MARCH 2.003

                                              MARZO 2.003

Data-Medicos 
Dermagic/Express MEDermatology Journal
Marzo 2.003  March 2.003 

1.) ORAL ERYTHROMYCIN, MINOCYCLINE, and VALACYCLOVIR against SARS Severe acute respiratory Syndrome
Author: Lapenta JJ, Dermatologist, DERMAGIC/EXPRESS   March 2.003
 
Why Erythromycin, Minocycline and Valacyclovir against a virus of the I member of
Coronavirus, the one which this killing our population? Do clinical evidences exist to use these
three drugs against the stranger?
The Erythromycin: This old one and faithful antibiotic it has demonstrated to be effective
against illnesses that being of viral Origin has had good results, I refer to the Pityriasis Rosea
of Gibert, which has been related with the virus of the family herpes 6 and 7, however, being
viral the illness, is two published studies that they demonstrate that the old but potent
Erythromycin has HEALED the cases of Pityriasis Rosea notably, to which are also attributed
bacterial causes.
The Erythromycin has also been used in the illness of Mucha Habermann (Ulceronecrotic
variant-Acute Pityriasis lichenoides) with great success, it is not known and why, but it is
effective against this illness whose cause is still ignored but she has been associated to the
virus cytomegalovirus, therefore this drug has a great immunomodulatory effects and it could
be useful in the SARS
DOSE suggested 2 daily grs
The minocycline: other old giant which has been used in a great quantity of illnesses with
success including: hansen disease (Mycobacterium leprae), Erythema migrans (Borrelia
Burgdorferi), pemphigus, Confluent and reticulated papillomatosis, cicatricial pemphigoid,
pyoderma gangrenosum, Mycobacterium kansasii, nocardiosis, rheumatoid arthritis, hepatic
cyst, Vibrio vulnificus infection, diffuse scleroderma and others. The minocycline has
demonstrated to be an antibiotic that has effect against infectious and NOT INFECTIOUS
diseases, also autoimmune diseases, I play the game agaist SARS with this drug
DOSE suggested 400 daily mgrs.
VALACYCLOVIR:
The classic antiviral against the family herpes virus, improved molecule of the old and effective
acyclovir that has demonstrated a great power like antiviral
DOSE suggested: 2 grs day
CONCLUSION:
When you have an infectious agent that is attacking and you don't know how to killing him
you have to use what you have in the hand and to shoot the trigger to try to stop it
THIS cocktail of drugs can be A REAL ALTERNATIVE against the SARS.
Let us don't wait that it kills us, let us put an end to the one alien with the whole artillery that
we have while the scientists discover the real DRUG against the alien !

Dr. José Lapenta R.
References:

1.) Mucha-Habermann's disease in children: treatment with erythromycin.
Arch Dermatol. 1978 Nov;114(11):1679-80.
2.) Erythromycin in pityriasis rosea: A double-blind, placebo-controlled clinical trial.
J Am Acad Dermatol. 2000 Feb;42(2 Pt 1):241-4.
3.) A Remarkable Result of a Double-Masked, Placebo-Controlled Trial of Erythromycin in
the Treatment of Pityriasis Rosea.
Arch Dermatol. 2000 Jun;136(6):775-776.
4.) Epidemiological study of human herpesvirus-6 and human herpesvirus-7 in pityriasis
rosea. Br J Dermatol. 2000 Oct;143(4):795-8.
5.) Human herpes virus-like particles in pityriasis rosea lesions: an electron microscopy study.
J Cutan Pathol. 2002 Jul;29(6):359-61.

                                          - LINKS -
The Pityriasis Rosea, looking for a causal agent
The Minocycline, the good, the bad and the ugly
The Valacyclovir and Famciclovir
The Pityriasis lichenoides a paraneoplastic syndrome ?

2.) SEVERE ACUTE RESPIRATORY SYNDROME
Information About Sudden Acute Respiratory Syndrome (SARS)
Source: www.cdc.gov/

April 2, 2003, 4:00 PM EST

A NEW DISEASE CALLED SARS

The Centers for Disease Control and Prevention (CDC) is investigating a new disease called severe acute respiratory syndrome (SARS). The disease was first reported among people in Guangdong Province (China), Hanoi (Vietnam), and Hong Kong. It has since spread to other countries. As of April 1, more than 70 cases of SARS had been reported in the United States. This fact sheet describes the disease and important guidelines for preventing the spread of SARS.

SYMPTOMS OF SARS

In general, SARS begins with a fever greater than 100.4°F [>38.0°C]. Other symptoms may include headache, an overall feeling of discomfort, and body aches. Some people also experience mild respiratory symptoms. After 2 to 7 days, SARS patients may develop a dry cough and have trouble breathing.

HOW SARS SPREADS

Public health experts think that SARS is spread by close contact between people. SARS is most likely spread when someone sick with the disease coughs droplets into the air and someone else breathes them in. It is possible that SARS also can spread more broadly through the air or from touching objects that have become contaminated. To find out more about SARS, go to CDC's SARS Web site and the WHO's SARS Web site. The Web sites are updated daily.

WHO IS AT RISK FOR SARS

Cases of SARS continue to be reported mainly among people who have had direct close contact with an infected person, such as those sharing a household with a SARS patient and health care workers who did not use infection control procedures while taking care of a SARS patient. In the United States, there is no indication of community spread at this time. CDC continues to monitor this situation very closely.

WHAT YOU SHOULD DO TO PROTECT YOURSELF

CDC has issued interim guidelines for patients with suspected SARS in the healthcare setting and in households. These guidelines may change as we learn more about SARS. If you get sick with the symptoms described above and have been in close contact with someone who might have SARS, see your health care provider and follow the guidelines below.

GUIDELINES

If you think you (or someone in your family) might have SARS, you should:

Consult a health care provider as soon as possible.
Cover your mouth and nose with tissue when coughing or sneezing. If you have a surgical mask, wear it during close contact with other people. A mask can reduce the number of droplets coughed into the air.
If you have SARS and are being cared for at home, you should:
Follow the instructions given by your health care provider.
Limit your activities outside the home during this 10-day period. For example, do not go to work, school, or public areas.
Wash your hands often and well, especially after you have blown your nose.
Cover your mouth and nose with tissue when you sneeze or cough.
If possible, wear a surgical mask when around other people in your home. If you can't wear a mask, the members of your household should wear one when they are around you.
Don't share silverware, towels, or bedding with anyone in your home until these items have been washed with soap and hot water.
Clean surfaces (counter or tabletops, door knobs, bathroom fixtures, etc.) that have been contaminated by body fluids (sweat, saliva, mucous, or even vomit or urine) from the SARS patient with a household disinfectant used according to the manufacturer's instructions. Wear disposable gloves during all cleaning activities. Throw these out when you are done. Do not reuse them.
Follow these instructions for 10 days after your fever and respiratory symptoms have gone away.
If you are caring for someone at home who has SARS, you should:
Be sure that the person with SARS has seen a health care provider and is following instructions for medication and care.
Be sure that all members of your household are washing their hands frequently with soap and hot water or using alcohol-based hand wash.
Wear disposable gloves if you have direct contact with body fluids of a SARS patient. However, the wearing of gloves is not a substitute for good hand hygiene. After contact with body fluids of a SARS patient, remove the gloves, throw them out, and wash your hands. Do not wash or reuse the gloves.
Encourage the person with SARS to cover their mouth and nose with a tissue when coughing or sneezing. If possible, the person with SARS should wear a surgical mask during close contact with other people in the home. If the person with SARS cannot wear a surgical mask, other members of the household should wear one when in the room with that person.
Do not use silverware, towels, bedding, clothing, or other items that have been used by the person with SARS until these items have been washed with soap and hot water.
Clean surfaces (counter or tabletops, door knobs, bathroom fixtures, etc.) that have been contaminated by body fluids (sweat, saliva, mucous, or even vomit or urine) with a household disinfectant used according to the manufacturer's instructions. Wear disposable gloves during all cleaning activities. Throw these out when done. Do not reuse them.
Follow these instructions for 10 days after the sick person's fever and respiratory symptoms have gone away.
If you develop a fever or respiratory symptoms, contact your health care provider immediately and tell him or her that you have had close contact with a SARS patient.

