Download Executive Summary/Abstract

GIDSAS
Severe Acute Respiratory
Syndrome (SARS):
Basics
Update May 8, 2003
Rashid A. Chotani, MD, MPH
Assistant Professor, School of Medicine, School of Public Health &
Center for International Emergency, Disaster & Refugee Studies
Director, Global Infectious Disease Surveillance & Alert System
Johns Hopkins School of Medicine & Public Health
410-614-8330
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GIDSAS
Overview
This lecture is divided in five
sections and will be updated weekly
as new events unfold.
I.
II.
III.
IV.
V.
VI.
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Background
Epidemiology
The Virus
The Disease
Infection Control
Discussion
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PART I: Background
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Model of disease causation
Infected/Infectious host
patient
Dynamic interaction
Change in components
alters equilibrium
environment
environment
agent
Contaminated objects
reservoir
Colonized persons
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Koch’s postulates
1. Organism is found with the disease in
accordance with lesion and the clinical
stage observed
2. The same organisms must be grown in
pure culture from the diseased host
3. The same disease is reproduced when a
pure culture of the organism is inoculated
into a healthy host
4. The organism must be recovered from
experimentally infected hosts.
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Severe Acute Respiratory
Syndrome
First described 26 February in Hanoi
48 year old business man high fever,
atypical pneumonia and rapidly
progressing respiratory symptoms
WHO official (Dr Carlo Urbani) in Hanoi
alarmed by unusual disease
notified WHO HQ
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Dr. Carlo Urbani, 46, of Italy, the first doctor
to realize that the world was dealing with
the unfamiliar disease SARS (Severe Acute
Respiratory Syndrome). Urbani, a World
Health Organization expert on
communicable diseases, who died of
illness in Bangkok, Thailand, Saturday,
March 29, 2003. Urbani became infected
while working in Vietnam, where he
diagnosed an American businessman
hospitalized in Hanoi, who later died.
(AP Photo/Guido Picchio)
A portrait of Carlo Urbani is seen at
the entrance to a memorial service
in Hanoi. (AFP/Hoang Dinh Nam)
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WHO Response:
Global Surveillance
Infectious agent
Possible new agent
Rapid nosocomial transmission
Burden on health care systems
Pandemic potential
Additional information:
H5N1 Hong Kong early February 2003
Atypical pneumonia Guangdong Province,
China Nov 2002 to Feb 2003
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WHO Response:
Global Alert
12 March Global Alert
15 March WHO Emergency Travel
Advisory
Increase global awareness of signs and
symptoms of SARS
Increase global awareness of need for
isolation of suspected cases and
appropriate hospital infection control
measures
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GIDSAS
March 18, Kuala Lumpur,
Malaysia
An official of the
Malaysia Health
Ministry's Disease
Control Department
reads a SARS leaflet at
the ministry in Kuala
Lumpur, Malaysia.
(AP Photo/Teh Eng Koon)
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March 31 – Toronto, Canada
A man wears a surgical
mask for protection from
the SARS virus just
before the start of AL
action between the
Toronto Blue Jays and
the New York Yankees in
Toronto.
(AP Photo/Frank Gunn)
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March 31 – Toronto
A man reads the
warning signs on the
doors at the Hospital for
Sick Children in
Toronto. The SARS
outbreak has
hospitalized some five
children. It was the first
confirmation that
children are among the
dozens of probable and
suspected cases north
of the U.S. border.
(AP Photo/CP, Kevin Frayer)
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(AFP/Peter Parks)
An official hands out disinfectant in Hong Kong to
battle a deadly outbreak.
Russian health authorities think SARS may have
been designed as a biological weapon.
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April 1 - Germany
(AP Photo/Martin Meissner)
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Senior consultant
of the pulmonary
hospital in Hemer,
Germany, Dr. Lutz
Freitag, points at a
slide-projection of
the Corona virus
during a press
conference A 72year-old man who
fell ill after
returning from the
Far East is being
treated at the
hospital for SARS.
GIDSAS
April 1 - Thailand
Woman Adjusts Mask On Her
Baby
Thailand's Rungfa Barcena
adjusts a mask on her one
month old son, Adrian
Barcena, as both prepare for
a flight to the Philippines at
the Bangkok airport.
The Thai Public Health
Ministry announced that
Thailand has found seven
patients connected with
SARS, all of them came from
overseas high-risk areas.
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Money Changer Wears Protective Mask
A money changer wears a protective mask while
making change at the Bangkok airport. The Thai Public
Health Ministry announced that Thailand has found
seven patients connected
with Severe Acute Respiratory Syndrome (SARS) so far,
all of them came from overseas high-risk areas.
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April 1 - Indonesia
Muslim nurses wear
surgical masks in
attempt to protect
themselves from SARS,
at a hospital in Batam,
Indonesia. Indonesian
authorities sent teams
of doctors to airports
and ferry terminals to
prevent the spread of
the disease. The port of
Batam, where
thousands of people
enter Indonesia daily on
ferries from nearby
Singapore, was of
particular concern.
