BREAKING BIG: POSSIBLE PATHOGEN DETECTED IN SARS CASE

PROMED ^ | 03-18-03

[Mother Abigail]

Paramyxovirus-like particles identified by electron microscopy

Numerous tests have been performed on the 3 patients admitted on Saturday 15 March to the Isolation Unit at Frankfurt am Main with suspected severe acute respiratory syndrome (SARS). Tests from respiratory specimens for influenza A and B virus, respiratory syncytial virus, enteroviruses, _Mycoplasma pneumoniae_ and _Chlamydia_ spp. by antigen enzyme linked immunosorbent assay (ELISA) and/or polymerase chain reaction (PCR) were all negative; antibody tests for dengue, influenza A and B, measles, hantaviruses, _Mycoplasma pneumoniae_ and _Chlamydia_ spp. were likewise negative or unremarkable so far; further test results are pending.

Particles morphologically resembling paramyxoviruses were seen in respiratory specimens (throat swab and sputum) obtained from the index patient, a doctor from Singapore, by the teams in Marburg and in Frankfurt am Main.

It remains to be seen whether this finding can be confirmed -- tests including low-stringency paramyxovirus PCR and tissue culture are currently under way in Hamburg, in Marburg and in Frankfurt am Main. It needs to be emphasised that at this time these preliminary results only indicate a suspicion. Furthermore, even if the presence of a paramyxovirus was confirmed, it is not clear at this stage whether this might represent the causal agent of SARS or rather a coincidental finding.

[aristeides]

The Spanish flu is thought to have originated in China, but it certainly spread all over the world, even getting as far as Spitzbergen (I don't think the Black Death got that far.)

[aristeides]

I was meaning to suggest that, if the Spanish flu could have originated in China in 1917 or so, a similar strain of flu could emerge in China today.

[madison10]

So where was it seen before? The deserts of Kuwait?

[madison10]

Sorry, that article REALLY didn't help. LOL So is this a man-made (read Saddam-made) virus? or did the SARS just decide to morph into a nasty disease all by its lonesome?

[arkady_renko]

Sorry, that article REALLY didn't help. LOL So is this a man-made (read Saddam-made) virus? or did the SARS just decide to morph into a nasty disease all by its lonesome?

From the little I've read this afternoon, it seems that a similar virus hits pigeons pretty hard. There was a purge of poultry in Hong Kong a few years back because of a virus that jumped from fowl to humans, so I'm guessing that something like this has happened in China. Just a guess - I have no medical credentials at all.

A_R

[Mother Abigail]

The disease appears to spread like flu, through airborne droplets from coughs and sneezes. But its incubation period is typically much longer, four to five days, and the disease is not spreading
as fast as a new flu bug would.

German doctors said yesterday that blood tests on a Singapore physician and his wife in Frankfurt had indicated that the cause of their disease could be an unidentified paramyxovirus, a group of viruses that includes measles, mumps and parainfluenza viruses.

Wilhelm Doerr, a virus specialist at the University Clinic in Frankfurt, said that laboratory tests had found a virus belonging to this family. But he was cautious about the significance of the findings, which needed to be compared with results from Asia.

[CathyRyan]

New PorMED-Mail UPDATE


http://www.promedmail.org/pls/askus/f?p=2400:1001:150915020210750576::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,21008

[aruanan]

I notice there's a case in Chicago. I know a lot of Asians. I wonder how many degrees of separation I am from the victim.

[Mother Abigail]

Since the Ministry of Health (MOH) press release yesterday, 2 more patients have been diagnosed with SARS. The new cases are both close contacts of the cases. In total, 23 cases of SARS have been reported. Other than the initial 3 cases, the additional 20 patients are all close contacts of patients with SARS, 8 of them being hospital staff. All the patients are stable, except for 4 patients who are in a serious condition.

The Ministry of Health would like to appeal to the public to avoid travel to Hong Kong, Hanoi, and Guangdong province in China for the time being, unless absolutely necessary. This would help us greatly in our efforts to contain the number of new cases. We hope that we will continue to see a decreasing number of cases of SARS as we have put in place the necessary precautionary measures.

