pneuonia illness started in Asia -> Canada & Europe

pneuonia illness started in Asia -> Canada & Europe

www.washingtonpost.com/wp...Mar15.html

news.asiaco.com/news/exte...391976.htm

"Separately, a WHO expert that the Guangdong outbreak of atypical pneumonia appeared to have been controlled. Chinese health authorities said the outbreak was caused by an unusual strain of <strong>chlamydia</strong> not transmitted through sexual contact."

More info

Date: Sat, 15 Mar 2003 23:08:15 -0500 (EST)

SEVERE ACUTE RESPIRATORY SYNDROME - WORLDWIDE (02): ALERT
***************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

[1] Taiwan
[2] USA response/briefing
[3] Worldwide summary alert
[4] Hong Kong
[5] East Asia

[1]

Date: Sun, 16 Mar 2003 11:24:28 +0800 (CST)
From: "Peter Chang, MD, MPH, ScD"

Official report by the CDC of Taiwan: Another Suspected Atypical Pneumonia
Case in Taiwan - follow up report on 15 Mar 2003
---------------------------
Here in Taiwan, we have one more reported case of atypical pneumonia, this
64-year-old woman developed fever on 8 Mar 2003 about one week after
traveling to Guandong (China) and Hong Kong. She was hospitalized on 13 Mar
2003 due to subsequent respiratory symptoms. Chest radiogram revealed an
atypical pneumonia in the right lower lung. CDC Taiwan has reviewed the
regular surveillance system for Acute respiratory distress syndrome (ARDS)
and complicated influenza cases. So far, there was no evidence of community
spread except for the couple reported on 14 Mar 2003 [see ProMED-mail Acute
respiratory syndrome - East Asia 20030314.0630]

We would appreciate any useful advice and assistance for pathogen
investigation.

Peter Chang, MD, MPH, ScD
Advisor and Coordinator for Health Affairs
for
Tzay-Jinn Chen, M.D., M.P.H.
Directer-General,
Center for Disease Control,
Department of Health,
Taiwan

******
[2]

Date: 15 Mar 2003
From: ProMED-mail
Source: CDC Press Release

Severe Acute Respiratory Syndrome
Center for Disease Control and Prevention CDC [USA] Issues Health Alert
About Atypical Pneumonia
----------------------------
Atlanta: In response to reports of increasing numbers of cases of an
atypical pneumonia that the World Health Organization (WHO) has called
Severe Acute Respiratory Syndrome (SARS), the CDC today announced several
steps to alert US health authorities at local and state levels.

CDC activated its emergency operations center on Fri, 14 Mar 2003, upon
learning of several cases reported in Canada among travelers recently
returned from Southeast Asia and their family members. The federal public
health agency:

Issued a health alert to hospitals and clinicians on Sat 15 Mar 2003
Briefed state health officials on Sat 15 mar 2003
Is investigating illness among travelers who may have passed through the
United States after having potential exposure to the virus.

Is preparing health alert cards to give to travelers returning from
Southeast Asia.

Is preparing guidance to assist public health departments, health care
facilities and clinicians in monitoring and identifying potential cases.

Deployed 8 CDC scientists to assist the WHO in the global investigation.

Is analyzing specimens to identify a cause for the illness.

CDC has been working with the World Health Organization (WHO) since late
February [2003] to investigate and confirm outbreaks of this severe form of
pneumonia in Viet Nam, Hong Kong, and parts of China. No cases have been
identified to date in the United States.

"The emergence of 2 clusters of this illness on the North American
continent indicates the potential for travelers who have been in the
affected areas of Southeast Asia to have been exposed to this serious
syndrome," said Dr. Julie L. Gerberding, CDC Director. "The World Health
Organization has been leading a global effort, in which CDC is
participating, to understand the cause of this illness and how to prevent
its spread. We do know that it may progress rapidly and can be fatal.
Therefore, we are instituting measures aimed at identifying potential cases
among travelers returning to the United States and protecting the people
with whom they may come into contact."

The WHO issued a global alert about the outbreak on 12 Mar 2003, cautioning
that the severe respiratory illness may spread to hospital staff. No link
has been made between this illness and any known influenza, including the
"bird flu" (A[H5N1]) outbreak reported in Hong Kong on 19 Feb 2003.

******
[3]

Date: 15 Mar 2003
From: ProMED-mail
Source: New York Times 16 Mar 2003 (from website)

As a mysterious respiratory illness spread to more countries, the World
Health Organization (WHO) yesterday issued a rare health alert, declaring
the ailment "a worldwide health threat" and urging all countries to help in
seeking its cause and control.

