). This report describes the scope of the outbreak,
preliminary case definition, and interim infection control guidance for
the
United States.
On 11 Feb 2003, the Chinese Ministry of Health notified WHO that 305 cases
of acute respiratory syndrome of unknown etiology had occurred in 6
municipalities in Guangdong province in southern China from 16 Nov 2002 to
9 Feb 2003. The disease was characterized by transmission to health care
workers and household contacts; 5 deaths were reported (1). On 26 Feb
2003,
a man aged 47 years who had traveled in mainland China and Hong Kong
became
ill with a respiratory illness and was admitted to hospital shortly after
arriving in Hanoi, Vietnam. Health care providers at the hospital in Hanoi
subsequently developed a similar illness. The patient died on 13 Mar 2003
after transfer to an isolation facility in Hong Kong. In late February, an
outbreak of a similar respiratory illness was reported in Hong Kong among
workers at another hospital; this cluster was linked to a patient who had
traveled previously to southern China. On 12 Mar 2003, WHO issued a global
alert about the outbreak and instituted worldwide surveillance.
As of 19 Mar 2003, WHO has received reports of 264 patients from 11
countries with suspected and probable* SARS [see table on website
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5211a5.htm, the same table
contained in the ProMED-mail posting of 19 Mar 2003 with WHO worldwide
update figures]. Areas with reported local transmission include Hong Kong
and Guangdong province, China; Hanoi, Vietnam; and Singapore. More limited
transmission has been reported in Taipei, Taiwan, and Toronto, Canada. The
initial cases reported in Singapore, Taiwan, and Toronto had all traveled
to China.
On 15 Mar 2003, after issuing a preliminary case definition for suspected
cases (Box, CDC initiated enhanced domestic surveillance for SARS, CDC
also
advised that people planning nonessential travel to Hong Kong, Guangdong,
or Hanoi consider postponing their travel
(http://www.cdc.gov/travel/other/acute_resp_syn_multi.htm). On 16 Mar
2003,
CDC began advising passengers arriving on direct flights from these 3
locations to seek medical attention if they had symptoms of febrile
respiratory illness. As of 18 Mar 2003, about 12 000 advisory notices had
been distributed to airline passengers. In addition, surveillance is being
heightened for suspected cases of SARS among arriving passengers. As of 19
Mar 2003, a total of 11 suspected cases of SARS in the United States are
under investigation by CDC and state health authorities.
Among patients reported worldwide as of 19 Mar 2003, the disease has been
characterized by rapid onset of high fever, myalgia, chills, rigor, and
sore throat, followed by shortness of breath, cough, and radiographic
evidence of pneumonia. The incubation period has generally been 3 to 5
days
(range: 2 to 7 days). Laboratory findings have included thrombocytopenia
and leukopenia. Many patients have had respiratory distress or severe
pneumonia requiring hospital admission, and several have required
mechanical ventilation. Of the 264 suspected and probable cases reported
by
WHO, 9 people (3 per cent) have died. In addition, secondary attack rates
of greater than 50 per cent have been observed among health care workers
caring for patients with SARS in both Hong Kong and Hanoi. Additional
clinical and epidemiological details are available from WHO at
http://www.who.int/wer/pdf/2003/wer7812.pdf.
In the United States, initial diagnostic testing for people with suspected
SARS should include chest radiograph, pulse oximetry, blood cultures,
sputum Gram stain and culture, and testing for viral respiratory
pathogens,
particularly influenza types A and B and respiratory syncytial virus.
Clinicians should save any available clinical specimens (for example,
respiratory samples, blood, serum, tissue, and biopsies) for additional
testing until diagnosis is confirmed. Instructions for specimen collection
are available from CDC at
http://www.cdc.gov/ncidod/sars/pdf/specimencollection-sars.pdf.
Specimens
should be forwarded to CDC by state health departments after consultation
with the SARS State Support Team at the CDC Emergency Operations Center.
Clinicians evaluating suspected cases should use standard precautions (for
example, hand hygiene) together with airborne (for example, N-95
respirator) and contact (for example, gowns and gloves) precautions
(http://www.cdc.gov/ncidod/sars/infectioncontrol.htm). Until the mode of
transmission has been defined more precisely, eye protection also should
be
worn for all patient contact. As more clinical and epidemiological
information becomes available, interim recommendations will be updated.