We also advise you to stay calm and continue with your daily routine. Though SARS is infectious, there is no need for alarm as your risk of SARS is low.
The World Health Organization (WHO) has reported that the disease is spread from person to person but only through close contact with an infected person. There is no evidence to date that the disease spreads through casual contact. Apart from the initial 3 cases, those who came down with SARS in Singapore were family members and friends, and hospital staff who had come into close contacts with the infected patients.

The Ministry would like to reiterate that you should seek immediate medical attention if you have:

- fever (greater than 38 degrees Celsius) and respiratory symptoms including cough, shortness of breath, or breathing difficulty; AND

- have travelled to Hong Kong, Hanoi, or Guangdong province in China, within 2 weeks of onset of the symptoms; or

- are a close contact of a person(s) diagnosed with SARS. (Close contact means having cared for, having lived with, or having had direct contact with respiratory secretions and body fluids of a person with SARS)

[Mother Abigail]

Since the Ministry of Health (MOH) press release yesterday, 2 more patients have been diagnosed with SARS. The new cases are both close contacts of the cases. In total, 23 cases of SARS have been reported. Other than the initial 3 cases, the additional 20 patients are all close contacts of patients with SARS, 8 of them being hospital staff. All the patients are stable, except for 4 patients who are in a serious condition.

The Ministry of Health would like to appeal to the public to avoid travel to Hong Kong, Hanoi, and Guangdong province in China for the time being, unless absolutely necessary. This would help us greatly in our efforts to contain the number of new cases. We hope that we will continue to see a decreasing number of cases of SARS as we have put in place the necessary precautionary measures.

We also advise you to stay calm and continue with your daily routine. Though SARS is infectious, there is no need for alarm as your risk of SARS is low.
The World Health Organization (WHO) has reported that the disease is spread from person to person but only through close contact with an infected person. There is no evidence to date that the disease spreads through casual contact. Apart from the initial 3 cases, those who came down with SARS in Singapore were family members and friends, and hospital staff who had come into close contacts with the infected patients.

The Ministry would like to reiterate that you should seek immediate medical attention if you have:

- fever (greater than 38 degrees Celsius) and respiratory symptoms including cough, shortness of breath, or breathing difficulty; AND

- have travelled to Hong Kong, Hanoi, or Guangdong province in China, within 2 weeks of onset of the symptoms; or

- are a close contact of a person(s) diagnosed with SARS. (Close contact means having cared for, having lived with, or having had direct contact with respiratory secretions and body fluids of a person with SARS)

[arkady_renko]

Chicago media is picking this up. Dosen't help that everyone I know in the midwest has struggled with an unshakable 'cold' the last few months. I see panic in the making as people proceed with self-diagnosis.

A_R

[Mother Abigail]

Since the Ministry of Health (MOH) press release yesterday, 2 more patients have been diagnosed with SARS. The new cases are both close contacts of the cases. In total, 23 cases of SARS have been reported. Other than the initial 3 cases, the additional 20 patients are all close contacts of patients with SARS, 8 of them being hospital staff. All the patients are stable, except for 4 patients who are in a serious condition.

The Ministry of Health would like to appeal to the public to avoid travel to Hong Kong, Hanoi, and Guangdong province in China for the time being, unless absolutely necessary. This would help us greatly in our efforts to contain the number of new cases. We hope that we will continue to see a decreasing number of cases of SARS as we have put in place the necessary precautionary measures.
We also advise you to stay calm and continue with your daily routine. Though SARS is infectious, there is no need for alarm as your risk of SARS is low. The World Health Organization (WHO) has reported that the
The following is jointly issued by the Department of Health and the Hospital Authority: As at 1pm today (18 Mar 2003), the admission statistics of patients who have been in close contacts with atypical pneumonia patients are as follows:

A. Staff of Hospitals/Clinics

(numbers in brackets are those with symptoms of pneumonia) Staff of Prince of Wales Hospital (PWH) admitted to: Prince of Wales Hospital 44 (36)

Kwong Wah Hospital 1 (1)
Princess Margaret Hospital (PMH) 1 (1)

Tseung Kwan O Hospital 1 (1)

Staff of Kwong Wah Hospital (KWH) admitted to: Kwong Wah Hospital 2 (2)

