Severe Acute Respiratory Syndrome (SARS) Update: Wednesday, April 16, 2003

Alfred J. Saint Jacques, Editor, Medscape Pulmonary Medicine

Today's Leading News

Worldwide SARS Death Toll Tops 150 as Hong Kong Has ?Worst? Day; WHO Plans Global Scientific Meeting on SARS for June

On April 15, the death toll for severe acute respiratory syndrome (SARS) passed the 150 mark, reaching 154, as Hong Kong experienced its worst day since the outbreak began. A record 9 patients died in the last day in Hong Kong, bringing the total mortality to 56 cases.

The World Health Organization (WHO) announced plans yesterday to hold an international scientific meeting on SARS June 17-18, 2003, in Geneva, Switzerland, to discuss global control strategies.

On April 14, a German biotech company, Artus GmbH of Hamburg, began distributing what the company claims is the first commercial test for the SARS virus. The test can detect the virus through throat swabs, sputum, or feces; and results are received within two hours, according to company representatives.

On April 14, a group of Canadian scientists announced they had decoded the genome of the coronavirus that has been linked to SARS. Researchers at the British Columbia Cancer Agency in Vancouver said that the genome seems to indicate a completely new coronavirus, unrelated to any that are known to exist in humans or animals.

On April 13, Chinese Premier Wen Jiabao pledged that China would truthfully disclose case and mortality data regarding SARS. He went on to instruct leaders at all levels to assume responsibility for fighting the epidemic. The Beijing government has been criticized for not disclosing the true extent of the SARS outbreak.

Scientists from the U.S. Army Medical Research Institute for Infectious Diseases at Fort Detrick, Maryland, have started testing at least 2,000 currently available therapies to see if they have an effect on the SARS virus.

As of April 15, WHO reports a cumulative total of 3,235 cases of SARS, with 154 deaths in 24 countries. This represents an increase of 66 cases and 10 deaths since April 14. WHO also reported that as of April 15, a total of 1,515 patients have recovered from SARS.

As of April 13, the Centers for Disease Control and Prevention (CDC) is reporting a total of 193 suspected U.S. cases in 32 states, up from 166 cases in 31 states on April 10. As of April 13, Health Canada is reporting a total of 287 probable or suspected SARS cases and 13 deaths, up from 283 and 13 on April 13. As of April 15, the Hong Kong Department of Health is reporting a cumulative total of 1,232 cases, 56 deaths, and 243 discharges, an increase from April 14 of 42, 9, and 14, respectively. As of April 14, the Chinese Ministry of Health is reporting a cumulative total of 1,418 SARS cases, 64 deaths, and 1,088 discharges.

Two antibody tests and one molecular test (and polymerase chain reaction [PCR] primers) are now available to help identify patients with SARS. An ELISA test and immunofluoresence assay (IFA) can both detect antibodies that have been found in many SARS patients. However, antibodies are detected in SARS patients after a minimum of 10 days of onset of the disease. PCR-based tests can quickly detect genetic material of coronavirus in various specimens (blood, stool, or respiratory secretions), and several primers for coronavirus genetic material have been developed. Laboratories in the WHO multicenter collaborative network on SARS are currently comparing these tests, and the first results should be forthcoming shortly.

Summary of Events to Date

On March 15, 2003, WHO issued a global alert of a multicountry outbreak of SARS, an atypical pneumonia of as yet unidentified etiology. The syndrome was first recognized on February 26, 2003, in Hanoi, Vietnam, by WHO investigator Carlo Urbani, MD.

According to WHO, as of April 12, 2003, SARS cases have been reported in Brazil, Canada, China, France, Germany, Hong Kong, Italy, Ireland, Japan, Kuwait, Malaysia, Romania, Singapore, South Africa, Spain, Switzerland, Taiwan, Thailand, United Kingdom, United States, and Vietnam. A total of 2,960 cases and 119 deaths have been reported to date.

SARS appears to be transmitted by close contact, most probably via airborne droplets; the majority of new cases have been reported in healthcare workers and family members of affected persons. Evidence of community spread of the disease is emerging, however.

On March 31, the Hong Kong Department of Health ordered the quarantine of all residents of an apartment block after the detection of 107 cases of severe acute respiratory syndrome (SARS) in the building, and 213 SARS cases in the 19-building Amoy Gardens apartment complex. At least 240 residents have since been relocated to vacation camps outside of the city. Hong Kong and WHO scientists are investigating this troubling demonstration of community spread of SARS, which was hitherto documented to be spread via close and prolonged contact.

On March 26, Chinese authorities officially reported a total of 792 SARS cases and 31 deaths that occurred in 7 cities of Guangdong Province between November 16, 2002, and February 28, 2003. Between March 1 and March 31, 2003, 361 new SARS cases and 9 deaths were recorded there, signifying that the SARS epidemic is continuing there. As of April 8, WHO is reporting a total of 1,279 suspected SARS cases and 53 deaths in mainland China.

Scientists at the University of Hong Kong announced on March 27 that they had developed a diagnostic test to rapidly identify cases of SARS. The researchers also announced that they had confirmed a coronavirus as the cause of SARS. A new coronavirus remains the prime suspect in the search for the cause of SARS, although it has yet to be confirmed as the single cause of the disease.

On March 29, WHO announced the death of Dr. Carlo Urbani, who first identified the SARS outbreak. Dr Urbani had acquired the disease in the course of his investigations.

On April 1, WHO issued a recommendation that people avoid traveling to Guangdong Province and to Hong Kong, where a large community outbreak of SARS is being investigated. "This is the first time that we have recommended people avoid an area and this is of course because we do not understand the disease completely, because there's no vaccine and there's no drug," said David Heymann, MD, executive director of WHO's Communicable Diseases division, in a press briefing on April 2.

On April 7, WHO named a novel coronavirus (SARS virus) as the major causative agent of SARS, but did not rule out the significance of other pathogens as cofactors in the disease.

On April 14, a group of Canadian scientists announced they had decoded the genome of the coronavirus that has been linked to SARS. Researchers at the British Columbia Cancer Agency in Vancouver said that the genome seems to indicate a completely new coronavirus, unrelated to any that are known to exist in humans or animals.

Also on April 14, a German biotech company, Artus GmbH of Hamburg, began distributing what the company claims is the first commercial test for the SARS virus. The test can detect the virus through throat swabs, sputum, or feces; and results are received within two hours, according to company representatives.

An international scientific meeting on SARS is planned by WHO to be held June 17-18, 2003, in Geneva, Switzerland, to discuss global control strategies.

Key Resources

"Preventing the Spread of Severe Acute Respiratory Syndrome (SARS)," a Public Health Training Network Live Satellite Webcast, was sponsored by the World Health Organization and supported by Centers for Disease Control and Prevention. It was originally broadcast on April 4, 2003, and is now available at http://www.cdc.gov/ncidod/sars/webcast/broadcast040403.htm.

WHO has established a SARS information page, which provides global and regional details, including the number of suspected and confirmed cases and deaths: http://www.who.int/csr/sars/en/

The U.S. Centers for Disease Control and Prevention has also set up an information page that provides an interim case definition, and infection control, diagnosis, and management recommendations, as well as other advisories: http://www.cdc.gov/ncidod/sars/

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