The agency said that in the last week it had received reports of more than
150 new suspected cases of the illness, now known as Severe Acute
Respiratory Syndrome, or SARS. The syndrome has caused at least 9 deaths,
the last one a nurse in Hanoi. It apparently does not respond to antiviral
and antibiotic drugs. [according to a Center for Disease Control and
Prevention (CDC) telebriefing held today, 15 Mar 2003 (available at:
) Dr. Gerberding's
response about efficacy of antimicrobials was: "...there is no consistent
utilization of antibiotics or antiviral therapy in the areas that have had
the most cases, and so we have no real information to help tell us whether
or not anything is having a clinical impact. At best we could just provide
anecdotal suggestions and no data or advice.", hence a conclusion that
there is no response to antiviral and antibiotics maybe premature. - Mod. MPP]

Reported cases have come from Canada and 6 countries in Asia — Hong Kong
and elsewhere in China, Indonesia, the Philippines, Singapore, Thailand and
Vietnam, the health organization said. There have been no reports of the
illness in the United States. But yesterday [today - 15 Mar 2003], an ill
passenger and 2 companions who traveled from New York City were removed
from a flight after it arrived in Frankfurt and put in isolation in a
German hospital.

The ill passenger is a doctor from Singapore who treated one of the
earliest cases there, and who flew to a medical meeting in New York City,
said Dick Thompson, a WHO spokesman. The doctor may have gone to a hospital
in New York — the agency is not certain which one — before flying back to
Singapore via Frankfurt with his wife and another doctor. Before boarding
the flight, the doctor called a colleague in Singapore to describe his
symptoms, and the colleague notified WHO.

The cause has not been identified, and scientists do not know whether it is
a virus or even an infectious agent. Although health officials have
suspected avian influenza, which has infected a small number of people
sporadically in Hong Kong since 1997, laboratory tests have not detected
that rare strain, known as influenza A(H5N1). As a result, laboratory
scientists are focusing on the possibility of a previously unknown
infectious agent.

Dr. Julie L. Gerberding, director of CDC, said in a news conference
yesterday [today - 15 Mar 2003] that it appeared to take direct and
sustained contact to transmit the illness from an affected individual to
other people. "There is no evidence to suggest that this can be spread
through brief contact or assemblages of large numbers of people," she said.

Asked whether this might be an instance of bioterrorism, she replied, "We
are keeping an open mind."

In an emergency advisory issued yesterday, WHO said that "there is
presently no indication to restrict travel to any destination."

But Dr. Gerberding said, "We are advising persons planning nonessential or
elective travel to affected areas that they may wish to postpone their trip
until further notice."

Updated information will be posted on the centers' Web site,
.

WHO and American officials urged all travelers to be aware of the main
signs. In addition to the breathing problems, the illness can cause a dry
cough and other flulike symptoms that are thought to develop 2 to 7 days
after exposure. They usually start with a sudden onset of high fever and go
on to include muscle aches, headache, sore throat and shortness of breath.

Standard lab tests often show low numbers of white blood cells and
platelets, which help blood to clot.

The health agency said any passenger or airline crew member who developed
such symptoms should immediately seek medical attention and ensure that
information about their recent travel was passed on to the health care
staff. "Any traveler who develops these symptoms is advised not to
undertake further travel until they have recovered," it said.

If a passenger became ill on a flight, the agency asked airlines to alert
the airport of destination and to refer any ill passengers to airport
health officials.

"There are currently no indications to restrict the onward travel of well
passengers, but all passengers and crew should be advised to seek medical
attention if they develop" symptoms, the agency said.

In another rare step, the CDC activated its emergency operations center in
Atlanta, including sophisticated communications technology, to enhance its
ability to coordinate information from other countries and to investigate
any suspect cases in this country.

The CDC has used the operations center only twice before, for the
mosquito-borne West Nile fever epidemic last year and the anthrax attacks
in 2001. The last time it issued a global health alert was in 1993, to
enhance measures to control tuberculosis. WHO officials said they could not
recall the last time an emergency global travel advisory was issued.

The CDC and New York City health officials are now investigating the travel
histories of the passengers now in a German hospital as well as one of the
8 cases suspected to be the new syndrome in Toronto and Vancouver, British
Columbia [Canada].

Two hours before the plane landed, the WHO notified German health
officials, who had the plane moved to a separate runway where the doctor,
his wife and a colleague disembarked and were taken to a nearby hospital.
German health officials advised the other passengers to monitor their
health and gave them a telephone number to call if they developed any
symptoms. Officials did not release any information on his condition.

Mr. Thompson, the spokesman for the WHO, said the cases in Toronto involved
a family who returned home after flying to Hong Kong. A woman, died shortly
after her return. Five other family members who had not been to Hong Kong
have since become ill; 4 are still in the hospital while the fifth, [the
fatal case's] son, died on 13 Mar 2003, according to Toronto Public Health
officials.

Toronto health officials said they were aware of 2 other cases in
Vancouver, both people who had recently traveled to Hong Kong. CDC
officials are aiding in the investigation because [the fatal case's]
daughter, who is being treated in Toronto, had flown to Atlanta recently,
Mr. Thompson said.

So far, laboratory scientists have not been able to identify a known or
novel infectious agent, said Dr. David L. Heymann, a WHO official.