Staff of Pamela Youde Nethersole Eastern Hospital (PYNEH) admitted to: Pamela Youde Nethersole Eastern Hospital 7 (7)

Staff of Queen Elizabeth Hospital admitted to: Queen Elizabeth Hospital 4 (1)

Staff of a Private Clinic in Mong Kok admitted to: Princess Margaret Hospital 3 (3) Tuen Mun Hospital 1 (0)

Staff of a private hospital on HK Island admitted to: Pamela Youde Nethersole Eastern Hospital 3 (3)
Sub-total (A) 67 (55)

B. Medical Students (numbers in brackets are those with symptoms of pneumonia) Medical students Prince of Wales Hospital 17 (17)

C. Other Close contacts of Index Patient (numbers in brackets are those with symptoms of pneumonia) Family members & visitors PWH, PMH, KWH, PYNEH & Queen Mary Hospital 39 (39)

Total admissions
(A + B + C) 123 (111)

[Mother Abigail]

It is possible for the status of a reported case to change over time. SARS is a diagnosis of exclusion. This means that whenever a known cause is found that could fully account for a patient's clinical condition, this patient should no longer be considered to be a case of SARS.

Two cases attributed to Switzerland on 17 Mar 2003 no longer fulfilled the case definition of SARS after further clinical assessment.
+ The Chinese authorities have reported suspect and probable cases in Guangdong province. Figures are being updated.
* No documented secondary transmission in-country. No affected areas.
**The death attributed to Hong Kong SAR of China occurred in a case medically transferred from Viet Nam.

At present, the vast majority of cases are concentrated in Hong Kong Special Administrative Region of China and Hanoi, Viet Nam.

Singapore is currently reporting the third largest number of cases. All reported cases in other parts of the world are linked to travel within the past 10 days to one of these destinations. It remains undetermined whether an outbreak of atypical pneumonia in southern China, which began in November, is related to the current outbreaks.
In Hanoi, 13 of the 57 patients are showing signs of clinical improvement.

Awareness of the disease is now very high throughout the world. Surveillance is proving to be sensitive, with suspected cases rapidly detected, reported to national authorities and WHO, and investigated according to the standard case definition. An increase in the number of suspected cases is to be expected in such an atmosphere of heightened awareness.

In areas where person to person transmission has been documented, cases have occurred almost exclusively in health care workers or in people in very close contact with patients, such as family members. Currently available data indicate that transmission of the infectious agent requires direct and close contact. There is no evidence of transmission following casual contact.

Due to heightened awareness, cases are now being quickly identified and immediately isolated. No cases of secondary transmission are occurring following the detection and proper management of imported cases.

Protective measures and strict barrier nursing procedures are now in place in hospitals in all areas where cases have been reported. In areas where person to person transmission has occurred, these measures are expected to decrease transmission to health staff and families of patients. Strict protective measures in countries managing imported cases are likewise expected to reduce the risk that the disease will spread to others within these countries.

Efforts are under way to expedite identification of the causative agent, improve diagnostic precision, and develop a diagnostic test. A network of 11 highly qualified laboratories in 10 countries was established yesterday and has begun data sharing and regular reporting today.

Many countries have activated well designed national preparedness plans for dealing with an emerging infectious disease. The global surveillance system, which WHO coordinates, is working well in the ways needed to prevent the outbreak from becoming a global epidemic.

[Mother Abigail]

HONG KONG (AP): A pneumonia patient believed to have spread a mysterious respiratory illness to dozens of hospital workers in Hong Kong traveled to mainland China before he became ill. Dr Leung Ping-chung, who has been working throughout the pneumonia outbreak at Hong Kong's hardest-hit hospital, told the Associated Press the patient believed to have spread the illness was a man aged in his 40s who had visited Hainan island and other parts of southern China. Leung said the patient, who has not been identified by name, is "still very sick" in the hospital.

Health authorities are trying to determine whether disease outbreaks in Hong Kong, Vietnam and elsewhere are linked to an illness in mainland China's southern Guangdong province that recently sickened 305 people and killed 5.

On Monday, Hong Kong's health chief, Dr Yeoh Eng-kiong, said that officials had identified the "index patient" who apparently has spread the disease to 68 people, mainly medical workers, at the Prince of Wales Hospital, but declined to provide any details about the patient.

