SARS epidemic spreads in Taiwan, three other CDC officials have become ill.

An epidemic of suspected severe acute respiratory syndrom (SARS) cases that included the deputy director of the Center for Disease Control (CDC), three other health officials and a National Taiwan University Hospital nurse was reported yesterday. CDC deputy director Hsu Kuo-hsiung was reported to have come down sick after working closely on the SARS investigation.

Hsu said it was just a regular cold, though, and that he had already returned to full health.

A nurse at the National Taiwan University hospital who was part of the team that took care of the country's first reported case of SARS is also reported to have starting running a fever.

Unconfirmed reports said that she had been given sick leave after taking care of a Taiwanese businessman surnamed Chin after he turned up ill after coming back from mainland China.

All three are thought to have worked in the same office with the son of the Taiwanese businessman who seems to have picked up SARS while working in China. The three officials were all told to go home and rest.

The son is considered to be one of Taiwan's six "confirmed" SARS cases, together with his parents and three other people who had recently returned from the other side of the Taiwan Strait.

Those six cases can not be confirmed as being SARS, however, because materials for making such a determination have not yet arrived in Taiwan, according to CDC director Chen Tsai-chin. Chen said that at present all that can be said is that the symptoms being seen are extremely similar to those typical of SARS.

As at 1 PM 24 Mar 2003, the admission statistics of patients who have been in close contacts with atypical pneumonia patients are as follow:

(The numbers in bracket are those with Pneumonia Symptoms)

A. Staff of Hospitals/Clinics

Staff of Prince of Wales Hospital (PWH) admitted to: Prince of Wales Hospital 66 (62)

Prince of Wales Hospital (Private doctors) 3 ( 3)

Kwong Wah Hospital 3 ( 3)

Princess Margaret Hospital (PMH) 4 ( 4)

Tseung Kwan O Hospital (TKOH) 1 ( 1)

Queen Mary Hospital (QMH) 1 ( 1)

Staff of Kwong Wah Hospital (KWH) admitted to: Kwong Wah Hospital 4 ( 4)

One of the health care workers was discharged

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

Staff of Queen Elizabeth Hospital (QEH) admitted to: Queen Elizabeth Hospital 5 ( 2)

One of the health care workers was discharged

Tseung Kwan O Hosptial 1 ( 1)

Staff of a Private Clinic in Mong Kok admitted to: Princess Margaret Hospital 4 ( 4)

3 of the health care workers were discharged

Tuen Mun Hospital 1 ( 1)

Staff of a private hospital on HK Island admitted to: Pamela Youde Nethersole Eastern Hospital 3 ( 3)

Staff of a private hospital in Kowloon admitted to:
Princess Margaret Hospital 8 ( 8)

Pamela Youde Nethersole Eastern Hospital 1 ( 1)

Total 112 (109)

5 of the health care workers were discharged

B. Medical Students
Medical students Prince of Wales Hospital 17 (17) One of the medical students was discharged

C. Other Patients

Patients, patient's family members & visitors PWH, PMH, PYNEH, QEH, TKOH, QMH, Tuen Mun Hospital, United Christian Hospital 136 (134) 6 of the patients were discharged

Total Admission (A + B + C) 265 (260)

12 were discharged

10 patients with atypical pneumonia died recently in the following public hospitals:

Kwong Wah Hospital (2 patients);

Princess Margaret Hospital (1 patient);

Pamela Youde Nethersole Eastern Hospital (1 patient);

Prince of Wales Hospital (6 patients).

The Department of Health (DH) on 24 Mar 2003 confirmed that 2 more students had contracted atypical pneumonia, this brings to 7 the total number of students infected with the disease.

Consultant in-charge of the Disease Prevention and Control Division of DH, Dr Tse Lai-yin said they are among the 260 persons confirmed today to have contracted atypical pneumonia. The first case involved a 17-year-old girl who is a student of Wa Ying College in Ho Man Tin. She has been feeling unwell since 10 Mar 2003 and took sick leave since 13 Mar 2003. She was admitted to Princess Margaret Hospital (PMH) on 22 Mar 2003 for treatment. Her condition is stable. The second case involved a 13-year-old girl who is a student of SKH Kei Tak Primary School (AM) in Wong Tai Sin. She has not attended school since 13 Mar 2003 and developed symptoms on 12 Mar 2003. She was admitted to PMH on 22 Mar 2003. Her condition is stable.

