Posted on 03/21/2003 7:05:35 PM PST by Mother Abigail
CDC increases SARS cases to 22 in U.S.
By Steve Mitchell
UPI Medical Correspondent
Published 3/21/2003 6:41 PM
WASHINGTON, March 21 (UPI) -- Centers for Disease Control and Prevention officials said Friday they increased the number of suspected cases of the mysterious severe acute respiratory syndrome outbreak they are investigating to 22.
Officials said the agency also is investigating two cases in which Americans who contracted the pneumonia-like illness while traveling abroad might have transmitted it to others when they returned to the United States, CDC Director Dr. Julie Gerberding said during a teleconference.
There have been no U.S. deaths so far from SARS, but there are suspected cases of infection in 12 states. Worldwide, more than 350 cases of the illness, including 10 deaths, have been reported in 14 countries.
Referring to the two overseas travelers, Gerberding said, "We have identified a situation where a case in a traveler may have involved transmission to others in the United States"
In one case, an individual who traveled to Asia might have infected two healthcare workers who provided care. In another case, a person who also traveled to Asia is thought to have transmitted the infection to a family member.
The CDC is investigating the cases of two Americans who stayed in the Hong Kong Metropole Hotel, which might have been where the outbreak began, Gerberding said. The two individuals are included among the 22 cases, she noted.
Also on Friday, World Health Organization officials said they might have isolated the infectious agent responsible for SARS.
WHO spokesman Dick Thompson told United Press International, "We may have grown, but are not sure, the infectious agent that causes the disease."
Researchers "have grown in cell cultures an infectious agent but we don't know exactly what it is," Thompson said. The agent may be a new member of the paramyxoviridae family of viruses, which includes diseases such as mumps and measles, he said. However, it also could be something different that merely resembles a paramyxo virus, he noted. Further experiments seemed to confirm the researchers had isolated the culprit virus for the SARS outbreak. Researchers exposed the agent to blood from recovering patients and found the agent died, indicating the patients had developed protective antibodies against the virus. Blood from healthy people did not kill the agent.
WHO officials are still conducting additional tests to conclusively identify the virus, Thompson said. "This is just another step down the road but it's a good step," he said. "It may mean we could soon develop a diagnostic test and that would be a huge step forward."
Gerberding said CDC researchers are "working around the clock" to identify cause of the illness. The agency also is working with other labs around the world and consulting molecular microbiologists who have expertise in identifying novel organisms, she said.
In the meantime, appropriate safeguards can prevent the illness from infecting others, she said. "We know that we can apparently prevent spread of this illness by use of appropriate precautions in the healthcare environment," such as isolating the patient and the use of masks by doctors and nurses, she said. "So far we are not seeing any cases even in Asia outside of" healthcare workers and close family contacts of the infected patients, she added. CDC officials also "have taken several steps in the last few days even in the last 24 hours to assist in our progress of the investigation and interventions to prevent spread," Gerberding said.
This includes distributing "35,000 health alerts to arriving travelers and (intercepting) five planes and boats that have passengers ill that have traveled to the affected areas," she said.
Authorities also are still trying to determine which treatments are most effective against the agent. "It's a confused picture still but we are trying to straighten out," Thompson said.
The majority of the suspected cases have occurred in Hong Kong, Vietnam and Singapore. Hong Kong is investigating 203 cases, including 6 deaths; Vietnam 62 cases and 2 deaths, and Singapore 39 cases, no deaths.
U.S. cases have been reported in California with 6; Hawaii with 3; one each for Maine, Massachusetts, New Jersey, New Mexico, Rhode Island, Utah and Wisconsin, and two each for North Carolina, New York and Virginia.
Scouts Out! Cavalry Ho!
Note: "Septic" refers to an infection of the bloodstream.
From Listserve For Emergency Medical Practioners: [EMED-L]
http://www.ucsf.edu/its/listserv/emed-l/11411.html
Update from Dr. Buckley in HK.
-------- Original Message -------- Subject: Re: SARS Date: Fri, 21 Mar 2003 06:07:15 +0800 From: Tom Buckley To:
-snip of recipient's address-
We are using routine community acquired antibiotics but all our cases who have had contact with ward have not responded. We are now only admitting cases to our hospital who have had contact with our original case. We are now seeing the second wave - relatives of primary contacts.
