EID Weekly Updates:Emerging and Reemerging Infectious Diseases, Region of the AmericasVol. 2, No. 17—29 April 2004
Sequence of Events, 2004 The first case reported to WHO on 22 April involved a 20-year-old nurse who developed symptoms compatible with the illness in Beijing on 5 April, and who was hospitalized in Beijing hospital on 7 April and was subsequently transferred to another hospital on 14 April. The patient is receiving intensive care. On 23 April, WHO reported the existence of three other cases:
On 26 April, WHO reported the existence of 4 new cases still classified as probable, all of whom have had close contact with the 20-year-old nurse who took care of the female student in the Beijing hospital. These new cases all appeared in Beijing, with the onset of symptoms between 16 and 19 April. One of them is in critical condition; the rest are stabilized. On 28 April, the Chinese authorities reported to WHO the detection of yet another SARS case, as yet unconfirmed. This new case involves a 49-year-old female doctor who was admitted to the same hospital as the nurse, but for another reason. She began to develop symptoms compatible with SARS on 19 April and was transferred to a hospital in Ditan and put into isolation. On 29 April, WHO announced the confirmation of 2 cases related to the nurse by reason of clinical profile, laboratory results and epidemiological linkage. Both belong to the third generation of cases. Conclusions These are the first SARS cases since January of this year, when the Guandong authorities reported the existence of 4 cases (3 confirmed and 1 probable) where the probable source of infection was environmental. If it is indeed determined that the source of infection was the National Institute of Virology in Beijing, this will be the first outbreak caused by laboratory transmission. This kind of event probably produces a different pattern of illness and transmission. In September and December 2003, 2 cases were reported (in Singapore and Taiwan) where the source of infection was associated with a laboratory. Both cases recovered completely and there wasn’t any further transmission. In the current outbreak, all the cases are linked to chain of transmission, which indicates transmission involving close personal contact. There is no evidence of widespread airborne transmission in the community, although some recent studies suggest that this type of event could have occurred in last year’s outbreak. To date, a total of 9 cases and 1 death have been reported. Of the 9 cases, 2 have been confirmed and 7 are as yet unconfirmed, since the WHO surveillance guidelines stipulate that to classification as confirmed cases requires independent verification of laboratory test results by an external international reference laboratory. Of these 9 cases, 7 are from Beijing and 2 from Anhui. Nearly 1,000 close contacts have been identified that are now under observation, 70% of them in Beijing and 30% in Anhui. WHO recognizes the possibility of additional exposure having taken place, since the patients were treated in 7 different hospitals (5 in Beijing and 2 in Anhui) and 2 of the people involved had traveled within the country over a wide area. The Chinese authorities have intensified surveillance and follow-up activities with these contacts, besides taking various environmental samples from the places where the cases occurred to determine the source of infection. Additional Information
Source: Severe Acute Respiratory Syndrome (SARS). Geneva: World Health Organization (WHO). Outbreak of Acute Diarrhea in the Town of Rojas, Buenos Aires Province, Argentina This past 25 March, PAHO received a report of an outbreak of acute diarrhea in the town of Rojas, Province of Buenos Aires, Argentina. This discovery spurred intensive surveillance activity for waterborne diseases, which include acute diarrheas, viral hepatitis, and hemolytic uremic syndrome (HUS). By 6 April 2004, a total of 3,165 cases of diarrhea had been reported, with a cumulative incidence of 1,385 for every 10,000 inhabitants, with 102 cases requiring hospitalization. The highest incidence rates occurred between 29 March and 1 April; with the trend diminishing from that time to the date of the report (see Figure 1). The population most affected has been children between the ages of 1 and 4. According to the laboratory results available to date, Shigella has been isolated in 24 of the 159 feces cultures carried out (15 with Shigella flexneri and 8 with Shigella sonnei), and Escherichia coli in 12 (with one isolated case of enterotoxigenic Escherichia coli). Three suspected cases of Hepatitis A were detected, two of which were ruled out and one confirmed. Up to now, there have been no reported cases of HUS. Bacteriological analysis of the water from the Partido de Rojas system was conducted between 21 March and 1 April, where the presence of coliforms was above the maximum acceptable levels; some samples also showed E. coli.
Source: Data compiled by Pan American Health Organization / World Health Organization (PAHO/WHO), Communicable Disease Unit, Emerging and Reemerging Diseases, based on annual reports from the countries participating in the Antimicrobial Resistance Surveillance Network. Additional Information
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The Pan American Health Organization Promoting Health in the Americas |