For more information, visit CDC's SARS Web site, or call the CDC public response hotline at (888) 246-2675 (English), (888) 246-2857 (Español), or (866) 874-2646 (TTY)


3.) Severe Acute Respiratory Syndrome - Press briefing
Source: www.who.int/

Wednesday, 2 April, 08:30 Palais des Nations

World Health Organization

Dr David Heymann, Executive Director, Communicable Diseases
Dr Guenael Rodier, Director, Communicable Disease Surveillance and Response
Mr Dick Thompson, Communications Officer

Mr Dick Thompson
This will be an abbreviated press briefing. You will have an opportunity to ask a few questions, but not many. The reason is that they are getting on a flight to attend Carlo Urbani's funeral in Italy.

Statement from Dr David Heymann
Good morning. Thank you for coming this morning. We have two different types of information to offer to you this morning. The first is that China is now a full partner with WHO. The teams have been asked to immediately go to Guangdong. Guangdong has reported the number of cases that have occurred during the month of March, which is 361 cases and 9 deaths, which mean that the epidemic is still going on in Guangdong, and they have promised that later today they will provide all of the information that they have obtained from their national disease surveillance system looking for SARS. So we are very pleased to announce that China is now a full partner with other international partners, in fact with the rest of the world, in collaborating on stopping this epidemic and in finding out the various aspects that we need to find out.

The second [type of information] is that since control measures have begun in Hong Kong, which began on 15 March, just after we made our announcement, and in other parts of the world, control measures have been successful in stopping the disease. For example, in Viet Nam the disease has been stopped we believe. In Singapore and Toronto, activities are going on and they are having good success.

I would like to focus now on Hong Kong, however, where since 15 March there have been 9 people, travellers, tourists or businessmen, from Beijing, from Taiwan, and from Singapore, who have returned home from Hong Kong infected with SARS. In addition in Hong Kong, they have found that transmission does not seem to be only by close contact from person to person. It appears that there is something in the environment that is transferring virus, which is serving as a vehicle to transfer the virus from one person to another. We do not believe this is the air. We believe that it is something else in the environment and we have talked about that in past press conferences. It is possibly an object that people are touching and getting infected from, where there has been a SARS patient who has coughed, or possibly a sewage system or a water system or some type of environmental vehicle that takes the virus from a sick person to others. So we see clusters of cases where there is one case, for example, living in an apartment building, where other people in that apartment building have been infected.

So for these two reasons, because of the fact that we do not completely understand the means of transmission in Hong Kong, and because since the 15 March tourists and businessmen have returned from Hong Kong to their countries with infection, we have decided to make a recommendation that people who are planning travel to both Hong Kong and Guangdong, which as you know is adjacent to Hong Kong, consider postponing their travel until another time. We will be working daily with the Hong Kong authorities, and we have daily conference calls with them and now we will begin also with Guangdong authorities, to determine if there are any reasons that we can stop that recommendation. In other words, the recommendation will be reevaluated every day and we will make a decision every day whether or not that needs to be changed. So now what we have is from all sites where there is a SARS outbreak that is causing chains of transmission, we have requested that tourists or travellers understand about the disease, that airports screen passengers who are returning to their countries from these sites, and now, in addition, we are telling travellers who are planning to go to Hong Kong and Guangdong that they consider postponing their travel. So what we have is a system in place now which will, we hope, stop the spread from the sites where SARS is occurring internationally and at the same time help passengers, tourists or businessmen who are planning to go to Hong Kong or Guangdong decide better whether or not they should go. We are recommending that they reconsider their travel plans and postpone if possible their travel to Hong Kong or Guangdong.

Dr Guenael Rodier
Clearly Guangdong and Hong Kong are the two largest foci for infection, two foci where transmission is documented to be ongoing, and two foci where more investigation is required to get the full picture of what is going on in terms of transmission and the exact size of the event.

Questions and answers.

Q. You say that travellers should consider postponing their travel. Do you have a scale of travel advice for this? Is it code red, code B, code C? Is there an absolute prohibition?

A. Dr David Heymann: WHO has a book of International travel and health and we recommend various ways of preventing disease to passengers or travellers internationally when they go to a country. When they go to a country they look in the book and they decide what to do. Most of the diseases that are in the book have either a vaccine or a drug, so we recommend a vaccine or a drug. This is the first time that we have recommended people avoid an area and this is of course because we do not understand the disease completely, because there’s no vaccine and there’s no drug. So this is the first time that we have made this type of a recommendation in recent years to avoid an area because of a disease.

Q. During your consultation with the Hong Kong authorities, what was their reaction to your decision to declare Hong Kong an area of restriction?

A. Dr David Heymann: We have been discussing on a regular basis with Hong Kong authorities and of course no one wants to have a travel recommendation that recommends people not come to their place. But they have accepted this and they are working very hard now to better understand the situation. As they have been right along. We are very confident that Hong Kong will be able to, in a very few days, understand what is going on and then therefore be better able to control the outbreak there.

Q. You explained the two reasons why you are advising travellers to avoid Hong Kong. But for the second reason, about environmental factors, does that also apply to Guangdong?

A. Dr David Heymann: Guangdong, the recommendation has been made because we do not understand yet what is going on in Guangdong. We have put in a maximum level of recommendations, the same as we have for Hong Kong where we know what is going on. As we understand what is going on in Guangdong, we will know that the epidemic is continuing, we know that there were 361 cases in just the past month. So therefore we do not know anything more than that at present, but because we do not know we are making this recommendation.

Q. How and when will you release this recommendation? Do you have the exact wording?

A. Dr David Heymann: Yes, it will come out later today.

Q. How likely is it now that it spills over into other countries [note added to transcript: or areas] in the region, for example, Taiwan?

A. Dr David Heymann: Taiwan actually has had 1, 2, 3, 4, 5, businessmen [note added to transcript: 4 businessmen and 1 businesswoman] return from Hong Kong since the 19th of March [note added to transcript: 15 March] with what’s been reported as probable cases of SARS, but remember we don’t have a diagnostic test. We have no confirmed cases.

Q. Yes, Dr Heymann, can you explain a little bit about the process prior to issuing this advice? While it probably makes sense from the health perspective, it will have economic, social, political impact in the region. I’m wondering if you have consent from authorities in Guangdong, Hong Kong, or China?

