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Cases of Respiratory Illness Multiply Across Southeast Asia, Canada
By Jennifer Warner
March 17, 2003 -- Health officials across the globe are racing to unravel the mystery behind a dangerous and potentially deadly pneumonia-like illness that has spread quickly throughout Southeast Asia and now has taken root in North America.
So far, the World Health Organization (WHO), which has issued a rare global alert, says 167 cases, including four deaths, of the unknown disease identified only as severe acute respiratory syndrome (SARS) have been documented, and new clusters have been reported in Canada.
Although no cases have been confirmed in the U.S., CDC officials have issued a travel health alert and warned health care providers to be on the lookout for suspicious illnesses among travelers who have recently returned from Southeast Asia. Officials say that two people thought to have the condition recently traveled to New York City and Atlanta, but there is no immediate cause for concern in this country.
The CDC health alert advises travelers to Southeast Asia that if they become ill with a fever and respiratory symptoms, such as cough or difficulty breathing, within seven days of travel to affected areas, they should immediately contact their doctor. A related travel advisory also states that U.S. citizens planning nonessential travel to the regions affected by the outbreak may wish to postpone their trips until further notice.
"To date, we have not been able to identify an agent responsible for the outbreak," says Health and Human Services Secretary Tommy Thompson, in a briefing held in conjunction with the CDC today. "We are taking it very seriously and taking all prudent steps to ensure the maximum safety and health of all Americans."
Several international laboratories are currently analyzing samples in an attempt to determine the cause of the illness, but they do not know yet whether the disease is caused by a bacteria or virus. Officials say at this time there is no evidence to suggest that this illness might have unnatural causes or is an example of bioterrorism.
CDC Director Julie Gerberding, MD, says the pattern of transmission of the disease is what would normally be expected from a contagious respiratory or flu-like illness, but the CDC is keeping an open mind about the issue.
Investigators say the disease seems to spread only through close contact with an infected individual, such as having lived with, cared for, or having had direct contact with respiratory secretions and body fluids with a person that has it.
The WHO defines a case of the mysterious illness as someone with:
A fever of greater than 100.4 degrees;
One or more of following respiratory symptoms: cough, shortness of breath or difficulty breathing;
And either close contact with a known SARS case or a history of travel to one of the affected areas within the last 10 days before the emergence of symptoms.
Based on that broad definition of the illness, Gerberding says the center has received reports of 14 persons in the U.S. who meet that criteria and are currently being evaluated, but none of those cases have been confirmed.
Gerberding says that because the cause of the illness has not been identified, the CDC recommends that doctors treat the condition as they would any other unexplained pneumonia case, including treatment with antibiotics.
WHO says the first cases of the unknown disease were identified on Feb. 26 in Hanoi, Vietnam and then rapidly spread to Hong Kong, Singapore, China, and Thailand. Over the weekend, a group of seven cases was confirmed in Canada, and two died. All of the Canadian cases were among two extended families in which at least one member had recently traveled to Hong Kong within a week of developing symptoms.
One of those Canadian family members recently visited Atlanta in early March and was reported to have developed symptoms of the illness as she left the U.S. to return to Canada. The Georgia State Health Department is currently investigating the possibility of exposure to the illness among her American contacts and co-workers.
Gerberding says symptoms of SARS seem to appear within seven days of exposure, and they are reassured by the fact that none of the Canadian's contacts in Georgia have developed symptoms.
"There is no evidence that people without direct contact with an infected individual are at risk," says Gerberding, who also spoke at today's briefing.
She says the illness seems to be spread only through direct, face-to-face contact, and there is no evidence to suggest that the disease may be spread through casual contact.
The WHO say most of the cases have occurred in people who have had very close contact with other known cases, and more than 90% of those who have become ill with the condition are health care workers.
A doctor from Singapore who treated a patient with SARS in Singapore also became ill after attending a medical conference in New York City. The individual boarded a flight from New York to Frankfurt, Germany and was transferred to an isolation unit in Frankfurt as soon as the flight landed on March 15.
SOURCES: CDC Telebriefing, March 17, 2003. News release, World Health Organization, March 16, 2003. News release, CDC.
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