Information on the SARS health issue

Sunday, April 6th 2003

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The Centres for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have received reports of patients with Severe Acute Respiratory Syndrome (SARS) from Canada, China, Hong Kong Special Administrative Region of China, Indonesia, Philippines, Singapore, Thailand, and Vietnam.

The cause of these illnesses is unknown and is being investigated, although latest information from the director of the US Centres for Disease Control and Prevention, Dr. Julie Gerberding, reported that the agency now has "very strong evidence supporting coronavirus in the etiology of severe acute respiratory syndrome or SARS." It may be a "new or emerging coronavirus," she said. According to Dr. Gerberding, the CDC has been able to culture coronavirus in tissue from two of four affected patients. "That, in and of itself self does not prove causality," Dr. Gerberding said, "but what is interesting to us is that not only are we culturing it but we are finding it in affected tissues." In one patient, the virus was found in lung tissue and secretions as well as the kidney, she said.

Moreover, Dr. Gerberding said the patient had a negative early antibody test for coronavirus, but by the end of the illness had seroconverted "using a very specific assay for this new coronavirus." She said CDC also has evidence of coronavirus infection in seven other people. "A total of three have seroconverted and we are actively getting late serum to see if others will seroconvert as their illness progresses." "We know from sequencing pieces of the virus DNA that it is not identical to the corona viruses that we have seen in the past. This may very well be a new or emerging coronavirus infection, but it is very premature to assign a cause," Dr. Gerberding told reporters Early symptoms have included influenza-like symptoms such as fever, muscular pain, headache, sore throat, dry cough, shortness of breath, or difficulty breathing. In some cases these symptoms are followed by hypoxia - a deficiency of oxygen reaching the tissues of the body, pneumonia, and occasionally acute respiratory distress requiring mechanical ventilation and death.

Some close contacts, including healthcare workers, have developed similar illnesses. In response to these developments, CDC is initiating surveillance for cases of SARS among recent travellers or their close contacts. As of March 21, 2003, the majority of patients identified as having SARS have been adults aged 25--70 years who were previously healthy. Few suspected cases of SARS have been reported among children aged <15 years.

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 begins generally with fever (>100.4°F [>38.0°C]) and often chills and tremors, and may be accompanied by other symptoms, including headache, fatigue and muscular pain. At the onset of illness, some persons have mild respiratory symptoms. Typically, rash and neurologic or gastrointestinal findings are absent; however, some patients have reported diarrhoea.

After 3-7 days, a lower respiratory phase begins with the onset of a dry, non productive cough or dyspnoea (difficult or laboured respiration), which may be accompanied by or progress to hypoxemia, or deficient oxygenation of the blood. In 10-20% of cases, the respiratory illness is severe enough to require artificial respiration assistance. The case-fatality rate among persons with illness meeting the current WHO case definition of SARS is approximately 3%.

Early in the course of the disease, the white blood cell counts have generally been normal or decreased. At the peak of the respiratory illness, approximately 50% of patients low-normal platelet counts (50,000--150,000/µL). Early in the respiratory phase, elevated creatine phosphokinase levels (as high as 3,000 IU/L) and liver transaminases levels 2 to 6 times the upper limits of normal have been noted. In the majority of patients, kidney function has remained normal.

If you have been in contact with someone who has SARS, what do you need to know?

The severity of the illness may be highly variable, ranging from mild illness to death. Although a few close contacts of patients with SARS have developed a similar illness, the majority have remained well. Some close contacts have reported a mild fever without respiratory signs or symptoms, suggesting the illness might not always progress to the respiratory phase.

Patients with SARS pose a risk of transmission to close household contacts and health care personnel in close contact. The duration of time before or after onset of symptoms during which a patient with SARS can transmit the disease to others is unknown.

The following infection control measures are recommended for patients with suspected SARS in households or residential settings. These recommendations are based on the experience in the United States to date and may be revised as more information becomes available. SARS patients should limit interactions outside the home and should not go to work, school, out-of-home childcare, or other public areas until ten days after resolution of fever and respiratory symptoms. During this time, infection control precautions should be used, as described below, to minimize the potential for transmission.

All members of a household with a SARS patient should carefully follow recommendations for hand hygiene (e.g., frequent hand washing or use of alcohol-based hand rubs), particularly after contact with body fluids (e.g., respiratory secretions, urine, or faeces).

Use of disposable gloves should be considered for any direct contact with body fluids of a SARS patient. However, gloves are not intended to replace proper hand hygiene. Immediately after activities involving contact with body fluids, gloves should be removed and discarded and hands should be cleaned. Gloves must never be washed or reused. Each patient with SARS should be advised to cover his or her mouth and nose with a facial tissue when coughing or sneezing.

If possible, a SARS patient should wear a surgical mask during close contact with uninfected persons to prevent spread of infectious droplets. When a SARS patient is unable to wear a surgical mask, household members should wear surgical masks when in close contact with the patient. Sharing of eating utensils, towels, and bedding between SARS patients and others should be avoided, although such items can be used by others after routine cleaning (e.g., washing with soap and hot water). Environmental surfaces soiled by body fluids should be cleaned with a household disinfectant according to manufacturer's instructions; gloves should be worn during this activity.

Household waste soiled with body fluids of SARS patients, including facial tissues and surgical masks, may be discarded as normal waste. Household members or other close contacts of SARS patients who develop fever or respiratory symptoms should seek healthcare evaluation.

When possible, in advance of the evaluation, healthcare providers should be informed that the individual is a close contact of a SARS patient. Household members or other close contacts with symptoms of SARS should follow the same precautions recommended for SARS patients. At this time, in the absence of fever or respiratory symptoms, household members or other close contacts of SARS patients need not limit their activities outside the home. All cases, or suspected cases of SARS must be reported to health officials.

Footnote: By August 2003 it appears that the SARS virus is no longer a threat, with no new reported cases for over one month.

If you need help or advice, you are welcome to email our naturopathic team with your health question.

Disclaimer: The health information presented here has been written for the New Zealand health consumer. It is of a general nature and is only intended to provide a summary of the subjects covered. The information is not intended to be comprehensive or to provide medical advice to you. While all care has been taken to ensure the accuracy of the information, no responsibility or liability is accepted, and no person should act in reliance on any statement contained in the information provided. All health ailments should be treated by a qualified health professional.

 

ref:n101

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