A. Dr David Heymann: We’ve spoken first of all with IATA, which is the International Air Transport Association, and they have understood this and they have acknowledged that this is the recommendation which should be made at this point [for public health reasons]. We’ve discussed with the various different countries in the region, with our regional office and through our regional office, and we find that in those countries there are already much more strict recommendations than this is. For example, in Thailand, the government has announced that all [Thai nationals] returning from Hong Kong will be quarantined. So we understand that there are very serious measures already being taken in many countries. So we made this decision with countries, with WHO and, more importantly, with our expert group of advisers on travel and health. We’ve spoken with many of our advisers, you know we have various advisers around the world, we have talked with them as well. And through all of these discussions, which went on all day yesterday and the day before, we’ve come to this conclusion.

Q. So officially, Guangdong, Hong Kong and perhaps even Beijing – interjection from Dr Heymann: Beijing has no …, we have made no recommendation for Beijing.

Q. (continued) I’m talking about the Chinese government, the Guangdong local officials.

A. Dr David Heymann: Yes, they’ve been informed by our WHO office yesterday that we will be making this, as has Hong Kong.

Q. Historically, can you explain us when was the last time WHO issued such a thing? And on what occasion? And why?

A. Dr David Heymann: I can’t give you that answer right now, if WHO has ever done that, but we will find that out and we’ll let you know. I can’t tell you in the last …, as far as I know, this is the only time that this has ever been done, but I can’t tell you for sure, so I shouldn’t be quoted on that.

Q. In recent years?

A. Dr David Heymann: In recent years, this is the first time that this has been done, at least in the past 12-13 years.

Q. But can we get, I’m sorry, can we get later on today some information on this?

A. Yes.

Q. For those people who have to be in Hong Kong in the next few days, so what would you recommend?

A. Dr David Heymann: Our recommendation is that if it’s possible to postpone, they should consider it. But we don’t make any rules or regulations, that’s up to countries to make. So we are saying that there is still unknown information in Hong Kong, that tourists and businessmen appear to still be getting infected, the most recent on 25th March. And so we are therefore recommending that travel be postponed if it’s possible. If it’s not possible for business reasons, then that will have to go into consideration. But it’s a personal decision.

Q. For foreigners who are already in Hong Kong travelling, do you have any recommendation?

A. Dr David Heymann: No.

Q. How do you react to the Swiss government decision that Asian people cannot participate in the Basle Watch Fair?

A. Dr David Heymann: Those governments …, those decisions are made nationally. All we do is give out recommendations to governments. So I can’t comment on the decision of the Swiss government. You’ll have to ask the Swiss authorities why they’ve made that decision.

Q. Do you find it efficient, or wise or too much?

A. Dr David Heymann: I think that’s up to the government to say.

Closing comments? OK. Thank you.


4.) Dr. Carlo Urbani of the World Health Organization dies of SARS
Source: www.who.int/

29 March 2003

Dr. Carlo Urbani, an expert on communicable diseases, died today of SARS. Dr. Urbani, worked in public health programs in Cambodia, Laos and Viet Nam. He was based in Hanoi, Viet Nam. Dr. Urbani was 46.

Dr. Urbani was the first WHO officer to identify the outbreak of this new disease, in an American businessman who had been admitted to a hospital in Hanoi. Because of his early detection of the disease, global surveillance was heightened and many new cases have been identified and isolated before they infected hospital staff. In Hanoi, the SARS outbreak appears to be coming under control.

“Carlo was a wonderful human being and we are all devastated,” said Pascale Brudon, the World Health Representative in Viet Nam. “He was very much a doctor, his first goal was to help people. Carlo was the one who very quickly saw that this was something very strange. When people became very concerned in the hospital, he was there everyday, collecting samples, talking to the staff and strengthening infection control procedures.”

Dr. Urbani was married and the father of three children.

Dr. Urbani received his medical degree from the University of Ancona, Italy, and did post-graduate work in malaria and medical parasitology. He was an expert in the parasitic diseases of schoolchildren. He was also a president of Médecins Sans Frontières-Italy.

“Carlo Urbani’s death saddens us all deeply at WHO,” said Dr. Gro Harlem Brundtland, WHO’s Director-General. “His life reminds us again of our true work in public health. Today, we should all pause for a moment and remember the life of this outstanding physician.”

 

5.) Cumulative Number of Reported Cases of Severe Acute Respiratory Syndrome (SARS) Source: www.who.int/ From: 1 Nov 20021 To: 3 Apr 2003, 17:00 GMT+2   Country Cumulative number of case(s) Number of deaths Local chain(s) of transmission2 Australia  1  0  None Belgium  1  0  None Brazil 1 0  None Canada  62  6  Yes China  1190  46  Yes China, Hong Kong Special Administrative Region  734  17*  Yes China, Taiwan  14  0  Yes France  3  0  None Germany  5  0  None Italy  3  0  None Republic of Ireland  1  0  None Romania  1  0  None Singapore  98  4  Yes Switzerland  2  0  None Thailand  7  2  None United Kingdom  3  0  None United States  85§  0  Being determined Viet Nam  59  4  Yes Total 2270 79   Notes: Cumulative number of cases includes number of deaths. As SARS is a diagnosis of exclusion, the status of a reported case may change over time. This means that previously reported cases may be discarded after further investigation and follow-up. 1. The start of the period of surveillance has been changed to 1 November 2002 to capture cases of atypical pneumonia in China that are now recognized as being cases of SARS. 2. National public health authorities report to WHO on the areas in which local chain(s) of transmission is/are occurring. These areas are provided on the list of Affected Areas. §Due to differences in the case definitions being used at a national level, probable cases are reported by all countries except the United States of America, which is reporting suspect cases under investigation. *One death attributed to Hong Kong Special Administrative Region of China occurred in a case medically transferred from Viet Nam.

6.) Update 20 - Situation in China and Hong Kong SAR
Source: www.who.int/
3 April 2003

WHO team arrives in Guangdong Province
The WHO team of experts arrived in Guangdong Province, China today and immediately started its work. The team was authorized to travel to the province yesterday.

Meetings were held today with senior provincial health officials. The WHO team also listened to reports about the SARS outbreak, and held initial meetings with health workers at all levels. These workers, who have first-hand knowledge of the outbreak, include epidemiologists and clinicians treating SARS patients. Discussion focused on patterns of transmission, clinical profiles, and the suspected causative agent.

Chinese authorities had previously reported a cumulative total of 1153 cases and 40 deaths in Guangdong Province from 16 November, when the outbreak began, to the end of March, making this province the area most seriously affected by SARS to date.

The world’s first recognized case of SARS occurred in Guangdong Province on 16 November. Expectations are high that important clues will emerge concerning the origins of SARS, which is thought to be caused by a new virus in the coronavirus family. The exact identity of the virus has proved elusive. Scientists, who confer daily in teleconferences organized by WHO, currently speculate that the SARS virus either jumped to humans from an animal species or mutated into a more virulent form.

In its continuing work, the WHO team is expected to visit Foshan city, where the first case of SARS was reported, and Guangzhou city. The team will also visit health care facilities, review case records, and hold further discussions before returning to Beijing early next week.

In Beijing, the government of China is now gearing up to fight SARS on a priority basis. Reports in today’s media referred to a State Council executive meeting on SARS and described three key decisions.

