S evere A cute R espiratory S yndrome (SARS): Basics Update May 8, 2003

1. Severe Acute Respiratory Syndrome (SARS): BasicsUpdate 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

2. Overview • This lecture is divided in five sections and will be updated weekly as new events unfold. • Background • Epidemiology • The Virus • The Disease • Infection Control • Discussion

3. PART I: Background

4. Model of disease causation Dynamic interaction Change in components alters equilibrium Infected/Infectious patient host environment agent environment Contaminated objects reservoir Colonized persons

5. Koch’s postulates • Organism is found with the disease in accordance with lesion and the clinical stage observed • The same organisms must be grown in pure culture from the diseased host • The same disease is reproduced when a pure culture of the organism is inoculated into a healthy host • The organism must be recovered from experimentally infected hosts.

6. 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

7. 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)

8. 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

9. 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

10. 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)

11. 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)

12. 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)

13. (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.

14. April 1 - Germany 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 72-year-old man who fell ill after returning from the Far East is being treated at the hospital for SARS. (AP Photo/Martin Meissner)

15. 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.

16. Money Changer Wears Protective MaskA 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.

17. 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.

18. Brian Fairrington, The Arizona Republic, 4/24/03

19. 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.

20. Scott Stantis, The Birmingham News, 4/2/03

21. (AFP/File/Sebastian D'Souza) The Indian carrier's pilots are refusing to fly to Hong Kong due to the deadly outbreak of SARS

22. Disinfecting Plane From Hong KongMaintenance 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.

23. April 2 – Vancouver, Canada Selling Surgical Masks 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. (AP Photo / CP, Chuck Stoody)

24. April 2 – Amoy Gardens, Hong Kong 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. (AP Photo / Anat Givon)

25. 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

26. Kim Song Heng, Singapore, Lianne Zaobao, 4/28/03

27. 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. (AP Photo/Str)

28. 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.

29. April 10 - Amoy Gardens, Hong Kong 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. (AP Photo/Anat Givon)

30. April 10 - Philippine 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. (AP Photo/Aaron Favila)

31. Passengers Arrive From Hong KongPassengers 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.

32. 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)

33. 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)

34. 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)

35. April 11, Telford Garden – Hong Kong Health authorities have 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. (AP Photo/Anat Givon)