Rare Health Alert Is Issued by W.H.O. for Mystery Illness

As a mysterious respiratory illness spread to more countries, the World Health Organization today issued a rare health alert, declaring the ailment "a worldwide health threat" and urged 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 six deaths and not one of the survivors has fully recovered. It apparently does not respond to antiviral and antibiotic drugs.

The cause has not been identified. 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.

Reported cases have come from Canada and six 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 today, an ill passenger and two 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 passenger is a surgeon 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 spokesman for W.H.O. The surgeon 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 surgeon called a colleague in Singapore to describe his symptoms, and the colleague notified the World Health Organization.

In an emergency advisory issued today, the World Health Organization, an arm of the United Nations based in Geneva, said that "there is presently no indication to restrict travel to any destination."

But it urged all travelers to be aware of the main symptoms and signs. In addition to the breathing problems, the illness can cause a dry cough and other flulike symptoms that apparently develop about four to five 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.

W.H.O. said that any passenger or airline crew member who developed such symptoms should immediately seek medical attention and ensure that information about their recent travel is passed on to the health care staff. "Any traveler who develops these symptoms is advised not to undertake further travel until they have recovered," the agency 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 United States Centers for Disease Control and Prevention 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.

C.D.C. 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. W.H.O. officials said they could not recall the last time an emergency global travel advisory was issued.

C.D.C. is investigating the travel histories of the passengers who are now in a German hospital as well as one of the eight cases suspected to be the new syndrome in Toronto and Vancouver that Canadian health officials reported on Friday.

W.H.O. officials said they at first thought the surgeon who fell ill was on a flight to London, but learned from a pharmaceutical company that paid for his trip that he was flying to Frankfurt instead. Two hours before landing, W.H.O. notified German health officials, who had the plane moved to a separate runway where the surgeon, his wife and 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 said the cases in Toronto involved a family who returned home after flying to Hong Kong. A woman, Kwan Sui-chu, died shortly after her return. Five other family members who had not been to Hong Kong have since become ill; four are still in the hospital while the fifth, Mrs. Kwan's son, Chi Kwai Tse, died on March 13, according to Toronto Public Health officials.

Toronto health officials said they were aware of two other cases in Vancouver, British Columbia, both involving people who had recently traveled to Hong Kong.

C.D.C. officials are aiding in the investigation because Mrs. Kwan's daughter, who is being treated in an intensive care unit 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 W.H.O. official.

Japanese officials said their tests showed that the influenza virus was not the cause of the illness. But Dr. Heymann said that samples from more victims need 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.

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, hanta virus 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 before being sent back to Hong Kong.

today, Hong Kong's secretary for health and welfare, Dr. Yeoh Eng-kiong, denied that the Chinese territory was experiencing a serious public health problem. Dr. Yeoh said that the outbreak in Hong Kong remained almost entirely confined to hospital workers and had not spread to the general community.

http://news.bbc.co.uk/2/hi/health/2851487.stm

Friday, 14 March, 2003, 17:00 GMT

'An invisible killer in our midst'

Medical staff have been told to wear protective masks
There is growing concern in South-East Asia over the spread of a deadly flu virus.

Professor Andrew Burd, a surgeon in Hong Kong, tells BBC News Online what it has been like living and working in the midst of "an invisible killer".

This week appeared to begin like any other. In retrospect, however, on Monday I noticed one of the surgeons looking extremely unwell. He was eventually persuaded to go home for some rest.

Such an event is not unusual in a hospital where surgeons work long hours and want to remain on duty to support their colleagues and do their job.

The rumours began on Tuesday during our daily early morning round. A ward had been quarantined. Staff and patients were shut behind secured doors.

The rumours gained credence when we passed the ward and saw an eager reporter speaking to a presumed relative wearing a mask.

A photographer was angling for the shot over the shoulder and in the background a security guard was sitting impassively in front of firmly closed doors.

Rumours and reports

The rumours and media reports coalesced over the next 48 hours into an understanding that there was something going on.

Could it be possibly related to the strange outbreak of pneumonia that had affected 300 and killed five in Guangzhou in China?

Was it related to the strange tale of a family of five who had been to Fujian and who had developed some strange illness that had claimed a father in his 30s and a son under ten.

Or was it related to the case of an American businessman who had been evacuated from Hanoi to a specialist unit in Hong Kong during the week?

Certainly, something very strange had been going on in South-East Asia and now it was on our doorstep.

By Wednesday evening we were formally alerted by the hospital authorities that there was 'a situation' that required heightened measures of vigilance. We had a name to this new threat - "Community Acquired Pneumonia".

On Thursday morning, we had the first evidence that we were all in the front line. Arriving for the early morning round we were given facemasks and told to wear them. These were no ordinary surgical masks but the all enveloping masks worn by the DIY fanatic who is building up a dust storm on a British Sunday afternoon with his sander.

As we trailed from ward to ward to visit our patients, we saw more and more staff wearing these bright green masks.

We felt somewhat self-conscious and joked about alien dust and then sat in offices and took the masks off and wondered what it was all about.

On Thursday afternoon, our outpatient clinic was unusually quiet. Many patients did not turn up for their review appointments and those that did were greeted by doctors wearing the obtrusive green masks.

Working round the clock

By Friday morning, more facts were beginning to emerge. Contrary to rumour and speculation the authorities were not hiding anything. The microbiologists were working round the clock to find out what was going on.

There has been a total news blackout from Guangzhou, which unfortunately has fed some more lurid imaginations leading to speculation of mutated viruses, 'air-born aids', and experiments gone wrong. Of these, the possibility of a naturally mutated virus seems the most likely.

The numbers of patients in Hong Kong are rising, more hospitals are affected, and there have now been deaths of local people with no history of travel.

Operations have been cancelled, wards are being emptied in anticipation of an increased influx over the weekend, staff are being relocated to emergency departments

More details are being established. The two most seriously ill of our colleagues had been to see a patient for a routine consultation.

They are two dedicated and conscientious doctors who have always been quick to respond to requests for advice and now they are in hospital themselves, totally unsuspecting victims of this invisible and potentially deadly threat.

A group of keen medical students eager to listen to a new 'murmur' also lie in hospital. Nurses from the ward are high amongst the staff victims.

We are now looking at over 60 cases and over 40 are medical staff. People no longer make jokes about the masks. The hospital authorities are giving frequent press releases and making statements to the staff to keep everyone informed about the continually developing situation.

We have colleagues fighting for their lives. We have an invisible killer in our midst. We are professionals and we have a job to do. Now, as I sit at home with my young son quietly sleeping and my wife pottering in the background, I wonder what tomorrow will bring? We are at war but our enemy has no name, no identity.

This reality easily eclipses the nightmare fantasies of Bush and Saddam. For the moment, Iraq is no longer an issue in Hong Kong.

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Press Release

March 15, 2003
Contact: CDC Media Relations
404-639-3286

Severe Acute Respiratory Syndrome

CDC 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 Centers for Disease Control and Prevention (CDC) today announced several steps to alert US health authorities at local and state levels.

CDC activated its emergency operations center on Friday, March 14, 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 Saturday, March 15.
Briefed state health officials on Saturday, March 15.
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 eight 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 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 two 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 March 12, 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 February 19.

# # #

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