Severe Acute Respiratory Syndrome (SARS): Basics Update May 8, 2003

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Severe Acute Respiratory Syndrome (SARS)
BasicsUpdate May 8, 2003
Rashid A. Chotani, MD, MPH Assistant Professor,
School of Medicine, School of Public Health
Center for International Emergency, Disaster
Refugee Studies Director, Global Infectious
Disease Surveillance Alert System Johns Hopkins
School of Medicine Public Health 410-614-8330
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Overview

• This lecture is divided in five sections and will
  be updated weekly as new events unfold.
• Background
• Epidemiology
• The Virus
• The Disease
• Infection Control
• Discussion

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PART I Background
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Model of disease causation
Dynamic interaction Change in components alters
equilibrium
Infected/Infectious patient
host
environment
agent
environment
Contaminated objects
reservoir
Colonized persons
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Kochs postulates

1. Organism is found with the disease in accordance
   with lesion and the clinical stage observed
2. The same organisms must be grown in pure culture
   from the diseased host
3. The same disease is reproduced when a pure
   culture of the organism is inoculated into a
   healthy host
4. The organism must be recovered from
   experimentally infected hosts.

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Severe Acute Respiratory Syndrome

• First described 26 February in Hanoi
• 48 year old business man high fever, atypical
  pneumonia and rapidly progressing respiratory
  symptoms
• WHO official (Dr Carlo Urbani) in Hanoi alarmed
  by unusual disease
• notified WHO HQ

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Dr. Carlo Urbani, 46, of Italy, the first doctor
to realize that the world was dealing with the
unfamiliar disease SARS (Severe Acute Respiratory
Syndrome). Urbani, a World Health Organization
expert on communicable diseases, who died of
illness in Bangkok, Thailand, Saturday, March 29,
2003. Urbani became infected while working in
Vietnam, where he diagnosed an American
businessman hospitalized in Hanoi, who later
died.(AP Photo/Guido Picchio)
A portrait of Carlo Urbani is seen at the
entrance to a memorial service in Hanoi.
(AFP/Hoang Dinh Nam)
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WHO Response Global Surveillance

• Infectious agent
• Possible new agent
• Rapid nosocomial transmission
• Burden on health care systems
• Pandemic potential
• Additional information
• H5N1 Hong Kong early February 2003
• Atypical pneumonia Guangdong Province, China Nov
  2002 to Feb 2003

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WHO Response Global Alert

• 12 March Global Alert
• 15 March WHO Emergency Travel Advisory
• Increase global awareness of signs and symptoms
  of SARS
• Increase global awareness of need for isolation
  of suspected cases and appropriate hospital
  infection control measures

