<a href=iol.co.za>IOL March 31 2003 at 02:13PM

Hong Kong - A highly contagious respiratory virus spreading across the world has killed 59 people and infected more than 1 600 others, mainly in Asia.

Here are facts about severe acute respiratory syndrome (SARS), an atypical type of pneumonia:

What is it?

Scientists say SARS is caused by a new virus from the family of coronaviruses, which also causes the common cold.

The United States Centre for Disease Control and Prevention has confirmed that the virus is the primary causative agent, but experts say much laboratory work still needs to be done to pinpoint its exact characteristics. Development of a vaccine will take years.

The World Health Organisation says the disease originated in China's southern province of Guangdong, before spreading to Hong Kong, where it was then carried to Vietnam, Singapore and Canada. Other cases later surfaced in the United States, France, Britain, Taiwan and Germany.

Hong Kong and WHO scientists say the strain likely originated from animals.

Health experts in Hong Kong have ruled out any association with influenza A and B viruses, and also the H5N1 bird-flu virus which jumped the species barrier and killed six people in the territory in 1997, and one man in February.

SARS is a type of atypical pneumonia, which is usually caused by viruses, such as influenza viruses, adeno-virus and other respiratory viruses, according to Hong Kong health officials.

Atypical pneumonia can also be caused by organisms such as legionella, although that is rare in Hong Kong.

WHO officials say there is no indication that SARS is linked to bioterrorism.

What are the symptoms?

The WHO says the main symptoms of SARS are high fever (over 38°C), a dry cough, shortness of breath or breathing difficulties. Changes in chest X-rays, which are indicative of pneumonia, also occur. SARS may be associated with other symptoms, including chills, headache, muscular stiffness, loss of appetite, confusion, rash and diarrhoea.

Health experts say the disease has an incubation period of between two and seven days - with three to five days being more common - before victims start showing flu-like symptoms.

How dangerous is it?

The mortality rate appears to be between three to five percent. In Hong Kong, at least, those who are infected invariably develop severe pneumonia, which can cause numerous complications.

Conditions of victims deteriorate very quickly, in as short a period as five days.

How are patients treated?

There is currently no specific cure for the disease. But doctors worldwide have been treating it with ribavirin - an anti-viral drug - and steroids. Doctors say if treated early most patients without other serious illnesses can recover.

How does it spread?

The WHO and Hong Kong experts say the virus spreads through droplets by sneezing or coughing and such direct infection can usually happen within a radius of about one metre.

The virus can also spread indirectly as it can survive outside of the human body for three to six hours. Contact with any object that is tainted by droplets containing the virus could lead to infection if a person then touches their eyes, nose or mouth.

Health experts have not ruled out that it could be airborne, which infinitely raises the contagious nature of the virus and would make it far harder to contain.

How fast does it spread?

The WHO says SARS appears to be less infectious than influenza, and is not highly contagious when protective measures are used. Hong Kong's health chief has said the virus is highly infectious, but can be killed by a solution of common household bleach.

How does the virus travel globally?

The WHO says the speed of international travel creates a risk that cases can rapidly spread around the world.

When an infected person travels, he can spread the virus to other passengers on his flight and also to people at his destination. Authorities around Asia are hunting for passengers who were on about half a dozen flights as they fear that these passengers have been exposed.

Who is most likely to be infected?

Hong Kong experts say the virus is highly concentrated in discharges such as mucous or phlegm when the victim is very sick and in need of urgent medical care. Therefore, the virus has tended to spread primarily to health care professionals treating victims or close family members of victims.

How should infected patients be managed?

The WHO says patients should be placed in an isolation unit. Health care workers and visitors should wear efficient filter masks, goggles, aprons, head covers, and gloves when in close contact with the patient.

Is it safe to travel?

The WHO has not recommended restricting travel to any destination in the world. However, all travellers should be aware of the main symptoms and signs of SARS. People who have these symptoms and have been in close contact with a person who has been diagnosed with SARS, or have a recent history of travel to areas where cases of SARS have been spreading, should seek medical attention and inform health care staff of recent travel.