A special task force, headed by Minister of Health Dr Zhang Wenkang, will take charge of the fight against SARS. A vice secretary-general of the State Council will coordinate actions by relevant ministries.
The task force will provide updates on SARS to WHO.
A nationwide mechanism for outbreak alert and response will be set up shortly to ensure rapid detection and reporting of outbreaks.
Dr Zhang appeared on Chinese national TV to address SARS-related issues.

Situation in Hong Kong SAR
The Department of Health in Hong Kong SAR reported 26 new cases today, compared with 23 yesterday. These figures represent a significant decline from the 155 cases reported on Tuesday and 60 reported on Monday. This trend suggests that the extraordinary control measures undertaken by the government are working. The Department of Health further announced that 89 SARS patients have been discharged from hospitals.

Update on cases and countries
As of today, a cumulative total of 2270 SARS cases and 79 deaths have been reported from 16 countries. This represents an increase of 47 cases and 1 death (in Hong Kong) compared with yesterday.

With the addition of the first probable case in Brazil, SARS is now being reported on four continents.

New cases were reported in Canada (4), Hong Kong (26), Taiwan, China (1), France (2), Singapore (3), the United States of America (13), and Viet Nam (1). Brazil reported their first probable case. Two of Romania’s three reported cases, one of the two cases in the Republic of Ireland, and the single case in Spain were removed from the list when determined to have other causes.


7.) Update 18 - SARS outbreak:WHO investigation team moves to China, new travel advice announced [WHO PRESS RELEASE]
Source: www.who.int/

PRESS RELEASE ISSUED BY WHO
2 April 2003

The World Health Organization (WHO) today said that the Government of China had announced the WHO expert team currently in Beijing will travel to Guangdong Province to investigate the SARS outbreak there.

“These are very positive steps taken today by China,” said Dr David Heymann, Executive Director of Communicable Diseases at WHO. “As a result we’ll be able to gather even more evidence about the nature of the SARS outbreak in China.”

In addition, WHO began recommending that persons travelling to Hong Kong Special Administrative Region and Guangdong Province, China consider postponing all but essential travel. This updated travel advice comes as a result of new developments, particularly in Hong Kong, in the multi-country outbreak of Severe Acute Respiratory Syndrome (SARS).

This temporary recommendation will be reassessed daily as the epidemic evolves. The recommendation does not apply to passengers simply transiting through airports in Hong Kong Special Administrative Region or Guangdong Province, China.

The new travel advisory is intended to limit the spread of SARS by reducing travel to high risk areas. All other elements ofSevere Acute Respiratory Syndrome (SARS) WHO previous travel guidance still stand. See Severe Acute Respiratory Syndrome (SARS).

The SARS situation in Hong Kong Special Administrative Region, China has developed unique features. There is a continuing and significant increase in cases* with indications that SARS has spread beyond the initial focus in hospitals. These developments raise questions related to other possible routes of transmission of SARS. These may involve transport of the virus from one person to another via some type of environmental means. To date, no satisfactory explanation has been found regarding this possibility. Also, since March 19, nine travellers have been identified as SARS cases on returning from a visit to Hong Kong Special Administrative Region of China.

Many questions about the state of the outbreak in Guangdong Province, China which borders Hong Kong have yet to be answered. The Guangdong outbreak is the largest reported and has also shown evidence of spread in the wider community. New information provided today by provincial authorities of more than 300 new cases in March alone indicates the outbreak there continues.

Unprecedented global cooperation helps advance knowledge and containment of SARS

In the four weeks that WHO has been tracking SARS much has been learned. This is largely because scientists, clinicians, laboratory chiefs and public health officials everywhere have collaborated closely.

As a result of WHO's global alert issued on 15 March, national authorities have implemented heightened surveillance for cases of SARS. While an increasing number of countries are reporting new cases, these cases are quickly identified, patients are isolated and local transmission is stopped in most countries.

It is now known that infection control methods work to contain the spread of SARS in hospitals, even in countries which do not have the most modern equipment.

WHO and a network of 11 of the world's top laboratories are zeroing in on the cause of SARS and a diagnostic test is being developed. This test will help distinguish between those who are infected and those who are free of the SARS virus.

The laboratory network is continuing its investigations. So far, the agent causing SARS has not been fully characterized and there is no certain treatment, vaccine or known other preventative measure.

"There will be other new diseases that will emerge in the future, and we will respond just as we have with SARS — with maximum efforts to contain its spread," stated Dr Guénaël Rodier, Director, Communicable Disease Surveillance and Response, WHO.

* Cases of SARS and the countries in which they appear are posted on the WHO web site every evening in Geneva.


 8.) SEVERE ACUTE RESPIRATORY SYNDROME, Frequently Asked Questions

SOURCE: www.cdc.gov/

April 1, 2003, 9:30 AM EST

CDC has developed responses to many of the most commonly asked questions about severe acute respiratory syndrome (SARS). The responses are listed under the topics below and will be updated as new information becomes available.

GENERAL INFORMATION

The Illness
Spread of SARS
Cause of SARS
The Outbreak
Travel and Quarantine
Other
PREVENTION AND CONTROL: CDC RECOMMENDATIONS

Personal and Household
Health Care Setting
Travel and Quarantine

The Illness

What is SARS?
SARS is a respiratory illness that has recently been reported in Asia, North America, and Europe. For additional information, check the World Health Organization’s (WHO) SARS Web site or visit other pages on CDC’s SARS Web site.

What are the symptoms and signs of Severe Acute Respiratory Syndrome (SARS)?
The illness usually begins with a fever (measured temperature greater than 100.4°F [>38.0°C]). The fever is sometimes associated with chills or other symptoms, including headache, general feeling of discomfort, and body aches. Some people also experience mild respiratory symptoms at the outset.

After 2 to 7 days, SARS patients may develop a dry, nonproductive cough that might be accompanied by or progress to the point where insufficient oxygen is getting to the blood. In 10% to 20% of cases, patients will require mechanical ventilation. For more information, see the MMWR dispatch.

If I were exposed to SARS, how long would it take for me to become sick?
The incubation period for SARS is typically 2-7 days; however, isolated reports have suggested an incubation period as long as 10 days. The illness usually begins with a fever (>100.4°F [>38.0°C]) (see signs and symptoms, above).

What medical treatment is recommended for patients with SARS?
CDC currently recommends that patients with SARS receive the same treatment that would be used for any patient with serious community-acquired atypical pneumonia of unknown cause. Several treatment regimens have been used for patients with SARS, but there is insufficient information at this time to determine if they have had a beneficial effect. Reported therapeutic regimens have included antibiotics to presumptively treat known bacterial agents of atypical pneumonia. Therapy also has included antiviral agents such as oseltamivir or ribavirin. Steroids also have been administered orally or intravenously to patients in combination with ribavirin and other antimicrobials. For more information on SARS, see "Interim Information and Recommendations for Health Care Providers" on CDC's SARS web site.


Spread of SARS

How is SARS spread?
The principal way SARS appears to be spread is through droplet transmission; namely, when someone sick with SARS coughs or sneezes droplets into the air and someone else breathes them in. It is possible that SARS can be transmitted more broadly through the air or from objects that have become contaminated.

How long is a person with SARS infectious to others?
Information to date suggests that people are most likely to be infectious when they have symptoms, such as fever or cough. However, it is not known how long before or after their symptoms begin that patients with SARS might be able to transmit the disease to others.

