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Pastimes : SARS - what next? -- Ignore unavailable to you. Want to Upgrade?

To: Maurice Winn who wrote (770)	10/9/2003 11:03:06 AM
From: Henry Niman	Respond to of 1070

The report below details 6 cases imported to Singapore with special emphasis on airlines and potential transmission. However, the ironic part of the article below is the 29F who died after returning to Singapore on March 26 from Beijing. This traveler is almost certainly the Singaporean who flew to Beijing from Hong Kong on March 15 on CA-112. Over 20 passengers developed SARS on that flight including one from Singapore who subsequently died. Thus, although there was no documented transmission of SARS in Singapore from this patient, the index case on Flight 112 (who almost certainly contracted SARS from his niece who was at Prince of Wales Hospital in Hong Kong) did transmit SARS to HCWs in Beijing, the stewardesses transmitted SARS to relatives and HCWs in Hohhot, and Taiwanese travelers transmitted SARS to at least one relative (an 8 year). -----Original Message----- From: Niman, Henry L. Sent: Thu 10/9/2003 9:54 AM To: SARS News Cc: Subject: SARS NG Experience of Severe Acute Respiratory Syndrome in Singapore: Importation of Cases, and Defense Strategies at the Airport bcdecker.com ORIGINAL ARTICLES Experience of Severe Acute Respiratory Syndrome in Singapore: Importation of Cases, and Defense Strategies at the Airport -------------------------------------------------------------------------------- Annelies Wilder-Smith, Kee Tai Goh and Nicholas I Paton Annelies Wilder-Smith, MD, MIH, PhD and Nicholas I Paton, MD: Department of Infectious Diseases, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore; Kee Tai Goh, MD: Ministry of Health, Singapore. ABSTRACT -------------------------------------------------------------------------------- Background: The importation of SARS was responsible for the outbreaks in Singapore, Hong Kong, Vietnam and Canada at a time when this new disease had not been identified. We report the incidence and impact of cases of SARS imported to Singapore between 25 February and 31 May 2003, and describe national measures to prevent further importation. Methods: Information on imported cases of SARS and measures taken at entry points to Singapore was retrieved from the Ministry of Health and the Civil Aviation Authority of Singapore. Results: Of the 6 imported cases, which all occurred before screening measures were implemented at the airport, only the first resulted in extensive secondary transmission. Of 442,973 air passengers screened after measures were implemented, 136 were sent to a designated hospital for further SARS screening; none was diagnosed as having SARS. Conclusions: The SARS outbreak in Singapore can be traced to the first imported case. The absence of transmission from the other imported cases was probably a result of relatively prompt identification and isolation of cases, together with a low potential for transmission. New imported SARS cases therefore need not lead to major outbreaks if systems are in place to identify and isolate them early. Screening at entry points is costly, has a low yield and is not sufficient in itself, but may be justified in light of the major economic, social and international impact which even a single imported SARS case may have.

To: Maurice Winn who wrote (770)	10/20/2003 1:01:35 PM
From: Henry Niman	Respond to of 1070

The latest WHO report notes some interesting observations on the host range of SARS CoV. The earlier Science report showed that masked palm civets and a raccoon dog were infected with a SARS CoV which represents the animal reservoir. The virus from the civets was virtually identical to the raccoon dog and was greater than 99% homologous to SARS CoV from humans. The WHO report on Amoy Gardens indicates that at least 8 cats and 1 dog were PCR positive for SARS CoV and virus was isolated from at least one cat. This virus was virtually identical to human SARS CoV, which would suggest it contained the 29 nt deletion as well as the 4 dozen mutations seen in Amoy Garden SARS CoV isolates. There was no indication that the cats or dog were ill, even though they harbored a virus that was quite lethal in humans. WHO has maintained that SARS CoV was put back in the box and a re-emergence would likely come from a wild animal reservoir. If re-emergence sole came from wild animals in Guangdong Province, then public awareness and government precautions may limit the transmission, especially of the virus has to once again go through a series of mutations, including a 29 nt deletion. However, if the fully mutated virus readily replicates in asymptomatic pets, then the possibility that a re-emergence from multiple sources in previously hard hit areas would be increased. It is not clear how many cats were tested, but the report seemed to indicate hat only 2 dogs were tested and one was positive. Similarly, in Shenzhen only one raccoon dog was tested, and it was positive (as were 6/6 civets). As fall and winter approach in the northern hemisphere, a more comprehensive screening of pets traced to SARS CoV positive patients might be revealing.