So far no staff have been infected once isolation procedures were put in place. No one is wearing ordinary surgical masks. There have been some close calls with some nurses being reported as having atypical pneumonia after precautions have been taken but in all cases our contact tracing team has established that there was an earlier contact. Everyone has been wearing N95 masks and while I think (though don't know for sure) that N95 is satisfactory staff have not been wearing them properly or they do not fit.
We are switching to the N100 masks not because they are ~ 5% more efficient but because the nurses have found them more comfortable to breath through (less resistance) and they fit more comfortably on the face. The N95 masks, despite a variety of brands and sizes have been uncomfortable and difficult to breath through. There is also the psychological aspect as well.
We are going to try BIPAP. I do not expect it to work (hypoxic respiratory failure only) but because of the higher flow rates (along the lines of the nebulized ventolin in the Index Case) and potential for environmental spread I want it to be as safe as possible. So besides all our "usual" precautions we are going to do this in one of our isolation rooms - increased ventilation flow rates and personal HEPA units. If the staff can tolerate them we will distribute to all staff. Many problems with these but I cannot afford to lose one nurse. Mind you haven't made a final decision about the BiPAP.
Last night senior nurse rang me to say she was resigning. She is petrified. HK Government is down playing the whole thing presumably because of the economic implications but own hospital has been taken over completely by this infection. We currently have 24 cases of atypical pneumonia in ICU - now is that impressive or what.
It also appears to be out in the community. GPs are being admitted.
All of our patients in ICU are either on 100% O2 or they are ventilated (some prone).
Pulse steroids have been given by the physicians to patients on the general ward. They initially improve but are now septic and being referred to ICU. They claim some patients are better on the ward but I think these patients would have improved anyway. While I was able to dissuade them from using pulse steroids in ICU patients I had no control over the general wards.
Sorry to ramble. I am very tired but hope this is helpful
Tom Buckley
David McAlary
Washington
22 Mar 2003, 04:37 UTC
The World Health Organization says scientists have taken a step that might help curtail the mysterious Asian illness that has killed 10 people and sickened 359 in 15 nations as of Friday. The researchers have created what might be the first test to diagnose the pneumonia-like ailment.
A laboratory in a WHO global network investigating the new ailment has created a method that might determine who is infected and who is not.
The disease, called SARS, is hard to distinguish from many others because they share similar symptoms, including fever, cough, and breathing difficulties. So a diagnostic test would let doctors isolate infected SARS patients, helping curtail transmission.
Researchers found that antibodies in blood from recovering SARS patients stopped test tube growth of a virus extracted from the noses of other patients.
The WHO calls the finding the first important step towards the creation of a diagnostic test, but notes that much more work must be done to develop it.
The nasal virus used in the test is the leading suspect in the hunt for the organism that causes SARS. But the connection is not definitive. The director of the U.S. government's Centers for Disease Control, Dr. Julie Gerberding, said the best proof of a link would come if the virus were found in internal tissues of several patients, especially the lungs. "I think we all remain confident that we eventually will be able to identify this [germ], but it is too preliminary to ascribe the disease to any particular agent in this point in time. We still have an open mind about what we are ultimately going to learn," she said.
Dr. Gerberding said that even without knowing what causes SARS, control measures appear to have been effective. The only people known to have been infected are those who have had close contact with another infected person. These are either people who stayed in a certain Hong Kong hotel, hospital workers caring for SARS patients, or members of patients' families. "The fact that we have been able to prevent spread to the community suggests that the infection control, isolation practices in the hospital have been effective," she said. "In Vientnam, for example, there have been no new cases reported in the last 24 hours and that suggests that we may have limited spread beyond the first generation of individuals."
SARS is thought to be linked to an earlier outbreak of an unidentified illness that sickened more than 300 people and killed five in China's Guangdong province. A Chinese doctor who treated these people apparently brought the disease to Hong Kong.
At the invitation of China's Health Ministry, a World Health Organization team of U.S., British, German, and Australian infectious disease experts is on its way to investigate the Guangdong outbreak.
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