Travellers who develop these symptoms are advised not to undertake further travel until fully recovered.

<a href=www.kron4.com>Kron4.com Posted: March 31, 2003 at 4:38 p.m.

SAN FRANCISCO (BCN) -- The Department of Public Health reports that a suspected case of the Asian flu-like epidemic known as Severe Acute Respiratory Syndrome has been detected in San Francisco.

In a news conference at 1 p.m. today, Dr. Susan Fernyak, the department's director of disease control, said the suspected SARS patient was admitted to a San Francisco hospital over the weekend.

The local patient is being kept in isolation, despite being in stable condition and having an excellent prognosis for recovery, Fernyak said.

To date, the state Department of Health Services has reported a total of 16 possible SARS cases in California, including four in Santa Clara County, one in Alameda County, one in Marin County, and one in Sonoma County.

These local numbers are relatively low, as 1,622 cases of SARS have been reported so far in 13, mostly Asian, countries worldwide. Given the number of people in contact with Asia, and the broad definition of the syndrome's symptoms, Fernyak said she is surprised that more cases have not yet been detected in the Bay Area.

"We are going to have more cases under investigation (in the future)," said Fernyak. "It's inevitable, as people continue to travel abroad."

A suspected case is defined by the health department as someone with fever over 100.4 degrees, respiratory problems developed since Feb. 1 this year, and either close contact with another SARS patient, or recent travel to an Asian country with documented SARS cases.

The list of countries reporting cases to the World Health Organization includes Vietnam, Singapore, Canada, Hong Kong Special Administrative Region of China, and the entire country of China itself.

People with SARS are thought to be infectious from the time their symptoms start, until 10 days after the symptoms subside, and the main mode of infection is believed to be airborne, within close quarters.

Fernyak defined close quarters as being within six feet, and said that immediate family members of SARS patients and healthcare workers are therefore at greatest risk.

Family members of diagnosed patients are advised to wear surgical masks, and not to share eating utensils or towels until after the infectious period has passed.

So far, the illness has claimed around 60 lives, or approximately 4 to 5 percent of those infected.

In the early stages of the illness, Fernyak said healthcare workers weren't taking the illness seriously, and subsequently exposed themselves to infection -- a mistake they aren't making anymore.

Despite the seriousness of the epidemic, Fernyak doesn't want to cause people undue alarm, as the number of local cases is in fact still low.

"We don't want people panicking at this point -- we'll let you know if we want you to panic," she said.

San Francisco International Airport offers the most Bay Area flights to Asia, prompting officials there to take steps to warn the public of the disease.

SFO spokesman Mike McCarron said yellow alert notices are currently being handed out to all passengers on the three daily flights directly to and from Hong Kong, to caution them about the recent outbreaks.

