PROMED REPORT 24
SARS WORLDWIDE SICK: 2223 / DEAD: 78
Wed Apr 2 18:27:03 2003
208.152.73.31

SARS WORLDWIDE SICK: 2223 / DEAD: 78


-------- Original Message --------
Subject: PRO/EDR> SARS - worldwide (24): cases
Date: Wed, 2 Apr 2003 16:14:36 -0500 (EST)
From: promed@promed.isid.harvard.edu
Reply-To: promed@promed.isid.harvard.edu
To: promed-edr@promedmail.org


SARS - WORLDWIDE (24): CASES
**********************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases


[We have chosen to post all of the WHO updates from today, including part of
a press release so that the record would be "straight from the horse's
mouth" to counteract whatever additional sensationalism may be occurring
outside of these official releases. - Mod.MPP]

In this update:
[1] Worldwide cases, deaths, affected areas - WHO
[2] Travel advice, Hong Kong SAR, Guangdong Province, China - WHO
[3] Press release, China investigation and travel advice - WHO
[4] China investigation - WHO


******
[1]
Date: 2 Apr 2003
From: ProMED-mail
Source: WHO SARS website



[A] Cumulative Number of Reported Cases of Severe Acute Respiratory
Syndrome (SARS)


From: 1 Nov 2002 (1) To: 2 Apr 2003, 16:00 GMT+2

Country: Cumulative no. case(s)/ No. deaths/ Local chain(s) of
transmission(2)
Australia: 1/ 0/ None
Belgium: 1/ 0/ None
Canada: 58/ 6/ Yes
China: 1190/ 46/ Yes
China, Hong Kong SAR: 708/ 16*/ Yes
China, Taiwan: 13/ 0/ Yes
France: 1/ 0/ None
Germany: 5/ 0/ None
Italy: 3/ 0/ None
Republic of Ireland: 2/ 0/ None
Romania: 3/ 0/ None
Singapore: 95/ 4/ Yes
Spain: 1/ 0/ None
Switzerland: 2/ 0/ None
Thailand: 7/ 2/ None
United Kingdom: 3/ 0/ None
United States: 72§/ 0/ To be determined
Viet Nam: 58/ 4/ Yes

Total: 2223/ 78

Notes:

Cumulative number of cases includes number of deaths.

1. The start of the period of surveillance has been changed to 1 Nov 2002
to capture cases of atypical pneumonia in China that are now recognized as
being cases of SARS.

2. National public health authorities report to WHO on the areas in which
local chain(s) of transmission is/are occurring. These areas are provided
on the list of Affected Areas.

§Due to differences in the case definitions being used at a national level,
probable cases are reported by all countries except the United States of
America, which is reporting suspect cases under investigation.

*One death attributed to Hong Kong Special Administrative Region of China
occurred in a case medically transferred from Viet Nam.

[B] Affected Areas 2 Apr 2003



Affected Areas - Severe Acute Respiratory Syndrome (SARS)
--------------------

Country: Area

Canada: Toronto
Singapore: Singapore
China: Guangdong, Hong Kong Special Administrative Region of China, Shanxi,
Taiwan Province
Viet Nam: Hanoi

An affected area: an area in which local chain(s) of transmission of SARS
is/are occurring as reported by the national public health authorities.

--
ProMED-mail


******

[2]
Date: 2 Apr 2003
From: ProMED-mail
Source: WHO SARS website 2 Apr 2003


Update 17 - Travel advice - Hong Kong SAR China, and Guangdong Province,
China
------------------------------------------------------
The outbreak of severe acute respiratory syndrome (SARS) continues in the
affected areas* : Canada (Toronto), China (Guangdong Province, Hong Kong
SAR China, Shanxi Province, Taiwan Province), Singapore (Singapore),
Vietnam (Hanoi). The agent causing SARS is under intensive international
study, but as of today it has not been fully characterized, and there is no
vaccine or other prophylaxis available.

