Transcript No Slide Title

Responding to SARS
John Watson
Health Protection Agency
Communicable Disease
Surveillance Centre, London
November 2002
• Outbreak of pneumonic illness in
Guangdong province of southern China
11 February 2003
• China declares outbreak of pneumonia
in Guangdong province
• 300 cases and 5 deaths
20 February 2003
• Chicken ‘flu (influenza A H5N1) in Hong
Kong
• Outbreak in a family linked to southern
China
• Two deaths among four ill
• Two cases confirmed influenza virus
infection
11 March 2003
• Hong Kong reports outbreak of “acute
respiratory syndrome” among hospital
workers
12 March 2003
• WHO reports to all countries the
occurrence of outbreaks in Hong Kong
and Hanoi (Vietnam) as well as earlier
outbreak in China
• WHO recommends isolation of cases
and surveillance by national health
authorities
13 March 2003
• Information prepared in UK
• CMO cascade (to all doctors) activated
and Eurosurveillance published
• CDR publication delayed to next
morning due to network problems
14 March 2003
• WHO reports outbreaks in Singapore
and Taiwan
• WHO worker ill in Hanoi
• WHO seeking field experts
• Aetiology still unknown
15 March 2003
• WHO declares Severe Acute
Respiratory Syndrome (SARS) a
worldwide health threat
• Cases in Canada, Indonesia, Thailand
and Philippines
• WHO guidance about travel to SouthEast Asia
Sunday, 16 March 2003
• First UK-wide teleconference
Clinical features
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Incubation period 2-7 (?) days
Influenza-like illness
High fever
Cough, shortness of breath
Other systemic symptoms
Clinical features
• Recovery in many
• Progression in some
– pneumonia
– acute respiratory distress syndrome
• Death in 3-5%
• No response to anti-bacterial or antiviral agents
Epidemiological features
• Spread to close contacts
– droplet spread or direct contact with body
fluids
• Infectious when severely ill
• Explosive outbreaks
– Metropole Hotel
• International spread
Global SARS situation – 13 May 2003
• Total cases – 7458 (deaths 573 – 7.7%)
• Hong Kong – 1689 (23%)
• Taiwan – 207 (3%)
• China (mainland) – 5086 (68%)
• Singapore – 205 (3%)
• Vietnam – 63 (1%)
• Canada – 143 (2%)
Global SARS situation – 13 May 2003
• Total cases – 7458 (deaths 573 – 7.7%)
• Hong Kong – 1689 (23%)
• Taiwan – 207 (3%)
• China (mainland) – 5086 (68%)
• Singapore – 205 (3%)
• Vietnam – 63 (1%)
• Canada – 143 (2%)
UK results to 14 May 2003
• Total calls 380
• 8 initial ‘probable’ cases
– 4 other diagnoses (1 mycoplasma, 3 ‘flu A)
– 4 current, all recovered
• 159 initial ‘suspect’ cases
– 63 (40%) recovered
– 54 (34%) still ill
– 42 (26%) other diagnoses
• ‘not a case’ - 178
Why is SARS so dangerous?
• Lethal – 15 - 20% mortality in hosptialised
patients
• Spread via respiratory route
• Capable of sudden amplification in hospitals
and cities
• Vulnerability of health care staff
• Can spread quickly internationally
• Not easily controlled cf other emerging
infections
Early response in UK
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Surveillance system
Laboratory strategy and guidance
Guidance for health care professionals
Travel guidance
Public information
WHO definitions for surveillance
• Suspect
– >38 C
– Cough or other respiratory symptom
– Affected area within previous 10 days
• Probable
– as above with evidence of changes on
chest x-ray
Early response in UK
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•
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Surveillance system
Laboratory strategy and guidance
Guidance for health care professionals
Travel guidance
Public information
Summary management of a SARS case
Early response in UK
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Surveillance system
Laboratory strategy and guidance
Guidance for health care professionals
Travel guidance
Public information
UK Case definitions for SARS
Suspect LOW
A person presenting after 1 Feb 2003 with sudden
onset of:
high fever (>38°C)
And
cough or difficulty breathing
And
travelled in the 10 days before onset of illness to an
area in which there is more than 'limited' local
transmission of SARS during the travel period.
WHO website <http://www.who.int/csr/sarsareas/en/>)
UK Case definitions for SARS
Suspect HIGH
A person presenting after 1 Feb 2003 with sudden
onset of:
high fever (>38°C)
And
cough or difficulty breathing
And
had close contact with a probable SARS case from
an affected area in the 10 days before onset of
symptoms
UK Case definitions for SARS
Probable case
Either:
A suspect (Low or High) case with:
• chest x-ray findings of pneumonia and no response
to standard antimicrobial treatment or
• respiratory distress syndrome (RDS)
or
Death due to an unexplained respiratory illness with
autopsy findings of RDS without identifiable cause in
a person who travelled to an affected SARS area
within 10 days of illness.
Follow-up
• Follow-up categories
• Still ill
• Recovered = afebrile for at least 48 hours AND
cough, if present, resolving
• Dead
Follow-up forms faxed or emailed to CDSC
48 hours after the date of report
ten days after the date of report and/or
A final follow-up form once the patient is asymptomatic
15
/0
18 3/2
/0 0
20 3/2 03
/0 0
22 3/2 03
/0 0
24 3/2 03
/0 0 0
26 3/2 3
/0 0
28 3/2 03
/0 0
31 3/2 03
/0 0
02 3/2 03
/0 0
04 4/2 03
/0 0
06 4/2 03
/0 0
08 4/2 03
/0 0
10 4/2 03
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12 4/2 03
/0 0
15 4/2 03
/0 0
17 4/2 03
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21 4/2 03
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23 3/2 03
/0 0 0
25 4/2 3
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27 4/2 03
/0 0
30 4/2 03
/0 0 0
4/ 3
20
03
No. of reports
CDSC SARS Surveillance
35
30
25
20
Other reports
Probable and suspected
cases
15
10
5
0
Date of reports