SARS - Worldwide (24): Cases
April 2, 2003
A ProMED-mail post <http://www.promedmail.org ProMED-mail is a program of the International Society for Infectious Diseases <http://www.isid.org
[We have chosen to post all of the WHO updates from today, including part of a press release so that the record would be "straight from the horse's mouth" to counteract whatever additional sensationalism may be occurring
outside of these official releases. - Mod.MPP]
In this update:
[1] Worldwide cases, deaths, affected areas - WHO
[2] Travel advice, Hong Kong SAR, Guangdong Province, China - WHO
[3] Press release, China investigation and travel advice - WHO
[4] China investigation - WHO
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[1]
Date: 2 Apr 2003
From: ProMED-mail <promed@promedmail.org
Source: WHO SARS website
<http://www.who.int/csr/sars/en/
[A] Cumulative Number of Reported Cases of Severe Acute Respiratory Syndrome (SARS)
<http://www.who.int/csr/sarscountry/2003_04_02/en/
From: 1 Nov 2002 (1) To: 2 Apr 2003, 16:00 GMT+2
Country: Cumulative no. case(s)/ No. deaths/ Local chain(s) of
transmission(2)
Australia: 1/ 0/ None
Belgium: 1/ 0/ None
Canada: 58/ 6/ Yes
China: 1190/ 46/ Yes
China, Hong Kong SAR: 708/ 16*/ Yes
China, Taiwan: 13/ 0/ Yes
France: 1/ 0/ None
Germany: 5/ 0/ None
Italy: 3/ 0/ None
Republic of Ireland: 2/ 0/ None
Romania: 3/ 0/ None
Singapore: 95/ 4/ Yes
Spain: 1/ 0/ None
Switzerland: 2/ 0/ None
Thailand: 7/ 2/ None
United Kingdom: 3/ 0/ None
United States: 72§/ 0/ To be determined
Viet Nam: 58/ 4/ Yes
Total: 2223/ 78
Notes:
Cumulative number of cases includes number of deaths.
1. The start of the period of surveillance has been changed to 1 Nov 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.
[B] Affected Areas 2 Apr 2003
<http://www.who.int/csr/sarsareas/2003_04_02/en/
Affected Areas - Severe Acute Respiratory Syndrome (SARS)
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Country: Area
Canada: Toronto
Singapore: Singapore
China: Guangdong, Hong Kong Special Administrative Region of China,
Shanxi,
Taiwan Province
Viet Nam: Hanoi
An affected area: an area in which local chain(s) of transmission of SARS is/are occurring as reported by the national public health authorities.
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[2]
Date: 2 Apr 2003
From: ProMED-mail <promed@promedmail.org
Source: WHO SARS website 2 Apr 2003
<http://www.who.int/csr/sarsarchive/2003_04_02/en/
Update 17 - Travel advice - Hong Kong SAR China, and Guangdong Province,
China
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The outbreak of severe acute respiratory syndrome (SARS) continues in the affected areas* : Canada (Toronto), China (Guangdong Province, Hong Kong SAR China, Shanxi Province, Taiwan Province), Singapore (Singapore), Vietnam (Hanoi). The agent causing SARS is under intensive international study, but as of today it has not been fully characterized, and there is no vaccine or other prophylaxis available.
Since WHO issued the global alert on 12 Mar 2003
<http://www.who.int/csr/sarsarchive/2003_03_12/en/ national authorities have implemented heightened surveillance for cases of SARS, and where such cases have been identified their prompt isolation has prevented further spread of the disease in virtually all countries. For instance the outbreak in Hanoi has passed its peak and no new cases have been identified for the last week. Last week WHO issued recommendations aimed at further limiting the spread of SARS and protecting international air passengers. These recommendations still apply -- see WHO recommends new measures to prevent travel-related spread of SARS at:
<http://www.who.int/csr/sarsarchive/2003_03_27/en/
The SARS situation in Hong Kong SAR has developed features of concern: a continuing and significant increase in cases with indications that SARS has spread beyond the initial focus in hospitals. These developments have suggested environmental routes of transmission from a SARS infected person which may be related to contamination of common systems that link rooms or flats together. Despite the implementation of strict measures to control the outbreak, there have continued to be a small number of visitors to Hong Kong who have been identified as SARS cases after their return from Hong Kong. The epidemic in Guangdong Province of China, situated adjacent to Hong Kong, is the largest outbreak of SARS reported and has also shown evidence of spread in the wider community.