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Brian Fairrington, The Arizona Republic, 4/24/03
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April 1, 2003, in San Jose, Calif.
(AP Photo/The San Jose Mercury News, Patrick Tehan)
An American Airlines aircraft inbound to the United States
from Asia sits on the tarmac at San Jose International
Airport. The flight from Tokyo was held on the tarmac after
the captain reported five people on board appeared to
have SARS-like symptoms. Doctors later determined that
none of the five were showing signs of the disease.
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Scott Stantis, The Birmingham News, 4/2/03
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(AFP/File/Sebastian D'Souza)
The Indian carrier's pilots are refusing to fly to Hong
Kong due to the deadly outbreak of SARS
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Disinfecting Plane From Hong Kong
Maintenance crew members wearing preventive masks spray
disinfectant after the Philippine Airlines plane's arrival from
Hong Kong at Manila's international airport, Philippines. With
the spread of SARS, airport officials were trying to prevent its
spread though up to now there was no reported SARS
infected person in the country.
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April 2 – Vancouver, Canada
Selling Surgical Masks
(AP Photo / CP, Chuck Stoody)
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Dave Heel, left, and Shane
Gray sell surgical masks
to prevent the spread of
severe acute respiratory
syndrome, or SARS, along
Marine Drive on the road
to Vancouver International
Airport in Canada. The pair
claimed to have sold
dozens of masks at $10
each.
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April 2 – Amoy Gardens, Hong Kong
(AP Photo / Anat Givon)
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Food and Environmental
Hygiene Department workers
wear protective gear including
surgical mask, goggles, and a
coverall suit as they take part in
refuse removal from the
infected Block E of Amoy
Gardens apartment complex, in
Hong Kong, where 237 people
have been sickened with SARS.
More than half of the SARS
patients from Amoy Gardens
came from Block E which was
sealed off (March 31) by health
officials, and then evacuated a
day later amid fears that it was
not safe for residents.
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April 3 – Hong Kong
Buddhists wear
surgical masks in
an attempt to
protect
themselves from
SARS, during
prayers for world
peace and an end
to the outbreak
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Kim Song Heng, Singapore, Lianne Zaobao, 4/28/03
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April 7 – London, England
A cargo handler at
London's Heathrow
airport wears a
surgical mask as he
prepares to unload
baggage and cargo
from a flight newly
arrived from Hong
Kong.
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(AP Photo/Str)
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April 8 – Hong Kong
(Bobby Yip/Reuters)
Professor Malik Peiris, the chief virologist at the
University of Hong Kong, stands in front of a
projection of a virus infected cell at Queen Mary
Hospital in Hong Kong.
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April 10 - Amoy Gardens, Hong
Kong
(AP Photo/Anat Givon)
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Medical staff help a tenant
of block E at Amoy
Gardens in Hong Kong as
residents of the block
which was badly hit by
SARS, returned to their
homes. Some 240 people
were evacuated by the
government from the
housing complex and
spent nine days in holiday
camps that were turned
into makeshift quarantine
centers.
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April 10 - Philippine
(AP Photo/Aaron Favila)
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Filipino musicians wear
protective masks as they
welcome arriving
passengers in Manila's
International Airport
Thursday, April 10, 2003.
Philippine officials recently
advised against unnecessary
travel to Hong Kong and
China's Guangdong province
due to the outbreak of
severe acute respiratory
syndrome, or SARS, that has
killed at least 108 people
worldwide.
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Passengers Arrive From Hong Kong
Passengers wearing preventive masks arrive from Hong
Kong at Manila's international airport, Philippines.
Airport officials were trying to prevent its spread though
up to now no reported SARS infected person have been
identified in the country.
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April 10 – Beijing, China
China's Vice Minister of
Health, Ma Xiaowei
clasps his hands after a
news conference in
Beijing, China. China
said Thursday its death
toll from a mysterious
flu-like illness has risen
by two to 55, and said
its total number of
people sickened stands
at 1,290.
(AP Photo/Ng Han Guan)
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Director Zhong
Nanshan of the
Guangzhou Respiratory
Disease Research. The
top Chinese
epidemiologist strongly
disputed government
claims that SARS was
under effective control.
(AFP/Frederic J.Brown)
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April 11 – Changi Airport, Singapore
Since the outbreak of severe acute respiratory syndrome, or
SARS, check-in belts at Changi International Airport has
turned quiet in Singapore. Hit by both the effects of SARS and
the Iraq war, the Civil Aviation Authority of Singapore shows
that flights scheduled this week have plunged from 1,577 to
1,372. (AP Photo/Wong Maye-e)
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April 11, Telford Garden – Hong
Kong
Health authorities have
(AP Photo/Anat Givon)
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confirmed four more cases
of people who were recently
found to be infected with
severe acute respiratory
syndrome, or SARS. Health
workers and police Friday
enforced new quarantine
measures on people living
with SARS sufferers as
Hong Kong stepped up
efforts to contain the virus
that has killed 30 people and
sickened almost 1,000 in
Hong Kong alone.
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