Reported by: CDC SARS Investigative Team; AT Fleischauer, PhD, EIS
Officer,
CDC.
MMWR Editorial Note:
During 2000, about 83 million nonresident passengers arrived in China, 13
million in Hong Kong, and 2 million in Vietnam, and about 460 000
residents
of China, Hong Kong, and Vietnam traveled to the United States (2). During
1 Jan 1997 -- 18 Mar 2003, an estimated 5 per cent of ill tourists
worldwide who sought post-travel care from one of 35 worldwide GeoSentinel
travel clinics had pneumonia (International Society of Tropical Medicine,
unpublished data, 2003). In the United States, about 500 000 people with
pneumonia require hospital admission each year; in about half of these
cases, no etiologic agent is identified despite intensive investigation
(3,4). On the basis of these data and the broad and necessarily
nonspecific
case definition, cases meeting the criteria for SARS are anticipated
worldwide and in the United States. However, most of the anticipated cases
are expected to be unrelated to the current outbreak.
Electron microscopic identification of paramxyovirus-like particles has
been reported from Germany and Hong Kong (5). This family of viruses
includes measles, mumps, human parainfluenza viruses, and respiratory
syncytial virus in addition to the recently identified henipaviruses and
metapneumovirus. Additional testing is under way to confirm a definitive
etiology. Identification of the causative agent should lead to specific
diagnostic tests, simplify surveillance, and focus treatment guidelines
and
infection control guidance.
References
1. World Health Organization. Disease outbreak reported: acute respiratory
syndrome in China---update 3. Available at
http://www.who.int/csr/don/2003_2_20/en.
2. World Tourism Organization. Statistic tables 2001. Available at
http://www.world-tourism.org/market_research/facts&figures/latest_data/tita
01_07-02.pdf.
3. Martson BJ, Plouffe JF, File TM, et al. Incidence of community-acquired
pneumonia requiring hospitalization: results of a population-based active
surveillance study in Ohio. Arch Intern Med 1997; 157: 1709-18.
4. Marrie TJ, Durant H, Yates L. Community-acquired pneumonia requiring
hospitalization: 5-year prospective study. Rev Infect Dis 1989; 11:
586-98.
5. World Health Organization. Disease outbreak reported: acute respiratory
syndrome in China -- update 4. Available at
http://www.who.int/csr/don/2003_03_19/en.
* Suspected cases (See definitions on webpage:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5211a5.htmwith either a)
radiographic evidence of pneumonia or respiratory distress syndrome or b)
evidence of unexplained respiratory distress syndrome by autopsy are
designated probable cases by the WHO case definition.
******
[7]
Date: 20 Mar 2003
From: ProMED-mail promed@promedmail.org
Source: Eurosurveillance Weekly 2003; 7(12): 030320 (20 Mar) (edited)
http://www.eurosurveillance.org/ew/2003/030320.asp
Severe acute respiratory syndrome - update
------------------------------------------
On 15 Mar 2003, the World Health Organization (WHO) stated that the severe
acute respiratory syndrome (SARS), an atypical pneumonia of unknown
aetiology, is now "a worldwide health threat" (1). As of 19 Mar 2003, 264
suspect and probable cases have been reported to WHO since 1 Feb 2003 (2).
The surveillance case definitions have been modified (see below).
So far, 56 cases have been reported in Hanoi (Vietnam) and 150 cases in
Hong Kong, the 2 areas where the first cases were reported (3), 31 cases
have been notified in Singapore, 3 in Taiwan, one imported case from Hanoi
has been reported in Thailand, 8 patients have been reported in Canada,
one
in Germany, one in Slovenia, and 2 in the United Kingdom (UK).