Who is most at risk of contracting SARS?
Cases of SARS continue to be reported primarily among people who have had direct close contact with an infected person, such as those sharing a household with a SARS patient and health care workers who did not use infection control procedures while caring for a SARS patient. In the United States, there is no indication of community transmission at this time. CDC continues to monitor this situation very closely.

Cause of SARS

What is the cause of SARS?
Scientists at CDC and other laboratories have detected a previously unrecognized coronavirus in patients with SARS. While the new coronavirus is still the leading hypothesis for the cause of SARS, other viruses are still under investigation as potential causes.

What are coronaviruses?
Coronaviruses are a group of viruses that have a halo or crown-like (corona) appearance when viewed under a microscope. These viruses are a common cause of mild to moderate upper-respiratory illness in humans and are associated with respiratory, gastrointestinal, liver and neurologic disease in animals. Coronaviruses can survive in the environment for as long as three hours.

What evidence is there to suggest that coronaviruses may be linked with SARS?
CDC scientists were able to isolate a virus from the tissues of two patients who had SARS and then used several laboratory methods to characterize the agent. Examination by electron microscopy revealed that the virus had the distinctive shape and appearance of coronaviruses. Tests of serum specimens from patients with SARS showed that the patients appeared to have recently been infected with this coronavirus. Other tests demonstrated that coronavirus was present in a variety of clinical specimens from patients, including nose and throat swabs. In addition, genetic analysis suggests that this new virus belongs to the family of coronaviruses but differs from previously identified coronaviruses. These laboratory results do not provide conclusive evidence that the new coronavirus is the cause of SARS. Additional specimens are being tested to learn more about this coronavirus and its link with SARS.

If coronaviruses usually cause mild illness in humans, how could this new coronavirus be responsible for a potentially life-threatening disease such as SARS?
There is not enough information about the new virus to determine the full range of illness that it might cause. Coronaviruses have occasionally been linked to pneumonia in humans, especially people with weakened immune systems. The viruses can also cause severe disease in animals, including cats, dogs, pigs, mice, and birds.

Has new information about coronavirus changed the recommendations for medical treatment for patients with SARS?
The possibility that coronavirus is the cause of SARS has not changed treatment recommendations. The new coronavirus is being tested against various antiviral drugs to see if an effective treatment can be found.

Is there a test for SARS?
No "test" is available yet for SARS; however, CDC, in collaboration with WHO and other laboratories, has developed 2 research tests that appear to be very promising in detecting antibodies to the new coronavirus. CDC is working to refine and share this testing capability as soon as possible with laboratories across the United States and internationally.

What about reports from other laboratories suggesting that the cause of SARS may be a paramyxovirus?
Researchers from several laboratories participating in the WHO network have reported the identification of a paramyxovirus in clinical specimens from SARS patients. These laboratories are still investigating the possibility that a paramyxovirus is a cause of SARS.

The Outbreak

How many cases of SARS have been reported so far?
Visit WHO's SARS page for daily updates on case reports in the United States and other countries. To date, most of the cases have been reported from China.

How many people have died from SARS?
Visit WHO's SARS page for a daily update of SARS cases and deaths.

What is CDC doing to combat this health threat?
CDC is working closely with WHO and other partners as part of a global collaboration to address the SARS outbreak. For its part in this international effort, CDC has taken the following actions:

Activated its Emergency Operations Center to provide round-the-clock coordination and response.
Committed more than 160 infectious disease experts and support staff to work on the SARS response.
Deployed medical officers, epidemiologists, and other specialists to assist with on-site investigations around the world.
Provided ongoing assistance to state and local health departments in investigating possible cases of SARS in the United States.
Issued multiple notices providing guidance on ways to minimize the risk for SARS in health care facilities, in the household, when traveling, and in other settings.
Conducted extensive laboratory testing of clinical specimens from SARS patients to identify the cause of the disease.
Initiated a system for distributing health alert notices to travelers who may have been exposed to cases of SARS.
As always, CDC is committed to communicating regularly and effectively with public health professionals, elected leaders, clinicians, and the general public.


Travel and Quarantine

What are CDC's quarantine officials doing to prevent and control the spread of SARS?
CDC's quarantine inspectors or their designees are distributing health alert cards (http://www.cdc.gov/ncidod/sars/travel_alert.htm) to air passengers returning in airplanes either directly or indirectly to the United States from China, Singapore, and Vietnam. The notices ask travelers to monitor their health for 10 days and to see a doctor if they get a fever with a cough or have difficulty breathing. CDC distributes approximately 15,000 health alert notices each day to air travelers returning from the affected regions at 23 ports of entry. Inspectors also are boarding airplanes if a traveler has been reported with symptoms matching the case definition of SARS.

The World Health Organization (WHO) has recommended procedures http://www.who.int/csr/sars/travel/en/ for pre-departure screening of airline passengers from some countries for respiratory illnesses or other symptoms of SARS.

What information about SARS is being provided to people traveling on ships?
SARS information contained on CDC's health alert cards is being provided by the major shipping associations and the International Council of Cruise Lines to people traveling on cargo ships and cruise ships at U.S. ports. Inspectors also are boarding ships if a passenger or crew member has been reported with symptoms matching the case definition of SARS.

What does a quarantine inspector do?
Quarantine inspectors serve as important guardians of health at borders and ports of entry into the United States. They routinely respond to illness in arriving passengers and ensure that the appropriate medical action is taken.

What is considered routine health inspections of airplanes or ships versus what is happening now?
Routine health inspections consist of working with airline, cargo ship, and cruise ship companies to protect passengers and crew from certain infectious diseases. Quarantine inspectors meet arriving aircraft and ships reporting ill passengers and/or crew (as defined in the foreign quarantine regulations [pdf]) and assist them in getting appropriate medical treatment.

What is the risk to individuals who may have shared a plane or boat trip with a suspected SARS patient?
Cases of SARS continue to be reported primarily among persons who have had direct close contact with an infected person, such as those sharing a household with a SARS patient and health care workers who did not use infection control procedures while attending to a SARS patient. SARS has also occurred among air travelers, primarily travelers to and from Hong Kong, Hanoi, Singapore, and mainland China.

CDC is requesting locating information from travelers who are on flights with people suspected of having SARS. CDC, with the help of state and local health authorities, is attempting to follow-up with these travelers for 14 days to make sure no one develops symptoms consistent with SAR

Who actually notifies quarantine officials of potential SARS cases? Is it the crew of the airplane or ship? The passengers?
Under foreign quarantine regulations, the master of a ship or captain of an airplane coming into the United States from a foreign port is required by law to report certain illnesses among passengers. The illness must be reported to the nearest quarantine official. If possible, the crew of the airplane or ship will try to relocate the ill passenger or crew member away from others. If the passenger is only passing through a port of entry on his/her way to another destination, port health authorities may refer the passenger to a local health authority for assessment and care.

If I'm on board an airplane or ship with someone suspected of having SARS, will I be allowed to continue to my destination?
CDC does not currently recommend that the onward travel of healthy passengers be restricted in the event that a passenger or crew member suspected of having SARS is removed from the ship or airplane by port health authorities. All passengers and crew members may be advised by port health authorities to seek medical attention if they develop SARS symptoms.