Meanwhile, DH is also investigating a suspected case in which a 7 year old girl student, of SKH Kei Tak Primary School (PM) was found to have developed atypical pneumonia symptoms 23 Mar 2003. She was admitted to Kwong Wah Hospital today for observation.

As a precaution against atypical pneumonia, Wa Ying College and both the AM and PM sessions of SKH Kei Tak Primary School, in consultation with DH and the Education and Manpower Bureau, have decided to close for 7 days until 31 Mar 2003. Investigation is being conducted to ascertain if any of the girls' close contacts have contracted atypical pneumonia.

Update (11) on SARS cases in Singapore

As at 24 Mar 2003, a total of 65 people with SARS have been reported to the Ministry of Health (MOH). The 14 additional patients reported today comprise 4 hospital staff and 10 close contacts of patients. Among the close contacts are 3 siblings (two boys and one girl) aged 17, 13 and 5. Five patients have been discharged from hospital while the remaining 60 patients are hospitalised. All the patients are stable except for 12 patients who are in serious condition and being treated in the ICU.

Based on the detailed analysis of the 65 cases so far, the evidence is that SARS is transmitted only when a patient develops the symptoms of the illness. The incubation period is usually 3-7 days but could be up to 10 days. Epidemiological tracking of the outbreak shows that the initial 3 index cases resulted in 21 primary contacts developing probable SARS. This latter group of patients in turn have infected a further 41 cases of probable SARS. While stringent infection control measures have been instituted, their effect will only be apparent several days later, during which time we expect further increases in the numbers of SARS cases from secondary and tertiary transmission.

Since the implementation of the stringent control measures in hospitals, particularly TTSH/CDC, no new health care workers have been infected. The new cases of probable SARS involving healthcare workers are still traced back to the primary contacts.

At present, MOH/NEA officers trace contacts of cases and advise them to see a doctor in TTSH/CDC immediately if they develop fever or symptoms suggestive of SARS. In addition, the officers call the contacts every day to check on their condition. As a further step to reduce the possibility of transmission from symptomatic contacts to others in the community, MOH will be instituting home quarantine measures.

Home Quarantine Measures

MOH will be invoking the Infectious Diseases Act to isolate all contacts who have been exposed to infected SARS patients. They will be required to stay at home for 10 days and to minimise contact with other people. Those who do not heed the quarantine requirement are liable for prosecution under the Act.

During the home quarantine period, NEA officers will be checking with these contacts daily. If they develop symptoms suggestive of the illness, they will be immediately referred to CDC and TTSH for further evaluation and treatment if necessary. If they do not develop any of the symptoms of SARs after 10 days, they are unlikely to contract SARS.

There are presently more than 300 people on our contact tracing list who will be quarantined at home.

These are mainly family and friends who have come into close contact with the SARS patients.
MOH will make provisions for those who experience financial difficulties arising from home quarantine.

Tighter Screening Measures in Schools

The 5-year-old boy is from the Pats School House in Lim Ah Pin Road. As a precautionary measure, the Ministry of Health has asked Pats School House to close for 10 days.

The 13 year old girl, a student at Pei Cai Secondary School had limited contact with her classmates during the school holidays. Although she was well at that time when she was with her classmates, as a precautionary measure Pei Cai Secondary School has asked about 200 students who may have come in contact with her to stay away from school for a week. The 17 year old boy did not attend school during the school holidays.

WHO has not recommended closure of all schools as cases of transmission are still confined to those who have been in close contact with infected persons.

To prevent any possible SARS outbreak in childcare centres, pre-schools and schools, the MOH, Ministry of Education, and Ministry of Community Development and Sports have tightened screening measures in these places. Any child with fever will be asked not to attend school, even though they may not have been in contact with infected persons or had not travelled to the affected areas. Nurses from the Health Promotion Board will also help to detect unwell children in childcare centres and kindergartens for early medical attention.

The Health Advisory to child care centres, kindergartens and schools is attached at Annex A.

The MOH would like to appeal to all parents whose children have been to Hong Kong, Guangdong province in China or Hanoi to closely monitor their children.

They should not be sent to school if they have fever and should be seen by a doctor immediately.
More stringent infection control measures at hospitals

To fully protect visitors, MOH is heeding WHO advice to stop visitations from family and friends for all SARS patients. At all other hospitals, patients with fever which may or may not be SARS will be isolated until a diagnosis is made. All discharges from TTSH from 10 Mar 2003 will also be added to the contact tracing list for daily surveillance.

