Killer Virus (SARS) Identified

ProMed ^ | 03-18-03

[Mother Abigail]

Killer virus identified

A team from the Prince of Wales Hospital and Chinese University of Hong Kong have identified the virus that has caused the recent outbreak of severe acute respiratory syndrome worldwide, confirming that the current anti-viral treatment applied to patients has been the right choice. Identifying the virus as a member of the Paramyxoviridae family, Professor John Tam of the department of microbiology of the Chinese University said it was detected by electron microscopy. The finding, announced late last night, was further confirmed by a molecular technique that revealed the nucleic acid sequence of the virus.

Asked if the virus was curable, Tam reiterated that the finding last night had indicated that the current treatment applied to patients suffering from the syndrome, more commonly known as atypical pneumonia, had been the right choice. But he added that they still needed to monitor individual patients' reactions before they could conclude that the virus was curable.

Lo Wing-lok, Medical Association president and legislator, said the Paramyxoviridae family incorporated different viruses that could affect humans and, as such, further studies were needed to establish whether it was a new virus. Earlier it was revealed that at least 6 patients were responsible for spreading the pneumonia in Hong Kong. Health chief Yeoh Eng-kiong also said that a mainland professor who died in [Hong Kong] SAR on 4 Mar 2003 was a victim of the atypical pneumonia.

The new information from officials indicated the disease had been more widespread in the SAR than originally believed. Yeoh said the pneumonia and suspected cases had now been isolated into 6 "clusters". Yeoh again stressed the government was not hiding anything. He insisted there was no sign of an outbreak at the community level.

[This is the second identification of a paramyovirus-like organism from a patient with SARS (see ProMED-mail posting Severe acute respiratory syndrome - worldwide (06) 20030318.0677). The first identification was made by investigators in Frankfurt am Main and Hamburg from specimens taken from a physician from Singapore who had treated some of the earlier cases seen in Singapore and was admitted to hospital in Frankfurt, Germany en route back to Singapore over the weekend. As mentioned in our earlier posting, it is important to confirm these findings and to identify a similar agent from other cases of SARS before it can be concluded that this agent is the cause of SARS.

That being said, this second identification of a paramxovirus-like organism from patients with SARS offers hope that the etiology of this outbreak may be identified soon. - Mod.MPP]

[LadyDoc]

There was an epidemic in some Chinese city for at least three months. The Chinese didn't mention it to any international health organization, however. So no one noticed it until it came to Hanoi and to Hong Kong. Thanks to air travel, it's now in a half dozen countries.

It's not bioterror, just a new version of an old bug...

[Mother Abigail]

Good point,

With the traffic on the Left coast to and from Asia, we might expect a few clusters to start popping up

[Mother Abigail]

Agreed

As to the Guangzhou outbreak, ProMed was all over it like a cheap suit, starting with:

A ProMED-mail post

International Society for Infectious Diseases

Date: 10 Feb 2003

This morning I received this e-mail and then searched your archives and found nothing that pertained to it. Does anyone know anything about this problem?

"Have you heard of an epidemic in Guangzhou? An acquaintance of mine from a teacher's chat room lives there and reports that the hospitals there have been closed and people are dying."
--

Stephen O. Cunnion, MD, PhD, MPH
International Consultants in Health, Inc Member ASTM&H, ISTM

[Judith Anne]

Hospitals closed, people dying--that sounds bigger than 305 cases with 5 dead....thanks.

[Mother Abigail]

NIPAH VIRUS FACTSHEET

Overview: Nipah virus is a newly recognized zoonotic virus. The virus was 'discovered' in 1999. It has caused disease in animals and in humans, through contact with infectious animals. The virus is named after the location where it was first detected in Malaysia.

Nipah is closely related to another newly recognized zoonotic virus (1994), called Hendra virus, named after the town where it first appeared in Australia. Both Nipah and Hendra are members of the virus family Paramyxoviridae. Although members of this group of viruses have only caused a few focal outbreaks, the biologic property of these viruses to infect a wide range of hosts and to produce a disease causing significant mortality in humans has made this emerging viral infection a public heath concern.

Natural Host: It is currently believed that certain species of fruit bats are the natural hosts of both Nipah and Hendra viruses.

They are distributed across an area encompassing northern, eastern and south-eastern areas of Australia, Indonesia, Malaysia, the Philippines and some of the Pacific Islands. The bats appear to be susceptible to infection with these viruses, but do not themselves become ill. It is not known how the virus is transmitted from bats to animals.

Transmission: The mode of transmission from animal to animal, and from animal to human is uncertain, but appears to require close contact with contaminated tissue or body fluids from infected animals. Nipah antibodies have been detected in pigs, other domestic and wild animals. The role of species other than pigs in transmitting infection to other animals has not yet been determined.

It is unlikely that Nipah virus is easily transmitted to man, although previous outbreak reports suggest that Nipah virus is transmitted from animals to humans more readily than Hendra virus. Despite frequent contact between fruit bats and humans there is no serological evidence of human infection among bat carers. Pigs were the apparent source of infection among most human cases in the Malaysian outbreak of Nipah, but other sources, such as infected dogs and cats, cannot be excluded. Human-to-human transmission of Nipah virus has not been reported.