What does a quarantine official do if a passenger is identified as meeting the case definition for suspected SARS?
Quarantine officials arrange for appropriate medical assistance to be available when the airplane lands or the ship docks, including medical isolation. Isolation is important not only for the sick passenger's comfort and care but also for the protection of members of the public. Isolation is recommended for travelers with suspected cases of SARS until appropriate medical treatment can be provided or until they are no longer infectious.

What does a quarantine official do if a passenger identified as meeting the case definition for suspected SARS refuses to be isolated?
Many levels of government (Federal, State, and local) have basic authority to compel isolation of sick persons to protect the public. In the event that it is necessary to compel isolation of a sick passenger, CDC will work with appropriate State and local officials to ensure that the passenger does not infect others.

Other

Is there any reason to think SARS is or is not related to terrorism?
Information currently available about SARS indicates that people who appear to be most at risk are either health care workers taking care of sick people or family members or household contacts of those who are infected with SARS. That pattern of transmission is what would typically be expected in a contagious respiratory or flu-like illness.

CDC RECOMMENDATIONS

Personal and Household

What should I do if I think I have SARS?
If you are ill with a fever of over 100.4°F [>38.0°C] that is accompanied by a cough or difficulty breathing or that progresses to a cough and/or difficulty breathing, you should consult a health care provider. To help your health care provider make a diagnosis, tell him or her about any recent travel to regions where cases of SARS have been reported and whether you were in contact with someone who had these symptoms.

What has CDC recommended to prevent transmission of SARS in households?
CDC has developed interim infection control recommendations available at http://www.cdc.gov/ncidod/sars/ic-closecontacts.htm for patients with suspected SARS in the household. The basic precautions outlined in this document include the following:

Infection control precautions should be continued for SARS patients for 10 days after respiratory symptoms and fever are gone. SARS patients should limit interactions outside the home and should not go to work, school, out-of-home day care, or other public areas during the 10-day period.
During this 10-day period, all members of the household with a SARS patient should carefully follow recommendations for hand hygiene, such as frequent hand washing or the use of alcohol-based hand rubs.
Each patient with SARS should cover his or her mouth and nose with a tissue before sneezing or coughing. If possible, a person recovering from SARS should wear a surgical mask during close contact with uninfected persons. If the patient is unable to wear a surgical mask, other people in the home should wear one when in close contact with the patient.
Disposable gloves should be considered for any contact with body fluids from a SARS patient. However, immediately after activities involving contact with body fluids, gloves should be removed and discarded, and hands should be washed. Gloves should not be washed or reused, and are not intended to replace proper hand hygiene.
SARS patients should avoid sharing eating utensils, towels, and bedding with other members of the household, although these items can be used by others after routine cleaning, such as washing or laundering with soap and hot water.
Common household cleaners are sufficient for disinfecting toilets, sinks, and other surfaces touched by patients with SARS, but the cleaners must be used frequently.
Other members of the household need not restrict their outside activities unless they develop symptoms of SARS, such as a fever or respiratory illness.

CDC RECOMMENDATIONS

Healthcare Settings

What has CDC recommended to prevent transmission of SARS in the health care setting?
Transmission of SARS to health care workers appears to have occurred after close contact with symptomatic individuals before recommended appropriate infection control precautions were implemented. CDC has developed interim infection control recommendations for the management of exposures to SARS in the health care and other institutional settings. Visit http://www.cdc.gov/ncidod/sars/exposureguidance.htm to read these recommendations.

Health care facilities should be vigilant in conducting active surveillance for fever or respiratory symptoms among care givers with unprotected exposure to SARS patients. Health care workers who develop fever or respiratory symptoms during the 10 days following an unprotected exposure to a SARS patient should not report for duty. Such workers should stay home and report symptoms to the appropriate facility point of contact (e.g., infection control or occupational health) immediately. Exclusion from duty should be continued for 10 days after the resolution of fever and respiratory symptoms. During this period, infected workers should avoid contact with people both in the facility and in the community.

Exclusion from duty is not recommended for an exposed health care worker if they do not have fever or respiratory symptoms; however, the worker should report any unprotected exposure to SARS patients to the appropriate facility point of contact immediately.

What precautions should health care facilities follow regarding visits by close contacts of SARS patients?
Close contacts (e.g., family members or other members of the household) of SARS patients are at risk for infection. Health care facilities should implement a system to screen for fever or respiratory symptoms among such contacts who visit the facility. Close contacts with fever or respiratory symptoms should not be allowed to enter the health care facility as visitors and should be educated about this policy. Health care facilities should educate all visitors about use of infection control precautions http://www.cdc.gov/ncidod/sars/www.cdc.gov/ncidod/sars/infectioncontrol.htm when visiting SARS patients and should emphasize the importance of following these precautions.

CDC RECOMMENDATIONS

Travel and Quarantine

Are there any travel restrictions related to SARS?
At this time there are no travel restrictions in place that are directly related to SARS. However, a CDC travel advisory recommends that individuals who are planning nonessential or elective travel to mainland China, Hong Kong, Hanoi, Vietnam, or Singapore may wish to postpone their trip until further notice. For additional information about travel advisories, check CDC's Travelers' Health site, which will be updated as necessary.

What should I do if I have recently traveled to a country where cases of SARS have been reported?
You should monitor your own health for 10 days following your return. If you become ill with a fever of over 100.4°F [>38.0°C] that is accompanied by a cough or difficulty breathing or that progresses to a cough and/or difficulty breathing, you should consult a health care provider. To help your health care provider make a diagnosis, tell him or her about any recent travel to regions where cases of SARS have been reported and whether you were in contact with someone who had these symptoms.

CDC has recommended guidelines for medical aircraft that transport SARS patients. Should commercial airlines also follow these guidelines?
No. This guidance (available at http://www.cdc.gov/ncidod/sars/airtransport-sarspatients.htm) is intended specifically for air medical transport (AMT) service providers that use specialized aircraft to transport SARS patients. It should not be generalized to commercial passenger aircraft. These interim recommendations for AMT are based on standard infection control practices, AMT standards, and epidemiologic information from ongoing investigations of SARS, including experience from transport of 2 patients during this outbreak. Specific guidelines for airline crew and flight personnel of commercial aircrafts are available at http://wwwlink.cdc.gov/ncidod/sars/flight_crew_guidelines.htm. CDC also has developed interim guidance for cleaning of commercial passenger aircraft after a flight with a suspected SARS passenger http://www.cdc.gov/ncidod/sars/aircraftcleanup.htm.

9.) Killer pneumonia: FAQs for travellers to SE Asia

Source: Http://economictimes.indiatimes.com/

[ TUESDAY, APRIL 01, 2003 05:19:48 PM ]
Respiratory Syndrome (SARS) and 15 deaths, out of a global total of more than 1,600 infections and about 60 deaths. The Atlanta-based Centers for Disease Control and Prevention (CDC) has listed a few pointers to combat the killer disease.

What is SARS?

SARS is a respiratory illness that has recently been reported in Asia, North America, and Europe.

Which are the places where travelers are being given health alerts?

Travelers returning from Hong Kong, Guangdong Province, People's Republic of China and Hanoi, Vietnam are being given printed information (health alert notices) that they may have been exposed to cases of severe acute respiratory syndrome (SARS). Travelers are advised to monitor their health for at least seven days, to contact their physicians if they become ill with a fever accompanied by a cough or difficulty in breathing, and to inform their physician of their recent travel.