***As a measure of precaution WHO is now recommending that persons travelling to Hong Kong and Guangdong Province of China consider postponing all but essential travel. This temporary recommendation will be reassessed in the light of the evolution of the epidemic in the areas currently indicated, and other areas of the world could become subject to similar recommendations if the situation demands. Please note that this recommendation applies only to travellers entering Hong Kong SAR China and Guangdong Province of China, not to passengers directly transiting through international airports within those areas..***[asterisks added by ProMED -
Mod.JW].
* WHO has defined affected areas as an area in which local chain(s) of transmission of SARS is/are occurring as reported by the national public health authorities. The list of areas changes over time and the latest update can be found at: Affected Areas - Severe Acute Respiratory Syndrome (SARS) <http://www.who.int/csr/sarsareas/en/
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[3]
Date: 2 Apr 2003
From: ProMED-mail <promed@promedmail.org
Source: WHO SARS website
<http://www.who.int/csr/sarsarchive/2003_04_02a/en/
Update 18 - SARS outbreak:WHO investigation team moves to China, new travel advice announced
Press release issued by WHO 2 Apr 2003
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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 SAR 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.***[asterisks added by ProMED - Mod.JW].
The new travel advisory is intended to limit the spread of SARS by reducing travel to high risk areas. All other elements of Severe Acute Respiratory Syndrome (SARS) WHO previous travel guidance still stand.
The SARS situation in Hong Kong SAR, 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 19 Mar 2003, 9 travellers have been identified as SARS cases on returning from a visit to Hong Kong SAR 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 [2003] alone indicates the outbreak there continues.
Unprecedented global cooperation helps advance knowledge and containment of SARS
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In the 4 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 Mar 2003, 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, Switzerland.
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[4]
Date: 2 Apr 2003
From: ProMED-mail <promed@promedmail.org
Source: WHO SARS website 2 Apr 2003
<http://www.who.int/csr/sarsarchive/2003_02_02b/en/
Update 19 - China deepens its collaboration to contain SARS, WHO revises its advice to international travellers as new data come in
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New data from China, WHO team leaving immediately for Guangdong
Chinese authorities have today announced updated figures for the number of cases of severe acute respiratory syndrome (SARS) and deaths in Guangdong Province. The figures, which cover the reporting period of 1 to 31 Mar
2003, are 361 new SARS cases and 9 deaths.
Chinese authorities had previously reported 792 cases and 31 deaths in Guangdong Province in the reporting period of 16 Nov 2002 to 28 Feb 2003. The cumulative total of SARS cases in Guangdong from 16 Nov 2002 to 31 Mar 2003 now stands at 1153 cases and 40 deaths.
The Chinese Ministry of Health has further announced that a 5-person WHO team will be travelling immediately to Guangdong Province to confer with officials there. Chinese experience with the oldest SARS outbreak is expected to yield epidemiological and clinical clues useful in establishing policies to contain outbreaks elsewhere and prevent further international spread.
Many questions about the outbreak in Guangdong Province, which borders Hong Kong, have yet to be answered. This outbreak is the largest reported to date and has also shown evidence of spread in the wider community.
No transmission of new cases is being reported elsewhere in the country. Chinese authorities are in the process of setting up a reporting system that will result in daily real-time reporting of SAS cases throughout the country.
New advice to travellers
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On the basis of new data from China and Hong Kong, WHO has today revised its advice to international travellers as a measure for preventing the further international spread of SARS.
In a press release this morning, WHO issued the following advice:
***"The World Health Organization (WHO) today began recommending that persons travelling to Hong Kong Special Administrative Region of China and Guangdong Province, China consider postponing all but essential travel. This updated travel advice comes as a result of new developments in the multi-country outbreak of severe acute respiratory syndrome (SARS)."***[asterisks added by ProMED - Mod.JW].