[Mother Abigail]

There was a death of a Hong Kong man who visited mainland [China] and fell ill, admitted to hospital on 22 Feb 2003. He died 11 days later at Kwong Wah hospital on 4 Mar 2003. He had atypical pneumonia symptoms and his sister was also taken ill too, although little information is available. Later, we have the "official" HK outbreak reported at Kwong Wah Hospital, HK.

To put you in the picture a little, the Hong Kong/China border is busy, comprising 5 crossing points and built and staffed to handle more than 200 000 people a day plus countless container lorries.

Every day, thousands (I don't have a precise figure must be near 5000) cross the border, many people would consider a day trip to China as normal activity:

- border is open 24 hrs a day.

- thousands of people live in China and cross for work in Hong Kong.

- hundreds more cross the border twice a day, whether it is Chinese kids coming here for schooling in Hong Kong, or businessman going over for dinner and entertainment, or day shoppers or traders; the border creates great opportunities for trade and 2 way infection everyday.

[Mother Abigail]

As of today, health authorities are investigating reported cases in Canada, China, Taiwan (China), Germany, Hong Kong SAR of China, Singapore, Slovenia, Thailand, Viet Nam, and the United Kingdom." Newswire reports also mention suspected cases in the USA, Sweden, and Austria. Additional countries are likely to be added to the list as the heightened alert brings cases to the attention of the authorities. In this era of rapid transport and extensive travel, we live in a global village and should not be surprised to have cases among travellers who may have had close contact with SARS cases in countries where transmission has been identified.

In [4] above, it is interesting that there was travel to southern China preceded the onset of illness. [5] also mentions an early case with a history of travel to southern China, and an interesting description of the communications between southern China and Hong Kong SAR of China. We await more information on the outbreak of a SARS-like illness in Guangdong China when it becomes available.

On the positive note, it does not appear that casual contact with cases is a significant mode of transmission as the overwhelming majority of cases continue to be in people with known close contact with other cases. Also it appears that barrier nursing precautions

[TaxRelief]

The question the diary entry in post 78 brings to mind is:
If corpses, that were buried in 1918 after succumbing to the Spanish Flu, are emerging from the permafrost, could the virus be reactivated if someone handles the body?

[TaxRelief]

Apparently our posts are getting too complicated...

[Mother Abigail]

A potential source of the mystery illness that has been worrying public health officials around the globe may have been identified.

Scientists in Germany and possibly Hong Kong appear to have isolated what looks like a paramyxovirus, a member of a large family of viruses that cause ailments ranging from measles and mumps to many respiratory conditions.

While it's too early to say if this is the culprit responsible for sudden acute respiratory syndrome or SARS, infectious disease experts in Canada say it is plausible this is the pathogen scientists around the world have been desperately seeking.

"It's completely believable," said Dr. Brian Ward, an infectious disease specialist at McGill University in Montreal. "It's pretty compelling."

Researchers at the Institute for Medical Virology at Germany's Frankfurt University reported today they had seen something resembling a paramyxovirus in samples taken from two SARS patients there.

Such a finding would be considered interesting and important, but not solid proof. Other teams examining specimens from other patients would also have to find the same virus before the scientific community could begin to believe that the German researchers had indeed discovered the cause of the mysterious ailment.

There was an unconfirmed report today that a team from Hong Kong has also seen what looked like a paramyxovirus in specimens from SARS patients.

Microbiologists at a Toronto hospital treating two of Canada's 11 probable and suspected cases of SARS received a report from a colleague in Hong Kong in which he said he had identified what appeared to be paramyxovirus particles in some SARS specimens.

The virologist, from the Prince of Wales Hospital in Hong Kong, was not immediately available to comment.

But Dr. Andrew Simor, who read the report, said the second finding strengthens the case that the pathogen involved is a paramyxovirus.

"It makes it seem like it might be more likely," said Simor, head of microbiology at Sunnybrook and Women's College Health Sciences Centre. "It's still early. But it's another piece of evidence that may be helpful."

[Judith Anne]

DUH! (*JA slaps forehead, feels foolish*) Of course--the French should be immune!