Are there any travel restrictions related to SARS?

At this time there are no travel restrictions in place that are directly related to SARS. However, a CDC travel advisory recommends that individuals who are planning nonessential or elective travel to mainland China, Hong Kong, Hanoi, Vietnam, or Singapore may wish to postpone their trip until further notice.

What is the risk to individuals who may have shared a plane or boat trip with a suspected SARS patient?

Cases of SARS continue to be reported primarily among persons who have had direct close contact with an infected person, such as those sharing a household with a SARS patient and health care workers who did not use infection control procedures while attending to a SARS patient. SARS has also occurred among air travelers, primarily travelers to and from Hong Kong, Hanoi, Singapore, and mainland China.

.
Additionally, global health agencies are attempting to follow-up with travelers who shared flights with people suspected of having SARS. They are being kept under observation for 14 days to make sure no one develops symptoms consistent with SAR.

What are the symptoms and signs of Severe Acute Respiratory Syndrome (SARS)?

The illness usually begins with a fever (measured temperature greater than 100.4°F [>38.0°C]). The fever is sometimes associated with chills or other symptoms, including headache, general feeling of discomfort, and body aches. Some people also experience mild respiratory symptoms at the outset.

After 2 to 7 days, SARS patients may develop a dry, nonproductive cough that might be accompanied by or progress to the point where insufficient oxygen is getting to the blood. In 10% to 20% of cases, patients will require mechanical ventilation.

If I were exposed to SARS, how long would it take for me to become sick?

The incubation period for SARS is typically 2-7 days; however, isolated reports have suggested an incubation period as long as 10 days. The illness usually begins with a fever (>100.4°F [>38.0°C]).

What medical treatment is recommended for patients with SARS?

It is recommended that patients with SARS receive the same treatment that would be used for any patient with serious community-acquired atypical pneumonia of unknown cause. Several treatment regimens have been used for patients with SARS, but there is insufficient information at this time to determine if they have had a beneficial effect.

Reported therapeutic regimens have included antibiotics to presumptively treat known bacterial agents of atypical pneumonia. Therapy also has included antiviral agents such as oseltamivir or ribavirin. Steroids also have been administered orally or intravenously to patients in combination with ribavirin and other antimicrobials.

How is SARS spread?

The principal way SARS appears to be spread is through droplet transmission; namely, when someone sick with SARS coughs or sneezes droplets into the air and someone else breathes them in. It is possible that SARS can be transmitted more broadly through the air or from objects that have become contaminated.

How long is a person with SARS infectious to others?

Information to date suggests that people are most likely to be infectious when they have symptoms, such as fever or cough. However, it is not known how long before or after their symptoms begin that patients with SARS might be able to transmit the disease to others.

Who is most at risk of contracting SARS?

Cases of SARS continue to be reported primarily among people who have had direct close contact with an infected person, such as those sharing a household with a SARS patient and health care workers who did not use infection control procedures while caring for a SARS patient. In the United States, there is no indication of community transmission at this time.

What is the cause of SARS?

Scientists have detected a previously unrecognized coronavirus in patients with SARS. While the new coronavirus is still the leading hypothesis for the cause of SARS, other viruses are still under investigation as potential causes.

What are coronaviruses?

Coronaviruses are a group of viruses that have a halo or crown-like (corona) appearance when viewed under a microscope. These viruses are a common cause of mild to moderate upper-respiratory illness in humans and are associated with respiratory, gastrointestinal, liver and neurologic disease in animals. Coronaviruses can survive in the environment for as long as three hours.

What evidence is there to suggest that coronaviruses may be linked with SARS?

Scientists were able to isolate a virus from the tissues of two patients who had SARS and then used several laboratory methods to characterize the agent. Examination by electron microscopy revealed that the virus had the distinctive shape and appearance of coronaviruses. Tests of serum specimens from patients with SARS showed that the patients appeared to have recently been infected with this coronavirus. Other tests demonstrated that coronavirus was present in a variety of clinical specimens from patients, including nose and throat swabs.

In addition, genetic analysis suggests that this new virus belongs to the family of coronaviruses but differs from previously identified coronaviruses. These laboratory results do not provide conclusive evidence that the new coronavirus is the cause of SARS. Additional specimens are being tested to learn more about this coronavirus and its link with SARS.

If coronaviruses usually cause mild illness in humans, how could this new coronavirus be responsible for a potentially life-threatening disease such as SARS?

There is not enough information about the new virus to determine the full range of illness that it might cause. Coronaviruses have occasionally been linked to pneumonia in humans, especially people with weakened immune systems. The viruses can also cause severe disease in animals, including cats, dogs, pigs, mice, and birds.

Has new information about coronavirus changed the recommendations for medical treatment for patients with SARS?

The possibility that coronavirus is the cause of SARS has not changed treatment recommendations. The new coronavirus is being tested against various antiviral drugs to see if an effective treatment can be found.

Is there a test for SARS?

No "test" is available yet for SARS; however, Atlanta-based Centers for Disease Control and Prevention (CDC), in collaboration with the World Health Organisation (WHO) and other laboratories, has developed 2 research tests that appear to be very promising in detecting antibodies to the new coronavirus. CDC is working to refine and share this testing capability as soon as possible with laboratories across the United States and internationally.

What about reports from other laboratories suggesting that the cause of SARS may be a paramyxovirus?

Researchers from several laboratories participating in the WHO network have reported the identification of a paramyxovirus in clinical specimens from SARS patients. These laboratories are still investigating the possibility that a paramyxovirus is a cause of SARS.

What are quarantine officials doing to prevent and control the spread of SARS?

Quarantine inspectors or their designees are distributing health alert cards (http://www.cdc.gov/ncidod/sars/travel_alert.htm) to air passengers returning in airplanes either directly or indirectly to the United States from China, Singapore, and Vietnam. The notices ask travelers to monitor their health for 10 days and to see a doctor if they get a fever with a cough or have difficulty breathing.

CDC distributes approximately 15,000 health alert notices each day to air travelers returning from the affected regions at 23 ports of entry. Inspectors also are boarding airplanes if a traveler has been reported with symptoms matching the case definition of SARS.

The World Health Organization (WHO) has recommended procedures http://www.who.int/csr/sars/travel/en/ for pre-departure screening of airline passengers from some countries for respiratory illnesses or other symptoms of SARS.

What information about SARS is being provided to people traveling on ships?

SARS information contained on health alert cards is being provided by the major shipping associations and the International Council of Cruise Lines to people traveling on cargo ships and cruise ships at international ports. Inspectors also are boarding ships if a passenger or crew member has been reported with symptoms matching the case definition of SARS.

Which travelers are being given health alerts?

Travelers returning from Hong Kong, Guangdong Province, People's Republic of China and Hanoi, Vietnam are being given printed information (health alert notices) that they may have been exposed to cases of severe acute respiratory syndrome (SARS). Travelers are advised to monitor their health for at least seven days, to contact their physicians if they become ill with a fever accompanied by a cough or difficulty in breathing, and to inform their physician of their recent travel.

What does a quarantine inspector do?

Quarantine inspectors serve as important guardians of health at borders and ports of entry into the United States. They routinely respond to illness in arriving passengers and ensure that the appropriate medical action is taken.