Japanese officials said their tests showed that the influenza virus was not
the cause of the illness. But Dr. Heymann said samples from more victims
needed to be tested, because it can take weeks for the immune system to
produce influenza antibodies, the proteins that are formed to fight
invading microbes.

"We have not ruled out influenza definitively," Dr. Heymann said.

Tests of victims' samples have found no evidence of mycoplasma or similar
microbes that are the usual causes of atypical pneumonia. Additional tests
have shown no evidence of Ebola or any of the other viruses that cause
hemorrhagic fevers, hantavirus and bacteria.

In Hong Kong, an American businessman died on Thursday after passing
through Hong Kong and falling ill in Hanoi, where 30 doctors and other
medical personnel have fallen ill at the hospital where the businessman was
initially treated.

[by: Lawrence K. Altman and Keith Bradsher]

--
ProMED-mail

*****
[4]

Date: Sat 15 Mar 2003
From: "Pablo Nart"
Source: Reuters News online, Sat 15 Mar 2003 [edited]

Hong Kong: Total of Affected Medical Personnel Increases to 47
--------------------------------------------------------------
HONG KONG: Four Hong Kong medical workers were admitted to hospital on
Saturday with symptoms of a flu-like virus that has already killed one
person and infected dozens, sparking a rash of travel cancellations to the
territory. The 4 admitted on Sat 15 Mar 2003 brought the total of Hong Kong
medical workers suffering the same symptoms to 47. Thirty-seven have since
developed signs of severe pneumonia, up from 29 on Friday [14 Mar 2003].

Forty-one people in Hanoi are being treated for the illness, 2 of them in
critical condition. [according to another newswire report, one of these
cases died during the course of today - Mod.MPP] An outbreak of severe
pneumonia in China's southern Guangdong province in February infected 305
people, killing 5, but it is not known if there is any link. Singapore and
Taiwan issued travel warnings when a few of their residents contracted
pneumonia after trips to Hong Kong or mainland China. Vietnamese
immigration officials are now monitoring visitors for signs of infection.

[By Tan Ee Lyn and Vicki Kwong]

--
ProMED-mail

*****
[5]

Date: Sat 15 Mar 2003
From: H.L. Penning
Source: Straits Times Interactive, Agence France-Presse, Sat 15 Mar 2003
[edited]


East Asia: Pneumonia Outbreak Worsens
-------------------------------------
In Taiwan a 64-year-old woman and a married couple were confirmed to have
contracted the disease and were in hospital, said Mr Chen Tsai Chin, head
of the Taiwan Health Department's Centre for Disease Control (CDC). In
Hong Kong, 47 people are now under observation in 6 different Hong Kong
hospitals with 37 of them showing symptoms of pneumonia.

In Vietnam's capital Hanoi 6 more people were struck down with the illness,
a hospital spokesman said. The new cases brought the number of infections
in the capital to 40. Thirty employees of the Hanoi French Hospital
remained under treatment, with 2 people, including a French doctor, in a
critical condition, a hospital official said.

Singapore's Ministry of Health said on Fri 14 Mar 2003 that it had been
notified of 6 persons admitted to hospital for pneumonia, in addition to
who had earlier been confined after visiting Hong Kong. [more recent
newswires put the number of cases reported from Singapore at 16 - Mod.MPP]

--
H.L. Penning

Re: More info

Whose biological weapons can we blame this on?

Joe

Re: More info

Blame overuse/over-prescription of antibiotics, it's likely a factor.

Re: More info

Are you sure it is not the Iraqis?

Re: More info

No one can be sure it is not bioterrorism, but authorities think it is unlikely. Sad, one more person died today.

Re: pneuonia illness started in Asia -> Canada & Euro

What I had was close to that new strain of flu - except I got bronchitis. It's pretty devastating. I would hate to get the pneumonia strain.


Ladskater

Re: pneuonia illness started in Asia -> Canada & Euro

Ladskater, take care.

from CDC

suspected cases in USA

www.cdc.gov/od/oc/media/sars.htm

Severe Acute Respiratory Syndrome
Report of Suspected Cases Under Investigation
in the United States
This information in this table will be updated Monday through Friday.

These data were reported to the World Health Organization on March 19, 2003.

Numbers of suspected cases are expected to fluctuate as additional information becomes available.

State Suspected cases under investigation*
California 3
Hawaii 1
Maine 1
Massachusetts 1
New Jersey 1
New Mexico 1
North Carolina 2
Tennessee 1
Virginia 1
Wisconsin 1
Total Suspected Cases Under Investigation 13

Re: from CDC

There's a person in a Wichita hospital. They are waiting for test results. He was recently in Asia.

Re: pneuonia illness started in Asia -> Canada & Euro

Had I been out of the country lately, I'd be worried, because I've been sick for a week with respiratory something...UGH. Hope they find a cure/treatment/test for it soon....Kasey