The new travel advice is intended to limit further international spread of SARS by restricting travel [into] areas where the transmission patterns of SARS are not fully understood. The SARS situation, which is rapidly evolving, is under constant assessment by WHO in collaboration with three global networks of experts. The new advice is issued as part of a series of measures that will change as more information about SARS becomes available.
New data on international spread
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Overnight, WHO received reports on 9 persons, with a history of travel to Hong Kong dating from 15 Mar 2003, who subsequently developed symptoms suggesting probable cases of SARS when they travelled to other countries. These 9 cases of probable SARS, related to travel in Hong Kong, occurred in Taiwan, Province of China, and Singapore. The data on these cases, and what is known about the incubation period of SARS, indicate that travel to Hong Kong can contribute to the international spread of SARS.
15 Mar 2003 is the date when WHO issued its first SARS-related emergency travel advisory, which increased global awareness of this new disease, made travellers and health staff alert to symptoms, and initiated prompt reporting of cases.
The SARS outbreak in Hong Kong SAR has developed an unusual pattern of transmission. This pattern is different from what is being seen in the vast majority of other SARS outbreaks, and is not yet fully understood. The number of cases is continuing to increase significantly, and there is evidence that the disease has spread beyond the initial focus in hospitals.
These developments raise questions related to other routes of transmission, in addition to well-documented face-to-face exposure to droplets released when an infected person coughs or sneezes. Epidemiologists are considering whether SARS is being transmitted in Hong Kong by some environmental means for which no satisfactory explanation has been found. Particular concern centres on a large cluster of cases linked to residential buildings in the Amoy Garden housing estate in the Kowloon [mainland] district of HongKong.
Historical perspective
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This is the first time in the history of WHO that such travel advice has been issued for specific geographical areas because of an outbreak of an infectious disease.
Since 1958, WHO has issued weekly lists of areas infected with quarantinable diseases so that national authorities can decide whether to apply public health measures to arriving travellers. During the last years of the smallpox eradication campaign cases spread internationally by land. Controls at borders between neighbouring countries were relied on to prevent international spread. No global recommendations were necessary.
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[Our continuing thanks and gratitude to Marianne Hopp <mjh12@yahoo.com for her role as WHO notifications rapporteur.
The major increase in reported cases in the past 24 hours (from 1804 cases and 62 deaths to 2223 cases and 78 deaths) is primarily attributable to the 361 cases and 9 deaths reported to have occurred in Guangdong China during the period 1-31 Mar 2003, and represent a one month incidence and not a 24 hour incidence increase. The 24 hour increase in cases is 58, of which there were 23 in Hong Kong, another 23 were in [mainland] China.
Other areas with increases in reported cases include Canada with 5, Singapore with 3, & United States with 3. Neither Viet Nam nor Taiwan have reported new cases in the past 24 hours.
The enigma presented by the increase in cases in Hong Kong, that to date have *not* been confirmed as due to close contact, awaits further definition. Information from Hong Kong suggests that the index case in the Amoy Gardens outbreak was an individual on immunosuppressant medication for renal disease; perhaps serving as a co-factor for enhanced transmission of a higher viral load. Purely speculation at this point -- there are still many more questions than there are answers. This moderator still feels strongly that the high population density in this area may lead to many more "casual contacts" that by literal "space" definition may in fact be comparable to "close contact" in other areas, and may be a significant factor in disease transmission here.
The WHO travel advice is a first in its history. It is not a quarantine, but rather a sensible guidance to avoid travel to an identified area of high transmission if travel is not essential and can be avoided. Many individual countries have been making this recommendation for some time now. Once more information on SARS is known, this recommendation may change. The occurrence of cases in people who have travelled to the areas of high transmission (9 cases) -- combined with the enigma surrounding the increase in cases in Hong Kong that have not been identified as close contact transmission -- were the driving events behind this travel advice.
Just putting things into perspective, we are only in week 4 of major, international investigations into this newly emerging disease currently named SARS. Much more about this new disease is known now than was known in the comparable time frame following the identification of what is now referred to as HIV/AIDS. - Mod.MPP]