Since WHO issued the global alert on 12 Mar 2003
national authorities
have implemented heightened surveillance for cases of SARS, and where such
cases have been identified their prompt isolation has prevented further
spread of the disease in virtually all countries. For instance the outbreak
in Hanoi has passed its peak and no new cases have been identified for the
last week. Last week WHO issued recommendations aimed at further limiting
the spread of SARS and protecting international air passengers. These
recommendations still apply -- see WHO recommends new measures to prevent
travel-related spread of SARS at:


The SARS situation in Hong Kong SAR has developed features of concern: a
continuing and significant increase in cases with indications that SARS has
spread beyond the initial focus in hospitals. These developments have
suggested environmental routes of transmission from a SARS infected person
which may be related to contamination of common systems that link rooms or
flats together. Despite the implementation of strict measures to control
the outbreak, there have continued to be a small number of visitors to Hong
Kong who have been identified as SARS cases after their return from Hong
Kong. The epidemic in Guangdong Province of China, situated adjacent to
Hong Kong, is the largest outbreak of SARS reported and has also shown
evidence of spread in the wider community.

***As a measure of precaution WHO is now recommending that persons
travelling to Hong Kong and Guangdong Province of China consider postponing
all but essential travel. This temporary recommendation will be reassessed
in the light of the evolution of the epidemic in the areas currently
indicated, and other areas of the world could become subject to similar
recommendations if the situation demands. Please note that this
recommendation applies only to travellers entering Hong Kong SAR China and
Guangdong Province of China, not to passengers directly transiting through
international airports within those areas..***[asterisks added by ProMED -
Mod.JW].

* WHO has defined affected areas as an area in which local chain(s) of
transmission of SARS is/are occurring as reported by the national public
health authorities. The list of areas changes over time and the latest
update can be found at: Affected Areas - Severe Acute Respiratory Syndrome
(SARS)

--
ProMED-mail


******
[3]
Date: 2 Apr 2003
From: ProMED-mail
Source: WHO SARS website



Update 18 - SARS outbreak:WHO investigation team moves to China, new travel
advice announced
Press release issued by WHO 2 Apr 2003
------------------------------
The World Health Organization (WHO) today said that the Government of China
had announced the WHO expert team currently in Beijing will travel to
Guangdong Province to investigate the SARS outbreak there. "These are very
positive steps taken today by China," said Dr David Heymann, Executive
Director of Communicable Diseases at WHO. "As a result we'll be able to
gather even more evidence about the nature of the SARS outbreak in China."

***In addition, WHO began recommending that persons travelling to Hong Kong
SAR and Guangdong Province, China consider postponing all but essential
travel. This updated travel advice comes as a result of new developments,
particularly in Hong Kong, in the multi-country outbreak of Severe Acute
Respiratory Syndrome (SARS). This temporary recommendation will be
reassessed daily as the epidemic evolves. The recommendation does not apply
to passengers simply transiting through airports in Hong Kong Special
Administrative Region or Guangdong Province, China.***[asterisks added by
ProMED - Mod.JW].

The new travel advisory is intended to limit the spread of SARS by reducing
travel to high risk areas. All other elements of Severe Acute Respiratory
Syndrome (SARS) WHO previous travel guidance still stand.

The SARS situation in Hong Kong SAR, China has developed unique features.
There is a continuing and significant increase in cases* with indications
that SARS has spread beyond the initial focus in hospitals. These
developments raise questions related to other possible routes of
transmission of SARS. These may involve transport of the virus from one
person to another via some type of environmental means. To date, no
satisfactory explanation has been found regarding this possibility. Also,
since 19 Mar 2003, 9 travellers have been identified as SARS cases on
returning from a visit to Hong Kong SAR of China.

Many questions about the state of the outbreak in Guangdong Province, China
which borders Hong Kong have yet to be answered. The Guangdong outbreak is
the largest reported and has also shown evidence of spread in the wider
community. New information provided today by provincial authorities of more
than 300 new cases in March [2003] alone indicates the outbreak there
continues.

Unprecedented global cooperation helps advance knowledge and containment of
SARS
--------------
In the 4 weeks that WHO has been tracking SARS much has been learned. This
is largely because scientists, clinicians, laboratory chiefs and public
health officials everywhere have collaborated closely.