Severe Acute Respiratory Syndrome Report of Suspected Cases Under Investigation in the United States
State: No. suspected cases under investigation*

California: 10

Connecticut: 1

Hawaii: 3

Illinois: 1

Maine: 1

Massachusetts: 1

Michigan: 2

Missouri: 2

Mississippi: 1

New Jersey: 1

New Mexico: 1

North Carolina: 2

New York: 5

Pennsylvania: 1

Rhode Island: 1

Texas: 3

Utah: 1

Virginia: 2

Total Suspected Cases Under Investigation: 39

As of 24 Mar 2003, Health Canada has received reports of 11 individuals who have become ill with severe acute respiratory syndrome (SARS) in Ontario and British Columbia. There have been 3 deaths in Canada. All Canadian cases have occurred in persons who have traveled to Asia or had contact with SARS cases in the household or in a health-care setting. The details of the cases to date are as follows:

Ontario: 10 total cases. To date, all cases have occurred in close family contacts of travelers returning from Hong Kong or in heath care workers who have cared for these cases.

British Columbia: one person has been hospitalized with SARS after returning from travel in southeast Asia.

At this time, the cause of SARS remains unknown, however national and international laboratory testing and collaboration is ongoing. Here are the most recent developments:
Health Canada has deployed 3 epidemiologists to assist Toronto Public
Health and the Ontario Ministry of Health with the investigation of SARS cases currently under investigation.

Scientists at Health Canada's National Microbiology Laboratory (NML) in Winnipeg are now able to report that they have found evidence of human metapneumovirus (hMPV) in specimens from 6 of the 8 cases they are studying. The metapneumovirus is part of paramyxoviridae family. These findings are consistent with the results previously released by scientists in Germany and Hong Kong.

The findings of the NML are significant in that a common thread has been found in a majority of cases in Canada.

Doctors at the Vietnam-France Hospital, where the outbreak in Vietnam's capital began, said a 43-year-old Vietnamese nurse who worked at the facility and who was one of three patients there in critical condition, died on Monday afternoon. [She is the third death reported from VietNam, the other 2 were a nurse and a physician].

All 3 medical staff were apparently exposed to the virus after treating a U.S. businessman who was admitted with flu-like symptoms at the end of February 2003 and later died in Hong Kong where he had been taken for treatment.

First suspected case of SARS in Macau

A 25 year old British teacher is suspected of having SARS and is being treated. Officials from the Macau Centre for Disease Control and Prevention stated that specimen samples of the teacher have been sent to the Hong Kong labs for analysis.

Officials explained that the teacher went to Hong Kong on 10 Mar 2003 for the day and spent the day shopping and did not go to any of the hospitals in Hong Kong. The teacher was in Hong Kong for more than 10 hours and returned to Macau on the same day.

[Before drawing any conclusions that this is a community-acquired case of SARS, we await official word on the diagnosis and investigation of the above mentioned suspected case. As a reminder, SARS is not the only etiology of pneumonia, and at present, many cases acute respiratory syndrome are considered suspected cases of SARS that are later shown to have another etiology and therefore ruled out as due to SARS. - Mod.MPP]

WHO team of experts in China

A WHO international team of experts in epidemiology, microbiology,
virology, and respiratory diseases arrived in Beijing, China on Sunday 23
Mar 2003. The multinational team was assembled in response to a request
from the Chinese Ministry of Health to investigate possible links between
the current SARS outbreak, which began in Asia in mid-February 2003, and an
outbreak of atypical pneumonia which began in Guangdong Province in China
in mid-November 2002.

The WHO team, which includes experts from 5 countries, will review
available epidemiological and laboratory data on cases in the southern
China outbreak. It will also propose what additional investigations should
be carried out, and which additional reagents, antibodies, tests, equipment
and expertise might be required to continue the laboratory and virological
work. This additional expertise and equipment is expected to bolster
efforts to trace the source of atypical pneumonia in Guangdong Province.

Deadly Virus Infects Five People Who Toured Beijing

Tue March 25, 2003 12:17 AM ET
By Tan Ee Lyn

HONG KONG (Reuters) - Five people who returned to Hong Kong from a holiday in Beijing have contracted a mystery pneumonia virus which has killed more than 20 people around the world, a government spokesman said on Tuesday.

In Hong Kong, where debate is raging over whether the government reacted quickly enough, an official said the latest victims were among a tour group of 39 to the Chinese capital.

Six of their fellow travelers were in hospital and may have also been infected, the government spokesman said.

"We are still tracing the source, where and how they were infected," he said.

The group returned to Hong Kong on March 19. The virus usually takes between two and seven days to incubate before a victim starts showing symptoms.

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