PAHO Warns On Pneumonia, Urges Surveillance in the Americas

Washington, DC, 17 March 2003 (PAHO)--The Pan American Health Organization (PAHO) today asked the countries of the Americas to be alert in light of the emergence of cases of an unusual form of pneumonia, caused by a yet-unidentified virus or bacteria resistant to existing drugs.

Reports of over 150 cases of Severe Acute Respiratory Syndrome (SARS), an atypical pneumonia of unknown origin, have been received by the World Health Organization (WHO) since 26 February 2003. Nine of these cases, in nine countries, have been fatal. . In the Americas six probable cases have been reported in Canada, all members of a family that had traveled to Hong Kong in February.

PAHO’s Deputy Director of PAHO, Dr. David Brandling-Bennett, said the Organization has asked its member countries in the Americas to be on the lookout for any cases of this rare pneumonia. “We have to strengthen our epidemiological surveillance, maintain flow of the information and request our countries to be on alert and immediately report any suspected case,” he said.

The disease is spread from person to person but only through close contact with a case. To date, almost all reported cases have occurred in health workers involved in the direct care of reported cases or in close contacts, such as family members. There is no evidence to date that the disease spreads though casual contact. Various specimens have been collected from cases and postmortem examinations. A wide range of laboratory tests have been conducted to date but no agent has been definitively identified. Laboratory investigations are continuing.

WHO is coordinating the international investigation of this outbreak and working closely with health authorities in the affected countries to provide epidemiological, clinical and logistical support as required. The mode of transmission and the causative agent have yet to be determined. Aerosol and/or droplet spread is possible as is transmission from body fluids. Respiratory isolation, strict respiratory and mucosal barrier nursing are recommended for cases. Cases should be treated as clinically indicated.

Although it still has not been classified, this disease has been called Severe Acute Respiratory Syndrome (SARS). The main symptoms and signs include high fever (over 38 degrees C), cough, and shortness of breath or breathing difficulties. A proportion of patients with SARS develop severe pneumonia; some of them have needed ventilator support. What is most relevant is that, to date, patients do not respond to existing drugs, it is very contagious and can expand through contact with people that have traveled to southeast Asia.

Chinese authorities have now issued a summary report on an outbreak of what may be the same or a related disease that began in Guangdong province in southern China in November and peaked in mid-February. The Chinese report, which includes data on the diagnosis and management of more than 300 cases, is presently undergoing analysis and is expected to further contribute to understanding about the syndrome and possible links among the various outbreaks. The Chinese report, which covers the largest number of cases to date, may also boost international efforts to establish effective treatment guidelines, should a relationship between the outbreaks be established. The Ministry of Health of China has requested support from an international team. A WHO team is now being assembled.

Health authorities around the world are now alert to the risk of SARS. Tracking of the course of the epidemic shows that surveillance systems are sensitive, communication channels are open, and reporting is rapid. Information on cases compiled over the past three weeks is expected to shed new light on the behavior of this disease.

The speed of international travel creates a risk of rapid spread to additional areas. Because the clinical course and epidemiological behavior of this disease are poorly understood, WHO is calling upon national health authorities to maintain close vigilance for suspected cases. There is no current justification for any restriction in travel or trade.

In Canada, seven cases have been reported and two people have died. The cases have occurred in two separate extended family clusters, and in both families at least one person had recently traveled to Hong Kong. On March 15, a health care worker from Singapore who was visiting New York boarded a flight from New York to Frankfurt. The health care worker had recent close contact with a reported case of SARS in Singapore and was ill. German health authorities were notified and the health care worker was transferred to an isolation unit in Frankfurt as soon as the flight landed. There is no evidence of transmission in Germany.

In Vietnam, on February 26, 2003, a man, called the index or first case was admitted to hospital in Hanoi with a high fever, dry cough, myalgia and mild sore throat. Over the next four days he developed increasing breathing difficulties, severe thrombocytopenia, and signs of Adult Respiratory Distress Syndrome and required ventilator support. Despite intensive therapy he died March 13. On March 5, seven health care workers who had cared for the index case also became ill (high fever, myalgia, headache and less often sore throat). The onset of illness ranged from 4 to 7 days after admission of the index case. So far, 43 cases have been reported in Viet Nam. At least five of these patients are currently requiring ventilator support. Two deaths have occurred. With the exception of one case (the son of a health care worker) all cases to date have had direct contact with the hospital where the index case had first received treatment.

In Hong Kong, some 20 health care workers developed influenza-like symptoms on March 12, (high fever, headache and lower respiratory symptoms). Since then the number of reported cases has increased daily. Over 100 reported cases have been hospitalized, and at least two of then are receiving ventilatory support. One death, the index case from Viet Nam has been reported. The Ministry of Health in Singapore on March 13 reported three cases of SARS in people who had recently returned to Singapore after traveling to Hong Kong Special Administrative Region of China. Since then 13 additional cases have been reported, all persons who had very close contact with one or more of the initial three cases. One case was reported in Thailand in a person who had close contact with the Hanoi index case.

PAHO, established in 1902, is the world's oldest public health organization. It works with all the countries of the Americas to improve the health and quality of life of their inhabitants. It also serves as the Regional Office for the Americas of the World Health Organization.

For more information, video material, or photographs please contact: Daniel Epstein, Office of Public Information, (202) 974-3459, e-mail: epsteind@paho.org.