WHO Issues A Global Alert About Cases Of Atypical Pneumonia; Cases Of Severe Respiratory Illness May Spread To Hospital Staff

In Viet Nam the outbreak began with a single initial case who was hospitalized for treatment of severe, acute respiratory syndrome of unknown origin. He felt unwell during his journey and fell ill shortly after arrival in Hanoi from Shanghai and Hong Kong SAR, China. Following his admission to the hospital, approximately 20 hospital staff became sick with similar symptoms.

The signs and symptoms of the disease in Hanoi include initial flu-like illness (rapid onset of high fever followed by muscle aches, headache and sore throat). These are the most common symptoms. Early laboratory findings may include thrombocytopenia (low platelet count) and leucopenia (low white blood cell count). In some, but not all cases, this is followed by bilateral pneumonia, in some cases progressing to acute respiratory distress requiring assisted breathing on a respirator. Some patients are recovering but some patients remain critically ill.

Today, the Department of Health Hong Kong SAR has reported on an outbreak of respiratory illness in one of its public hospitals. As of midnight 11 March, 50 health care workers had been screened and 23 of them were found to have febrile illness. They were admitted to the hospital for observation as a precautionary measure. In this group, eight have developed early chest x-ray signs of pneumonia. Their conditions are stable. Three other health care workers self-presented to hospitals with febrile illness and two of them have chest x-ray signs of pneumonia.

Investigation by Hong Kong SAR public health authorities is on-going. The Hospital Authority has increased infection control measures to prevent the spread of the disease in the hospital. So far, no link has been found between these cases and the outbreak in Hanoi.

In mid February, the Government of China reported that 305 cases of atypical pneumonia, with five deaths, had occurred in Guangdong province. In two cases that died, chlamydia infection was found. Further investigations of the cause of the outbreak is ongoing. Overall the outbreaks in Hanoi and Hong Kong SAR appear to be confined to the hospital environment. Those at highest risk appear to be staff caring for the patients.

No link has so far been made between these outbreaks of acute respiratory illness in Hanoi and Hong Kong and the outbreak of `bird flu,` A(H5N1) in Hong Kong SAR reported on 19 February. Further investigations continue and laboratory tests on specimens from Viet Nam and Hong Kong SAR are being studied by WHO collaborating centres in Japan and the United States.

Until more is known about the cause of these outbreaks, WHO recommends patients with atypical pneumonia who may be related to these outbreaks be isolated with barrier nursing techniques. At the same time, WHO recommends that any suspect cases be reported to national health authorities.

WHO is in close contact with relevant national authorities and has also offered epidemiological, laboratory and clinical support. WHO is working with national authorities to ensure appropriate investigation, reporting and containment of these outbreaks.

###

UPDATE: World Health Organization Issues Emergency Travel Advisory

Severe Acute Respiratory Syndrome (SARS) Spreads Worldwide

15 March 2003 | GENEVA -- During the past week, WHO has received reports of more than 150 new suspected cases of Severe Acute Respiratory Syndrome (SARS), an atypical pneumonia for which cause has not yet been determined. Reports to date have been received from Canada, China, Hong Kong Special Administrative Region of China, Indonesia, Philippines, Singapore, Thailand, and Viet Nam. Early today, an ill passenger and companions who travelled from New York, United States, and who landed in Frankfurt, Germany were removed from their flight and taken to hospital isolation.

Due to the spread of SARS to several countries in a short period of time, the World Health Organization today has issued emergency guidance for travellers and airlines.

"This syndrome, SARS, is now a worldwide health threat," said Dr. Gro Harlem Brundtland, Director General of the World Health Organization. "The world needs to work together to find its cause, cure the sick, and stop its spread."

There is presently no recommendation for people to restrict travel to any destination. However in response to enquiries from governments, airlines, physicians and travellers, WHO is now offering guidance for travellers, airline crew and airlines. The exact nature of the infection is still under investigation and this guidance is based on the early information available to WHO.

TRAVELLERS INCLUDING AIRLINE CREW: All travellers should be aware of main symptoms and signs of SARS which include:

* X high fever (>38oC)

AND

* X one or more respiratory symptoms including cough, shortness of breath, difficulty breathing

AND one or more of the following:

* X close contact* with a person who has been diagnosed with SARS

* X recent history of travel to areas reporting cases of SARS.

In the unlikely event of a traveller experiencing this combination of symptoms they should seek medical attention and ensure that information about their recent travel is passed on to the health care staff. Any traveller who develops these symptoms is advised not to undertake further travel until they have recovered.

AIRLINES: Should a passenger or crew member who meets the criteria above travel on a flight, the aircraft should alert the destination airport. On arrival the sick passenger should be referred to airport health authorities for assessment and management. The aircraft passengers and crew should be informed of the person's status as a suspect case of SARS. The passengers and crew should provide all contact details for the subsequent 14 days to the airport health authorities. There are currently no indications to restrict the onward travel of healthy passengers, but all passengers and crew should be advised to seek medical attention if they develop the symptoms highlighted above. There is currently no indication to provide passengers and crew with any medication or investigation unless they become ill.

In the absence of specific information regarding the nature of the organism causing this illness, specific measures to be applied to the aircraft cannot be recommended. As a general precaution the aircraft may be disinfected in the manner described in the WHO Guide to Hygiene and Sanitation in Aviation.

* * *

As more information has become available, WHO-recommended SARS case definitions have been revised as follows:

Suspect Case

A person presenting after 1 February 2003 with history of :

* X high fever (>38oC)

AND

* X one or more respiratory symptoms including cough, shortness of breath, difficulty breathing

AND one or more of the following:

* X close contact* with a person who has been diagnosed with SARS

* X recent history of travel to areas reporting cases of SARS

Probable Case

A suspect case with chest x-ray findings of pneumonia or Respiratory Distress Syndrome

OR

A person with an unexplained respiratory illness resulting in death, with an autopsy examination demonstrating the pathology of Respiratory Distress Syndrome without an identifiable cause.

Comments

In addition to fever and respiratory symptoms, SARS may be associated with other symptoms including: headache, muscular stiffness, loss of appetite, malaise, confusion, rash, and diarrhea.

* * *

Until more is known about the cause of these outbreaks, WHO recommends that patients with SARS be isolated with barrier nursing techniques and treated as clinically indicated. At the same time, WHO recommends that any suspect cases be reported to national health authorities.

WHO is in close communication with all national authorities and has also offered epidemiological, laboratory and clinical support. WHO is working with national authorities to ensure appropriate investigation, reporting and containment of these outbreaks.

*Close contact means having cared for, having lived with, or having had direct contact with respiratory secretions and body fluids of a person with SARS.