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March 18, Kuala Lumpur, Malaysia
An official of the Malaysia Health Ministry's
Disease Control Department reads a SARS leaflet
at the ministry in Kuala Lumpur, Malaysia.
(AP Photo/Teh Eng Koon)
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March 31 Toronto, Canada
A man wears a surgical mask for protection from
the SARS virus just before the start of AL action
between the Toronto Blue Jays and the New York
Yankees in Toronto.
(AP Photo/Frank Gunn)
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March 31 Toronto
A man reads the warning signs on the doors at the
Hospital for Sick Children in Toronto. The SARS
outbreak has hospitalized some five children. It
was the first confirmation that children are
among the dozens of probable and suspected cases
north of the U.S. border.
(AP Photo/CP, Kevin Frayer)
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(AFP/Peter Parks)
An official hands out disinfectant in Hong Kong
to battle a deadly outbreak. Russian health
authorities think SARS may have been designed as
a biological weapon.
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April 1 - Germany
Senior consultant of the pulmonary hospital in
Hemer, Germany, Dr. Lutz Freitag, points at a
slide-projection of the Corona virus during a
press conference A 72-year-old man who fell ill
after returning from the Far East is being
treated at the hospital for SARS.
(AP Photo/Martin Meissner)
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April 1 - Thailand
Woman Adjusts Mask On Her Baby Thailand's Rungfa
Barcena adjusts a mask on her one month old son,
Adrian Barcena, as both prepare for a flight to
the Philippines at the Bangkok airport. The Thai
Public Health Ministry announced that Thailand
has found seven patients connected with SARS, all
of them came from overseas high-risk areas.
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Money Changer Wears Protective MaskA money
changer wears a protective mask while making
change at the Bangkok airport. The Thai Public
Health Ministry announced that Thailand has found
seven patients connected with Severe Acute
Respiratory Syndrome (SARS) so far, all of them
came from overseas high-risk areas.
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April 1 - Indonesia
Muslim nurses wear surgical masks in attempt to
protect themselves from SARS, at a hospital in
Batam, Indonesia. Indonesian authorities sent
teams of doctors to airports and ferry terminals
to prevent the spread of the disease. The port of
Batam, where thousands of people enter Indonesia
daily on ferries from nearby Singapore, was of
particular concern.
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Brian Fairrington, The Arizona Republic, 4/24/03
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April 1, 2003, in San Jose, Calif.
(AP Photo/The San Jose Mercury News, Patrick
Tehan)
An American Airlines aircraft inbound to the
United States from Asia sits on the tarmac at San
Jose International Airport. The flight from Tokyo
was held on the tarmac after the captain reported
five people on board appeared to have SARS-like
symptoms. Doctors later determined that none of
the five were showing signs of the disease.
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Scott Stantis, The Birmingham News, 4/2/03
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(AFP/File/Sebastian D'Souza)
The Indian carrier's pilots are refusing to fly
to Hong Kong due to the deadly outbreak of SARS
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Disinfecting Plane From Hong KongMaintenance
crew members wearing preventive masks spray
disinfectant after the Philippine Airlines
plane's arrival from Hong Kong at Manila's
international airport, Philippines. With the
spread of SARS, airport officials were trying to
prevent its spread though up to now there was no
reported SARS infected person in the country.
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April 2 Vancouver, Canada
Selling Surgical Masks Dave Heel, left, and
Shane Gray sell surgical masks to prevent the
spread of severe acute respiratory syndrome, or
SARS, along Marine Drive on the road to Vancouver
International Airport in Canada. The pair claimed
to have sold dozens of masks at 10 each.
(AP Photo / CP, Chuck Stoody)
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April 2 Amoy Gardens, Hong Kong
Food and Environmental Hygiene Department workers
wear protective gear including surgical mask,
goggles, and a coverall suit as they take part in
refuse removal from the infected Block E of Amoy
Gardens apartment complex, in Hong Kong, where
237 people have been sickened with SARS. More
than half of the SARS patients from Amoy Gardens
came from Block E which was sealed off (March 31)
by health officials, and then evacuated a day
later amid fears that it was not safe for
residents.
(AP Photo / Anat Givon)
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April 3 Hong Kong
Buddhists wear surgical masks in an attempt to
protect themselves from SARS, during prayers for
world peace and an end to the outbreak
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Kim Song Heng, Singapore, Lianne Zaobao, 4/28/03
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April 7 London, England
A cargo handler at London's Heathrow airport
wears a surgical mask as he prepares to unload
baggage and cargo from a flight newly arrived
from Hong Kong.
(AP Photo/Str)
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April 8 Hong Kong
(Bobby Yip/Reuters)
Professor Malik Peiris, the chief virologist at
the University of Hong Kong, stands in front of a
projection of a virus infected cell at Queen Mary
Hospital in Hong Kong.
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April 10 - Amoy Gardens, Hong Kong
Medical staff help a tenant of block E at Amoy
Gardens in Hong Kong as residents of the block
which was badly hit by SARS, returned to their
homes. Some 240 people were evacuated by the
government from the housing complex and spent
nine days in holiday camps that were turned into
makeshift quarantine centers.
(AP Photo/Anat Givon)
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April 10 - Philippine
Filipino musicians wear protective masks as they
welcome arriving passengers in Manila's
International Airport Thursday, April 10, 2003.
Philippine officials recently advised against
unnecessary travel to Hong Kong and China's
Guangdong province due to the outbreak of severe
acute respiratory syndrome, or SARS, that has
killed at least 108 people worldwide.
(AP Photo/Aaron Favila)
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Passengers Arrive From Hong KongPassengers
wearing preventive masks arrive from Hong Kong at
Manila's international airport, Philippines.
Airport officials were trying to prevent its
spread though up to now no reported SARS infected
person have been identified in the country.
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April 10 Beijing, China
China's Vice Minister of Health, Ma Xiaowei
clasps his hands after a news conference in
Beijing, China. China said Thursday its death
toll from a mysterious flu-like illness has risen
by two to 55, and said its total number of people
sickened stands at 1,290.
(AP Photo/Ng Han Guan)
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Director Zhong Nanshan of the Guangzhou
Respiratory Disease Research. The top Chinese
epidemiologist strongly disputed government
claims that SARS was under effective control.
(AFP/Frederic J.Brown)
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April 11 Changi Airport, Singapore
Since the outbreak of severe acute respiratory
syndrome, or SARS, check-in belts at Changi
International Airport has turned quiet in
Singapore. Hit by both the effects of SARS and
the Iraq war, the Civil Aviation Authority of
Singapore shows that flights scheduled this week
have plunged from 1,577 to 1,372. (AP Photo/Wong
Maye-e)
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April 11, Telford Garden Hong Kong
Health authorities have confirmed four more cases
of people who were recently found to be infected
with severe acute respiratory syndrome, or SARS.
Health workers and police Friday enforced new
quarantine measures on people living with SARS
sufferers as Hong Kong stepped up efforts to
contain the virus that has killed 30 people and
sickened almost 1,000 in Hong Kong alone.
(AP Photo/Anat Givon)
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(No Transcript)