What is considered routine health inspections of airplanes or ships versus what is happening now?

Routine health inspections consist of working with airline, cargo ship, and cruise ship companies to protect passengers and crew from certain infectious diseases. Quarantine inspectors meet arriving aircraft and ships reporting ill passengers and/or crew and assist them in getting appropriate medical treatment.

Who actually notifies quarantine officials of potential SARS cases? Is it the crew of the airplane or ship? The passengers?

Under foreign quarantine regulations, the master of a ship or captain of an airplane coming into the United States from a foreign port is required by law to report certain illnesses among passengers. The illness must be reported to the nearest quarantine official. If possible, the crew of the airplane or ship will try to relocate the ill passenger or crew member away from others.

If the passenger is only passing through a port of entry on his/her way to another destination, port health authorities may refer the passenger to a local health authority for assessment and care.

If I'm on board an airplane or ship with someone suspected of having SARS, will I be allowed to continue to my destination?

Even if a passenger or crew member -- suspected of having SARS -- is removed from the ship or airplane by port health authorities, global health agencies are not currently recommending that the onward travel of healthy passengers be restricted. All passengers and crew members may be advised by port health authorities to seek medical attention if they develop SARS symptoms.

What does a quarantine official do if a passenger is identified as meeting the case definition for suspected SARS?

Quarantine officials arrange for appropriate medical assistance to be available when the airplane lands or the ship docks, including medical isolation. Isolation is important not only for the sick passenger's comfort and care but also for the protection of members of the public. Isolation is recommended for travelers with suspected cases of SARS until appropriate medical treatment can be provided or until they are no longer infectious.

What should I do if I think I have SARS?

If you are ill with a fever of over 100.4°F [>38.0°C] that is accompanied by a cough or difficulty breathing or that progresses to a cough and/or difficulty breathing, you should consult a health care provider. To help your health care provider make a diagnosis, tell him or her about any recent travel to regions where cases of SARS have been reported and whether you were in contact with someone who had these symptoms.

How does one prevent transmission of SARS in households?

CDC has developed interim infection control recommendations available at http://www.cdc.gov/ncidod/sars/ic-closecontacts.html for patients with suspected SARS in the household. The basic precautions outlined in this document include the following:

" Infection control precautions should be continued for SARS patients for 10 days after respiratory symptoms and fever are gone. SARS patients should limit interactions outside the home and should not go to work, school, out-of-home day care, or other public areas during the 10-day period.
" During this 10-day period, all members of the household with a SARS patient should carefully follow recommendations for hand hygiene, such as frequent hand washing or the use of alcohol-based hand rubs.
" Each patient with SARS should cover his or her mouth and nose with a tissue before sneezing or coughing. If possible, a person recovering from SARS should wear a surgical mask during close contact with uninfected persons. If the patient is unable to wear a surgical mask, other people in the home should wear one when in close contact with the patient.
" Disposable gloves should be considered for any contact with body fluids from a SARS patient. However, immediately after activities involving contact with body fluids, gloves should be removed and discarded, and hands should be washed. Gloves should not be washed or reused, and are not intended to replace proper hand hygiene.
" SARS patients should avoid sharing eating utensils, towels, and bedding with other members of the household, although these items can be used by others after routine cleaning, such as washing or laundering with soap and hot water.
" Common household cleaners are sufficient for disinfecting toilets, sinks, and other surfaces touched by patients with SARS, but the cleaners must be used frequently.
" Other members of the household need not restrict their outside activities unless they develop symptoms of SARS, such as a fever or respiratory illness.


How does one prevent transmission of SARS in the health care setting?

Transmission of SARS to health care workers appears to have occurred after close contact with symptomatic individuals before recommended appropriate infection control precautions were implemented. CDC, for example, has developed interim infection control recommendations for the management of exposures to SARS in the health care and other institutional settings. Visit http://www.cdc.gov/ncidod/sars/exposureguidance.htm to read these recommendations.

Health care facilities should be vigilant in conducting active surveillance for fever or respiratory symptoms among care givers with unprotected exposure to SARS patients. Health care workers who develop fever or respiratory symptoms during the 10 days following an unprotected exposure to a SARS patient should not report for duty. Such workers should stay home and report symptoms to the appropriate facility point of contact (e.g., infection control or occupational health) immediately. Exclusion from duty should be continued for 10 days after the resolution of fever and respiratory symptoms. During this period, infected workers should avoid contact with people both in the facility and in the community.

Exclusion from duty is not recommended for an exposed health care worker if they do not have fever or respiratory symptoms; however, the worker should report any unprotected exposure to SARS patients to the appropriate facility point of contact immediately.

What precautions should health care facilities follow regarding visits by close contacts of SARS patients?

Close contacts (e.g., family members or other members of the household) of SARS patients are at risk for infection. Health care facilities should implement a system to screen for fever or respiratory symptoms among such contacts who visit the facility. Close contacts with fever or respiratory symptoms should not be allowed to enter the health care facility as visitors and should be educated about this policy. Health care facilities should educate all visitors about use of infection control precautions www.cdc.gov/ncidod/sars/infectioncontrol.htm when visiting SARS patients and should emphasize the importance of following these precautions.

What should I do if I have recently traveled to a country where cases of SARS have been reported?

You should monitor your own health for 10 days following your return. If you become ill with a fever of over 100.4°F [>38.0°C] that is accompanied by a cough or difficulty breathing or that progresses to a cough and/or difficulty breathing, you should consult a health care provider. To help your health care provider make a diagnosis, tell him or her about any recent travel to regions where cases of SARS have been reported and whether you were in contact with someone who had these symptoms.


10.)Severe Acute Respiratory Syndrome (SARS) Updated Interim Case Definition

Source: www.cdc.gov/

March 29, 2003, 8:00 PM EST


The previous CDC SARS case definition (published March 22, 2003) has been updated as follows:

Areas with documented or suspected community transmission of SARS have been expanded to include all of mainland China in addition to areas previously listed.

Suspected Case:

Respiratory illness of unknown etiology with onset since February 1, 2003, and the following criteria:

Measured temperature > 100.5°F (>38° C) AND

One or more clinical findings of respiratory illness (e.g. cough, shortness of breath, difficulty breathing, hypoxia, or radiographic findings of either pneumonia or acute respiratory distress syndrome) AND

Travel within 10 days of onset of symptoms to an area with documented or suspected community transmission of SARS (see list below; excludes areas with secondary cases limited to healthcare workers or direct household contacts)
OR
Close contact* within 10 days of onset of symptoms with either a person with a respiratory illness who traveled to a SARS area or a person known to be a suspect SARS case.
* Close contact is defined as having cared for, having lived with, or having direct contact with respiratory secretions and/or body fluids of a patient known to be suspect SARS case.

Areas with documented or suspected community transmission of SARS: Peoples' Republic of China (i.e., mainland China and Hong Kong Special Administrative Region); Hanoi, Vietnam; and Singapore

Note: Suspect cases with either radiographic evidence of pneumonia or respiratory distress syndrome; or evidence of unexplained respiratory distress syndrome by autopsy are designated "probable" cases by the WHO case definition.

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DATA-MEDICOS/DERMAGIC-EXPRESS /MARCH JOURNAL 2..003/ DR. JOSE LAPENTA R. 
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