By: Robert A. Wascher, M.D., F.A.C.S. Jewish World Review March 31, 2003

SARS (Severe Acute Respiratory Syndrome) is a viral infection that has recently become a source of concern among public health officials. First identified in Vietnam, cases of SARS have now appeared in China (in Hong Kong and Guangdong province, in particular), Singapore, Indonesia, Canada, Thailand, the Phillipines, and the United States. Approximately another dozen countries have reported possible cases of SARS within the past several days. At the present time, nearly 1600 cases SARS, including 54 deaths, have been reported throughout the world by the WHO and CDC. Although the causative agent of SARS is not fully understood at this time, it appears to be a previously unknown member of the coronavirus family of viruses. Sadly, the Italian physician who first identified SARS in a German businessman under his care in Vietnam has, himself, now died of the disease. According to the US Centers for Disease Control (CDC) and the World Health Organization (WHO), the symptoms of SARS include high fever, sore throat, dry cough, shortness of breath, and decreased white blood cell and platelet counts. Other typical symptoms of viral infection may occur with SARS, including headache, muscular pain and stiffness, loss of appetite, malaise, confusion, rashes and diarrhea. The incubation period for SARS appears to be relatively short, ranging from 2 to 7 days following initial exposure. Based upon the rather high prevalence of infections among healthcare personnel, the WHO has indicated that close and sustained contact with infected persons may be necessary to spread SARS. In particular, contact with respiratory droplets from coughs and sneezes, as well as direct contact with bodily secretions, are thought to be important infection vectors. However, recent reports of SARS spread among tenants within apartment buildings in China, and at least one case involving a flight attendant on a Hong Kong-based airline, suggest that the SARS virus may be passed with more casual contact. The treatment of patients infected with the SARS virus is similar to that recommended for other serious viral respiratory infections, as there are no antibiotics that have any activity against such diseases. The current recommendation is that patients with SARS should be kept in respiratory isolation wards. Supplemental oxygen, inhaled medications to keep the airways clear of secretions and to prevent collapse of small airways, control of excessive fever, intravenous fluids to support blood pressure and vital organs, and, in some cases, mechanical ventilation, are mainstays of supportive treatment. At the present time, public health officials are not advising prospective travelers to cancel their trips overseas. However, some officials are now suggesting that travel to endemic areas be deferred if possible. Some flight attendants and travelers have taken to wearing surgical face masks in an effort to reduce the risk of inhaling respiratory aerosols from potentially infected persons, although the efficacy of this strategy is uncertain at this time. If you-or anyone you know-has recently developed a severe upper respiratory infection, particularly following travel to one of the countries mentioned above, then medical care should be urgently sought. While there are hundreds of other viruses that can cause the same symptoms as SARS, the virulence of the virus causing SARS seems to approach, at least in some cases, that of strains of influenza that have caused pandemics of severe illness and death in the past. Update on Smallpox Vaccine The CDC announced, on March 25th, an advisory regarding the administration of the smallpox vaccine to people with a history of heart disease. More than 30,000 healthcare workers have recently received the smallpox vaccine as part of recent Homeland Defense initiatives. Among these volunteers, seven have developed cardiac-related complications, although it is presently unknown if these complications are directly related to the vaccine. Among these seven stricken healthcare workers, three have experienced heart attacks (one of which was fatal), two cases of angina (chest pain due to blocked coronary arteries) occurred, and two cases of myopericarditis (inflammation of the heart muscle or the fibrous sac that surrounds the heart) occurred. The CDC is currently studying the medical histories of each of these seven patients, and is carefully evaluating their cardiac disease risk profiles (at least one of these patients was reported to have had an extensive history of preexisting heart disease). While cases of heart inflammation were reported during the period when smallpox vaccine was most extensively administered (in the 1960s and 1970s), no epidemiologic studies were carried out at the time in order to ascertain any causative effect by the vaccine. As it is