Severe Acute Respiratory Syndrome Stevan Cordas DO MPH Definition Fever greater than 100.4° f. Dyspnea. Headaches. Coughing. Malaise. Chest x-ray abnormalities resembling atypical pneumonia. Criteria –Suspected Case Suspected case. The above mentioned clinical features plus. Being is close contact with a case of suspected or probable SARS during the 10 days prior to the onset of symptoms. Having traveled to Toronto, Hong Kong, Hanoi, portions of china and Singapore. Residing in these areas. Criteria –Probable Case A chest x-ray compatible with respiratory distress syndrome or pneumonia in addition to the above. Other causes should be excluded. Or a death with autopsy findings of RDS that meets these suspect and probable criteria. As of today, (April 26,2003) a cumulative total of 4836 cases with 293 deaths have occurred in 26 countries. This represents an increase of 190 new cases and 19 deaths compared with yesterday. The new deaths occurred in Canada (3), China (7), Hong Kong SAR (6), the Philippines (1), and Singapore (2). The SARS outbreak in Hong Kong SAR has developed an unusual pattern of transmission. This pattern is different from what is being seen in the vast majority of other SARS outbreaks, and is not yet fully understood. The number of cases is continuing to increase significantly, and there is evidence that the disease has spread beyond the initial focus in hospitals. These developments raise questions related to other routes of transmission, in addition to well-documented face-to-face exposure to droplets released when an infected person coughs or sneezes. Epidemiologists are considering whether SARS is being transmitted in Hong Kong by some environmental means for which no satisfactory explanation has been found. World Health Organization Advice “The World Health Organization (WHO) today began recommending that persons travelling to Hong Kong Special Administrative Region of China and Guangdong Province, China consider postponing all but essential travel. This updated travel advice comes as a result of new developments in the multi- country outbreak of severe acute respiratory syndrome (SARS).” April 2 2003 WHO Infectious Disease Specialist, Dr Carlo Urbani, the First WHO Officer to Identify the Outbreak of This New Disease and Treat the Earliest Cases in Hanoi, Died of SARS Today in Thailand, Accounting for the Additional Death. The Number of Cases in Viet Nam Remained at 58 for the Sixth Day in a Row, Indicating That the Outbreak in Hanoi Is Well-controlled. No U.S. Deaths As of April 26th 2003. Causation Today, April 16th 2003, the World Health Organization announced that a new pathogen, a member of the coronavirus family never before seen in humans, is the cause of Severe Acute Respiratory Syndrome (SARS). The speed at which this virus was identified is the result of the close international collaboration of 13 laboratories from 10 countries. While many lines of evidence have found strong associations between this virus and the disease over the last weeks, final confirmation came today. April 14, 2003 Contact: CDC Media Relations: 404-639-3286 CDC Lab Sequences Genome of New Coronavirus The Centers for Disease Control and Prevention (CDC) announced today that it has sequenced the genome for the coronavirus believed to be responsible for the global epidemic of severe acute respiratory syndrome or SARS. The CDC sequence is nearly identical to that determined by a Canadian laboratory late last week. The significant difference is that the CDC-determined sequence has 15 additional nucleotides, which provides the important beginning of the sequence, CDC scientists said. Transmission Touching the skin or even inaminate objects infected with droplets and then touching your nose, mouth etc. Breathing infected droplets. Possibly other mechanisms. Being explored. Tests PCR testing is now availabe at BS3 laboratories. Specific but not very sensitive. Your backup lab is: contact person: Prof. Dr. Schmitz fax 49 40 42 818 400 centers for disease control & prevention national centers for infectious diseases 1600 Clifton road, Mailstop G16 bldg 7, room 111 Atlanta, Georgia 30333 united states Lab Protection Label all blood specimens as possible SARS. Wear face masks, gloves, laboratory coats and eye protection (lab worker). Deal in BS2 lab with biological safety cabinet. N-95 respirator while centrifuging. Decontaminate surfaces with disinfectant. Hand washing afterward. CDC/NIH Biosafety in microbiological and biomedical laboratories manual (BMBL). Treatment Good nursing care. Symptomatic. Contact and respiratory protection N-95 masks. Isolation. U. S. Military testing hundreds of drugs in vitro against the SARS virus. Canadians use combination of antibacterial and antiviral drugs. Efficacy?