Clinical features: The incubation period is between 4 and 18 days.

In many cases the infection is mild or inapparent (sub-clinical). In symptomatic cases, the onset is usually with "influenza-like" symptoms, with high fever and muscle pains (myalgia). The disease may progress to inflammation of the brain (encephalitis) with drowsiness, disorientation, convulsions and coma. Fifty percent of clinically apparent cases die.

Treatment: No drug therapies have yet been proven to be effective in treating Nipah infection.

Treatment relies on providing intensive supportive care. There is some evidence that early treatment with the antiviral drug, ribavirin, can reduce both the duration of feverish illness and the severity of disease. However, the efficacy of this treatment in curing disease or improving survival is still uncertain.

Protection of Health Care Professionals: The risk of transmission of Nipah virus from sick animals to humans is thought to be low, and transmission from person-to-person has not yet been documented, even in the context of a large outbreak. Therefore, the risk of transmission of Nipah virus to health care workers is thought to be low. However, transmission without percutaneous exposure (through a break in the skin barrier) is theoretically possible, as respiratory secretions contain the virus. This is why it has been categorized as a biohazardous agent that should be managed in a high-level biosecurity laboratory. It is recommended that close contact with body fluids and infected tissues be avoided if Nipah infection is suspected.
Outbreaks of Nipah and Hendra Viruses:

From September 1998 - April 1999, there was a large outbreak of encephalitis in Malaysia. During the investigation of this outbreak, Nipah virus, a previously unrecognized virus, was identified as the causal agent. A total of 265 people were infected, of whom 105 died. Ninety-three percent of cases had occupational exposure to pigs. An associated outbreak among abattoir workers in Singapore during March 1999 led to 11 cases, with 1 death. These workers had been handling pigs that had been imported from the outbreak areas in Malaysia.
There have been 3 recognized outbreaks of Hendra virus in Australia in 1994, 1995 and1999. Three human cases, leading to 2 deaths were recorded in the 1994 and 1995 outbreaks. In 1995 a horse was infected, with associated human cases. The precise mode of virus transmission to the three Australian patients is not fully understood. All 3 individuals appear to have acquired their infection as a result of close contact with horses which were ill and later died.

[Ditter]

Do we know who this person is & when he arrived in Albuquerque?

[CathyRyan]

gallows humor...I have family that are planning to vist from another state next month...Do you think I need to clean the house or will we be under quarantine by then?

[Mother Abigail]

I will try to get that information for you

[Mother Abigail]

The seeker came to the master and asked: "What must I do to be enlightened teacher?"

The master responded: "Have you eaten you supper?"

The seeker nodded: "Yes"

And the good master said: "Go do the dishes"

The seeker obediently went and did the dishes, whereupon he became enlightened....

[Mother Abigail]

My feeling is this is fairly likely (to be a case of SARS) because the patient was in one of those areas," Voorhees said.

"We've sent samples to the CDC (Centers for Disease Control and Prevention), and we're trying to bring in people to look into it as quickly as we can."

No test to detect infection exists for SARS because the syndrome is very new. The only way to confirm it at this point is to rule out other possible diseases, Voorhees said.

The patient is in "fair" condition and in respiratory isolation. All other information about the patient, including his identify, is confidential, said Ed Benge, vice president of medical staff affairs at Presbyterian.

Health officials are conferring with the CDC to decide whether to release the patient's flight information.

[CathyRyan]

ROFL The first thing I have had a laugh about since this mess started. Thank You! :)

[Doc On The Bay]

re: "My # 34," --We survive DESPITE our "demonstrably 'unworthy' "Survival Skills"; ----- WE are "Earth's Best Shot" at "SPECIES SURVIVAL!!"

[per loin]

Cathay Pacific Airways Ltd. and Hong Kong Dragon Airlines Ltd.

These two airlines refer to each other as "our associated airline", with DragonAir serving mainland China and a few other Asian sites from Hong Kong, and Cathay handling flights to the rest of the world.

[Mother Abigail]

I suspect that these are ground based infections, but can't be sure.

There is a flurry of new travelers returning infected.

As per our conversation last night:

The reservoir of virus must be large and uncontained. HK has all but shut down information, other than "we are not lying" statements.

Have tried all day to get more info, but nada...

[Mother Abigail]

All species are subject to cycles of sustained growth and sudden calamity. It is a rhythm as old as life itself, and is an integral part of the evolutionary process.

The classical symptoms of a species in crisis include:

Increased aggression
Sexual dysfunction
And disease.

[per loin]

Cathay Pacific is Hong Kong's biggest air carrier. Very important to the economy there. Dragonair is its associate. By now the flight schedules of the "outbound" cases should be well known to the investigators, as should the work schedules of the afflicted two employees, and all others who worked with them. I'd suspect that WHO would be wanting to see how many of these other employees are now on sick leave.

[Judith Anne]

Do you think this is vastly underreported? I'm starting to think so...

[per loin]

Do you think this is vastly underreported?

Yes. If a cluster of cases is centered in Cathay Pacific, which flies about a million passengers a month, that airline could be financial history in a very short time.

[Mother Abigail]

Yes, and also still in the incubation period.

[null and void]

Looking around my house, I'd hope for the quarantine...