currently unclear whether or not the smallpox vaccine, which consists of a live virus that is related to the smallpox virus, is linked to these few cases of cardiac complications, the CDC is being somewhat circumspect in its advisory. The CDC is now recommending that persons with a history of cardiomyopathy, heart attack or angina, or any other evidence of heart disease be temporarily deferred from receiving the smallpox vaccine. Inflammatory Markers and Risk of Heart Failure There is growing evidence that the progression of coronary artery disease is influenced by mediators of inflammation. Most recently, C-reactive protein has taken center stage as a key inflammatory protein that appears to play a critical role in the development of coronary atherosclerosis. While coronary artery disease has been linked with inflammation and, in turn, directly with the risk of developing a heart attack, another equally life-threatening cardiac ailment has not previously been associated with inflammation. Congestive heart failure (CHF), which most commonly occurs after a heart attack permanently damages heart muscle, is a common cause of disability and death among older Americans. As its name implies, CHF results when the heart becomes sufficiently damaged so that its ability to pump blood to the body becomes seriously impaired. Patients with CHF may have difficulty breathing due to fluid build-up in their lungs, and often experience debilitating weakness and fatigue as a result of inadequate oxygen delivery throughout their bodies. Swelling of the lower extremities may also cause difficulties for patients with CHF. A new study in the journal Circulation looks at the potential role of inflammation in patients with CHF who have never had a heart attack before. This study was conducted within the framework of the highly respected Framingham Heart Study, one of the longest running and largest heart study research programs ever undertaken. In this new study, a total of 732 elderly patients who entered the Framingham Heart Study without any prior evidence of CHF or heart attack were followed for an average of 5.2 years. All study volunteers underwent extensive blood tests upon entry into the study, which included assays for known mediators of inflammation, including C-reactive protein, interleukin-6, and tumor necrosis factor-alpha. Among the 732 volunteers, 56 of them subsequently developed CHF-without experiencing any heart attacks-during the course of this study. The study determined that initially elevated levels of any of these inflammatory mediators were significantly correlated with the subsequent development of CHF among the study volunteers. Among patients who had elevations in the blood levels of all three of these markers upon entering the study, the risk of subsequently developing CHF was more than four time higher when compared to other study volunteers without elevated levels of these inflammatory markers. The study's authors concluded that a single measurement of inflammatory markers in the blood was highly predictive of the risk for subsequently developing CHF, even in the absence of heart attacks. Breast Fibroadenomas and the Risk of Breast Cancer The presence of benign fibrous nodules in the breast, called fibroadenomas, has been linked, in some studies, to a slightly increased risk of developing breast cancer. Other benign breast conditions, including ductal hyperplasia, and even a history of prior breast biopsies for benign lesions, have been statistically associated with small increases in breast cancer risk as well. A new study in the Archives of Surgery looked at 32 patients with fibroadenomas occurring in the breast at the same time as breast cancer. These patients were compared with 26 control patients who had breast fibroadenomas without the concomitant presence of breast cancer in the same breast. The researchers used several highly sensitive tests to assess both the fibroadenoma tumors and the breast cancer tumors for characteristic genetic mutations associated the development of cancer. The study determined that fibroadenomas of the breast, whether or not they co-existed with breast cancers in the same patient, did not contain any of the genetic mutations commonly identified in the breast cancer tumors. From these results, the authors infer that fibroadenomas are not directly associated with the development of breast cancers. This small study should be repeated with larger numbers of patients to validate its findings. However, these results should provide considerable reassurance to women with benign fibroadenomas of the breast. Dr. Robert A. Wascher is a regular columnist/contributor at Jewish World Review and a senior research fellow in molecular and surgical oncology at the John Wayne Cancer Institute in Santa Monica, CA. Comment by clicking here. Visit Dr. Wascher's web site. © 2003, Dr. Robert A. Wascher