Case definitions for surveillance of SARS, revised 18 Mar 2003
Suspect Case
A person presenting after 1 Feb 2003 with history of high fever (greater
than 38 C)
AND
one or more respiratory symptoms including cough, shortness of breath,
difficulty breathing
AND one or more of the following:
- close contact (having cared for, having lived with, or having had direct
contact with respiratory secretions and body fluids of a person with
SARS),
within 10 days of onset of symptoms, with a person who has been diagnosed
with SARS
- history of travel, within 10 days of onset of symptoms, to an area in
which there are reported foci of transmission of SARS.
Probable Case
A suspect case with chest x-ray findings of pneumonia or respiratory
distress syndrome
OR
A person with an unexplained respiratory illness resulting in death, with
an autopsy examination demonstrating the pathology of respiratory distress
syndrome without an identifiable cause.
In addition to fever and respiratory symptoms, SARS may be associated with
other symptoms including headache, muscular stiffness, loss of appetite,
malaise, confusion, rash, and diarrhea. To date, 5 deaths in the recent
outbreak have been reported. Over 90 per cent of the cases are in health
care workers, of whom most have been in close contact with other cases.
The mode of transmission is not confirmed, but is thought to occur by
droplet spread and/or body fluid contact. There is no evidence so far that
transmission can occur through casual contact. The incubation period
ranges
from 4 to 7 days. Although a wide range of laboratory tests have been
conducted, no causal agent has yet been found. It has been reported that a
virus of the Paramyxoviridae family has been recently identified in
samples
from some cases (4), but it seems too early at this point to attribute the
outbreak to this cause.
No recommendation to restrict travel to any country has been issued, but
WHO stresses the importance for travellers and airlines to be aware of the
main symptoms of the disease (1).
Investigations are ongoing in the affected countries. Epidemiologists, and
experts in case management, infection control and microbiology from WHO
and
several European and international organisations are assisting in the
management of the outbreak (2). In Europe, public health institutes are
developing national response plans based on WHO recommendations (1). On 18
March, the European Commission convened a meeting of European experts to
agree a common response to this outbreak and propose consensus guidelines
for advice and information.
Updates on the developing situation are also available from WHO, on
ProMED,
and at the websites of various national public health organisations,
including CDC, Health Canada, and the Public Health Laboratory Service in
the UK.
References :
1. WHO. Disease Outbreak News. Severe Acute Respiratory Syndrome (SARS) -
multi-country outbreak, 15 March 2003.
(http://www.who.int/csr/don/2003_03_15/en/ ).
2. WHO. Severe Acute Respiratory Syndrome (SARS). Cumulative number of
reported suspect and probable cases, 1 February 2003 - 18 March 2003.
(http://www.who.int/csr/sars/tablemarch18/en/).
3. De Benoist, A-C, Boccia D. WHO initiates enhanced global surveillance
in
response to acute respiratory syndrome in China, Vietnam, and Hong Kong,
special administrative region (SAR) of China. Eurosurveillance Weekly
2003;
7: 030313. (http://www.eurosurveillance.org/ew/2003/030313.asp).
4. ProMED mail. Severe Acute Respiratory Syndrome - worldwide (08).
(20030318.0679).
[by: Anne-Claire de Benoist (anneclaire.debenoist@phls.org.uk), and Delia
Boccia, European Programme for Intervention Epidemiology Training (EPIET),
Public Health Laboratory Service Communicable Disease Surveillance Centre,
London, England.]
--
ProMED-mail
promed@promedmail.org
[The comment in [3] A. Worldwide update WHO report "International
collaboration – on the part of the medical and research communities,
multinational teams in the field, and health authorities around the
world –
in the reporting, investigation, and management of this outbreak has been
outstanding." is worthwhile noting, and mentioning that WHO has been
instrumental at facilitating this international collaboration.
As there is a wealth of information available from official sources, this
ProMED-mail update does not contain any unofficial newswire reports as
most
reiterate the above official information, or speculations and rumors that
do not add to our current understanding of this outbreak. There was some
newswire coverage of a few possible SARS cases in Beijing, but official
reports are still pending.
Additional national website links for information on SARS reported in
countries not mentioned in the above posting include: United Kingdom -
PHLS
http://www.phls.co.uk/topics_az/SARS/menu.htm
Health Canada
http://www.hc-sc.gc.ca/english/protection/warnings/2003/2003_11.htm.
Mod.