gidsas chotani, 2003 severe acute respiratory syndrome (sars): basics update may 8, 2003 rashid a....

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Chotani, 2003Chotani, 2003

SSevereevere A Acutecute R Respiratoryespiratory SSyndromeyndrome (SARS): (SARS):

BasicsBasicsUpdate May 8, 2003Update May 8, 2003

Rashid A. Chotani, MD, MPH, MD, MPH

Assistant Professor, School of Medicine, School of Public Health & Assistant Professor, School of Medicine, School of Public Health & Center for International Emergency, Disaster & Refugee StudiesCenter for International Emergency, Disaster & Refugee Studies

Director, Global Infectious Disease Surveillance & Alert SystemDirector, Global Infectious Disease Surveillance & Alert System

Johns Hopkins School of Medicine & Public HealthJohns Hopkins School of Medicine & Public Health

410-614-8330 410-614-8330

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OverviewOverview

I.I. This lecture is divided in five This lecture is divided in five sections and will be updated weekly sections and will be updated weekly as new events unfold. as new events unfold.

II.II. BackgroundBackground

III. Epidemiology

IV. The Virus

V. The Disease

VI. Infection Control

VII. Discussion

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PART I: BackgroundPART I: Background

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Model of disease causationModel of disease causation

host

environmentagent

environment

reservoir

Infected/Infectious patient

Contaminated objects

Colonized persons

Dynamic interactionChange in components

alters equilibrium

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Koch’s postulatesKoch’s postulates

1.1. Organism is found with the disease in Organism is found with the disease in accordance with lesion and the clinical stage accordance with lesion and the clinical stage observedobserved

2.2. The same organisms must be grown in pure The same organisms must be grown in pure culture from the diseased hostculture from the diseased host

3.3. The same disease is reproduced when a pure The same disease is reproduced when a pure culture of the organism is inoculated into a culture of the organism is inoculated into a healthy hosthealthy host

4.4. The organism must be recovered from The organism must be recovered from experimentally infected hosts.experimentally infected hosts.

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Severe Acute Respiratory Severe Acute Respiratory SyndromeSyndrome

First described 26 February in HanoiFirst described 26 February in Hanoi

48 year old business man high fever, 48 year old business man high fever, atypical pneumonia and rapidly atypical pneumonia and rapidly progressing respiratory symptomsprogressing respiratory symptoms

WHO official (Dr Carlo Urbani) in Hanoi WHO official (Dr Carlo Urbani) in Hanoi alarmed by unusual disease alarmed by unusual disease

notified WHO HQ 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: WHO Response: Global SurveillanceGlobal Surveillance

Infectious agentInfectious agent

Possible new agentPossible new agent

Rapid nosocomial transmissionRapid nosocomial transmission

Burden on health care systemsBurden on health care systems

Pandemic potentialPandemic potential

Additional information:Additional information:

H5N1 Hong Kong early February 2003H5N1 Hong Kong early February 2003

Atypical pneumonia Guangdong Province, China Atypical pneumonia Guangdong Province, China Nov 2002 to Feb 2003Nov 2002 to Feb 2003

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WHO Response: WHO Response: Global AlertGlobal Alert

12 March Global Alert12 March Global Alert

15 March WHO Emergency Travel Advisory15 March WHO Emergency Travel Advisory

Increase global awareness of signs and Increase global awareness of signs and symptoms of SARSsymptoms of SARS

Increase global awareness of need for Increase global awareness of need for isolation of suspected cases and isolation of suspected cases and appropriate hospital infection control appropriate hospital infection control measuresmeasures

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An official of the Malaysia Health Ministry's Disease Control Department reads a SARS leaflet at the ministry in Kuala Lumpur, Malaysia.

March 18, Kuala Lumpur, March 18, Kuala Lumpur, MalaysiaMalaysia

(AP Photo/Teh Eng Koon)

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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.

March 31 – Toronto, CanadaMarch 31 – Toronto, Canada

(AP Photo/Frank Gunn)

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March 31 – TorontoMarch 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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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.

(AFP/Peter Parks)

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April 1 - GermanyApril 1 - GermanySenior 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)

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April 1 - ThailandApril 1 - ThailandWoman 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 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 connectedwith Severe Acute Respiratory Syndrome (SARS) so far,

all of them came from overseas high-risk areas.

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April 1 - IndonesiaApril 1 - IndonesiaMuslim 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.April 1, 2003, in San Jose, Calif.

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.

(AP Photo/The San Jose Mercury News, Patrick Tehan)

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

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The Indian carrier's pilots are refusing to fly to Hong Kong due to the deadly outbreak of SARS

(AFP/File/Sebastian D'Souza)

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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.

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April 2 – Vancouver, CanadaApril 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)

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April 2 – Amoy Gardens, Hong KongApril 2 – Amoy Gardens, Hong KongFood 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)

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April 3 – Hong KongApril 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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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.

April 7 – London, EnglandApril 7 – London, England

(AP Photo/Str)

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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.

April 8 – Hong KongApril 8 – Hong Kong

(Bobby Yip/Reuters)

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Medical staff help a tenant Medical staff help a tenant of block E at Amoy of block E at Amoy Gardens in Hong Kong as Gardens in Hong Kong as residents of the block residents of the block which was badly hit by which was badly hit by SARS, returned to their SARS, returned to their homes. Some 240 people homes. Some 240 people were evacuated by the were evacuated by the government from the government from the housing complex and housing complex and spent nine days in holiday spent nine days in holiday camps that were turned camps that were turned into makeshift quarantine into makeshift quarantine centers.centers.

April 10 - Amoy Gardens, Hong April 10 - Amoy Gardens, Hong KongKong

(AP Photo/Anat Givon)

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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.

April 10 - PhilippineApril 10 - Philippine

(AP Photo/Aaron Favila)

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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.

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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.

April 10 – Beijing, ChinaApril 10 – Beijing, China

(AP Photo/Ng Han Guan)

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Director Zhong Nanshan Director Zhong Nanshan of the Guangzhou of the Guangzhou Respiratory Disease Respiratory Disease Research. The top Research. The top Chinese epidemiologist Chinese epidemiologist strongly disputed strongly disputed government claims that government claims that SARS was under SARS was under effective control.effective control.

(AFP/Frederic J.Brown)

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Since the outbreak of severe acute respiratory syndrome, or Since the outbreak of severe acute respiratory syndrome, or SARS, check-in belts at Changi International Airport has SARS, check-in belts at Changi International Airport has

turned quiet in Singapore. Hit by both the effects of SARS and turned quiet in Singapore. Hit by both the effects of SARS and the Iraq war, the Civil Aviation Authority of Singapore shows the Iraq war, the Civil Aviation Authority of Singapore shows that flights scheduled this week have plunged from 1,577 to that flights scheduled this week have plunged from 1,577 to

1,372. (AP Photo/Wong Maye-e)1,372. (AP Photo/Wong Maye-e)

April 11 – Changi Airport, SingaporeApril 11 – Changi Airport, Singapore

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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.

April 11, Telford Garden – Hong April 11, Telford Garden – Hong KongKong

(AP Photo/Anat Givon)

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gidsas chotani, 2003 severe acute respiratory syndrome (sars): basics update may 8, 2003 rashid a....

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