<a href=www.khnl.com>News8-NBC Hawai March 31

Printer Friendly Version The state Department of Health reports two new suspected cases of mystery flu-like disease. The Health Department says the two Oahu women were part of a tour group that traveled to Northern China in mid-March. One woman was hospitalized on March 26th but is responding to treatment and is expected to be discharged tomorrow or Wednesday. The other woman did not require hospitalization. State epidemiologist Paul Effler says the department was aware of the two cases earlier but only list them as suspected severe acute respiratory syndrome, or SARS, after the Centers for Disease Control and Prevention expanded the case definition last Friday to include travel anywhere in China. While there have been no confirmed cases of SARS in Hawaii, Governor Lingle says the state will continue to be vigilant. She says state health officials aren't overly concerned, but they continue to watch for patients showing symptoms of the dangerous respiratory infection that has prompted travel warnings in parts of Asia. Worldwide, about 60 people have died from SARS. Lingle says the state Health Department is in contact with the C-D-C and the World Health Organization and will notify residents immediately if a case of SARS turns up in Hawaii.

9:24 AM EST,April 5, 2003 By AUDRA ANG, <a href=www.ctnow.com>Associated Press Writer

GUANGZHOU, China -- An international team is turning up possible clues to the spread of severe acute respiratory syndrome as it tries to follow the disease's tracks across the bustling landscape of southern China. Chinese experts in hard-hit Guangdong province told the scientists they have found a rare form of airborne chlamydia in some of their SARS patients, raising the possibility that more than one germ may be involved. Other Chinese cases suggest the disease might be passed by touching something tainted by a sick person's mucous or saliva. SARS continued to spread Saturday even as health officials stepped up their efforts to contain the disease. New cases were reported in Indonesia and Sri Lanka, while Hong Kong reported three more deaths and 39 new cases, while Malaysia announced its first death. In Hong Kong, workers covered head to toe in protective gear captured rats and roaches at an apartment complex where at least 250 people were infected. They also rounded up pets -- eight dogs, 14 cats, two hamsters and two turtles -- after a cat was found to carry a coronavirus. Coronaviruses are commonly found in animals, but microbiologists believe SARS is caused by a new form of coronavirus. Scientists are trying to determine if animals somehow carried the virus through the complex. Authorities at United Christian Hospital in Hong Kong announced Saturday that they would temporarily suspend all non-urgent services after more than 10 medical staff contracted the disease. The hospital has been one of the main care centers of SARS patients. China responded Saturday to criticism of its handling of the outbreak by promising to create a disease warning system and keep its public better informed. Vice Premier Wu Yi called for establishment of such a system "with emphasis placed on a public health information system," the official Xinhua News Agency and official newspapers said. Wu's comments were the highest-level response yet to demands that the reflexively secretive communist government change how it handles such outbreaks. It followed an extraordinary apology Friday by the country's top disease-prevention official amid complaints that China released information too slowly. On Saturday, the World Health Organization team met experts at Zhongshan University who collected hundreds of specimens of blood, lung fluid and other materials from people who died of SARS and those who recovered, said Dr. Robert Breiman, the team leader. The team wants to map the spread of the disease in Guangdong. WHO suggested comparing samples to find out whether those who died fell victim to a combination of viruses or bacteria, not just one strain, Breiman said. Chinese authorities say they found a rare, airborne form of chlamydia -- a virus usually transmitted through sexual contact -- in many who died. "It raises the question of, if you have one pathogen and you get hit with, say, coronavirus (do) you get a particularly bad disease?" Breiman said. "Or are you more likely to transmit? Do you become what we call a `super spreader'?" The WHO specialists say a key part of their search will be to draw on knowledge of Chinese experts who know the region and physicians with experience treating SARS patients. SARS has killed at least 85 people in Asia and Canada and sickened at least 2,200 in more than a dozen nations. Mainland China accounts for more than half the fatalities. No cure has been found, though health officials say most sufferers recover with timely hospital care. Symptoms include high fever, aches, dry cough and shortness of breath. On Friday, the WHO team visited Foshan, an industrial city in Guangdong where provincial officials say the world's first known SARS case occurred in November. Guangdong accounts for 40 of the 46 deaths reported by China. The WHO team said a key to the disease's speedy -- yet seemingly erratic -- transmission could lie in how the apparent first case, an unidentified businessman, passed it to four people without infecting his children. He survived and was released from the hospital in January. Many of the world's flu strains are traced to Guangdong and farms where people are believed to contract diseases from pigs and ducks. But the WHO team says most Chinese SARS cases are city dwellers, and Breiman said no link to animals has been established. "Contact with animals is still being looked into, but nothing convincing one way or the other has come out," he said. Another important clue that WHO unearthed from data provided by Foshan health authorities: The illness, originally thought to be transmitted primarily through such direct contacts as coughing and sneezing, appears also to be passed indirectly. Five of the 24 cases in Foshan show no actual "trace of transmission" to others, suggesting that infection can be spread by touching something tainted by a sick person's mucous or saliva, the experts said. The spread of SARS has disrupted air travel and forced the closure of schools, hospitals and businesses in many countries. Hong Kong's airport authority said 116 flights, one-fifth of all flights to the territory, were canceled on Saturday.