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GIDSAS PART V: Discussion Chotani, 2003 GIDSAS Factors leading to the emergence of infectious diseases Changes in society, technology, environment and microorganisms are leading to increases in host susceptibility and/or disease transmission and the evolution of new or drug-resistant microorganisms Chotani, 2003 GIDSAS Candidate Factors Affecting Emergence of SARS Human demographics and behavior Human susceptibility to infection Economic development and land use Changing ecosystems International travel and commerce Microbial adaptation and change Breakdown of public health measures To be determined . . . Chotani, 2003 IOM: Microbial Threats to Health: Emergence, Detection, and Response. March 2003. GIDSAS Infectivity Infectivity is the ability of a virus to jump from one person to another The recipient must receive a dose large enough to cause the disease From epidemic reports, it appears that SARS virus has low infectivity (ie it requires a large dose to pass on to the recipient) Other members of the coronavirus family have very high infectivity. Chotani, 2003 GIDSAS Virulence Virulence is the property of the virus to cause damage to the patient’s organs The SARS virus is very virulent Other members of the coronavirus family have low virulence. Chotani, 2003 GIDSAS Attenuation Attenuation is a phenomenon seen in some members of the coronavirus family, where the virulence decreases when it jumps from person to person. Initial decrease in cases suggested attenuation Enough information is still not available to suggest this phenomenon in the current SARS outbreak Recent clusters suggest that the virus might be getting more virulent Chotani, 2003 GIDSAS Seasonal incidence of coronavirus infections Disease is now in the Spring season? Chotani, 2003 GIDSAS Research in China Organ samples of 7 fatal cases of SARS 293 cell line inoculated from materials derived from lung to isolated the agent(s) Agents in organs and cell cultures revealed by immunoassay Result • Chlamydia-like & Coronavirus-like particles found on EM • Chlamydia-like agent visualized in both organs and cells – Were non-reactive with – genus-specific antibodies against Chlamydia – monoclonal antibodies against chlamydia pneumoniae and c. psittaci • Results consistent with a novel chlamydia-like agent Source: Hong T. et al. Chlamydia-like and coronavirus-like agents found in dead cases of atypical pneumonia by electron microscopy. National Medical Journal China 2003;83:632-6 Chotani, 2003 GIDSAS Addressing the Threat of SARS Enhancing global response capacity Improving global infectious disease surveillance Rebuilding domestic public health capacity Developing diagnostics Educating and training multidisciplinary workforce Vaccine development and production Need for new antimicrobial drugs Chotani, 2003 IOM: Microbial Threats to Health: Emergence, Detection, and Response. March 2003. GIDSAS Unanswered Questions? Future course of outbreak Source of virus Mode of transmission in community Risk of household transmission Risk of transmission on airplanes and ships Environmental persistence/deconta mination Chotani, 2003 Period of infectiousness Explanation for age distribution Importance of “hypertransmitters” Role of co-infection Optimal diagnostic test(s) Effective therapy Vaccine approaches GIDSAS Thank you!!!!!! Chotani, 2003