As a result of WHO's global alert issued on 15 Mar 2003, national
authorities have implemented heightened surveillance for cases of SARS.
While an increasing number of countries are reporting new cases, these
cases are quickly identified, patients are isolated and local transmission
is stopped in most countries.

It is now known that infection control methods work to contain the spread
of SARS in hospitals, even in countries which do not have the most modern
equipment.

WHO and a network of 11 of the world's top laboratories are zeroing in on
the cause of SARS and a diagnostic test is being developed. This test will
help distinguish between those who are infected and those who are free of
the SARS virus.

The laboratory network is continuing its investigations. So far, the agent
causing SARS has not been fully characterized and there is no certain
treatment, vaccine or known other preventative measure.

"There will be other new diseases that will emerge in the future, and we
will respond just as we have with SARS -- with maximum efforts to contain
its spread," stated Dr Guénaël Rodier, Director, Communicable Disease
Surveillance and Response, WHO.

* Cases of SARS and the countries in which they appear are posted on the
WHO web site every evening in Geneva, Switzerland.

--
ProMED-mail


******
[4]
Date: 2 Apr 2003
From: ProMED-mail
Source: WHO SARS website 2 Apr 2003


Update 19 - China deepens its collaboration to contain SARS, WHO revises
its advice to international travellers as new data come in
---------------------------
New data from China, WHO team leaving immediately for Guangdong

Chinese authorities have today announced updated figures for the number of
cases of severe acute respiratory syndrome (SARS) and deaths in Guangdong
Province. The figures, which cover the reporting period of 1 to 31 Mar
2003, are 361 new SARS cases and 9 deaths.

Chinese authorities had previously reported 792 cases and 31 deaths in
Guangdong Province in the reporting period of 16 Nov 2002 to 28 Feb 2003.
The cumulative total of SARS cases in Guangdong from 16 Nov 2002 to 31 Mar
2003 now stands at 1153 cases and 40 deaths.

The Chinese Ministry of Health has further announced that a 5-person WHO
team will be travelling immediately to Guangdong Province to confer with
officials there. Chinese experience with the oldest SARS outbreak is
expected to yield epidemiological and clinical clues useful in establishing
policies to contain outbreaks elsewhere and prevent further international
spread.

Many questions about the outbreak in Guangdong Province, which borders Hong
Kong, have yet to be answered. This outbreak is the largest reported to
date and has also shown evidence of spread in the wider community.

No transmission of new cases is being reported elsewhere in the country.
Chinese authorities are in the process of setting up a reporting system
that will result in daily real-time reporting of SAS cases throughout the
country.

New advice to travellers
--------------------
On the basis of new data from China and Hong Kong, WHO has today revised
its advice to international travellers as a measure for preventing the
further international spread of SARS.

In a press release this morning, WHO issued the following advice:

***"The World Health Organization (WHO) today began recommending that
persons travelling to Hong Kong Special Administrative Region of China and
Guangdong Province, China consider postponing all but essential travel. This
updated travel advice comes as a result of new developments in the
multi-country outbreak of severe acute respiratory syndrome
(SARS)."***[asterisks added by ProMED - Mod.JW].


The new travel advice is intended to limit further international spread of
SARS by restricting travel [into] areas where the transmission patterns of
SARS
are not fully understood. The SARS situation, which is rapidly evolving, is
under constant assessment by WHO in collaboration with three global
networks of experts. The new advice is issued as part of a series of
measures that will change as more information about SARS becomes available.

New data on international spread
-----------------------------
Overnight, WHO received reports on 9 persons, with a history of travel to
Hong Kong dating from 15 Mar 2003, who subsequently developed symptoms
suggesting probable cases of SARS when they travelled to other countries.
These 9 cases of probable SARS, related to travel in Hong Kong, occurred in
Taiwan, Province of China, and Singapore. The data on these cases, and what
is known about the incubation period of SARS, indicate that travel to Hong
Kong can contribute to the international spread of SARS.

15 Mar 2003 is the date when WHO issued its first SARS-related emergency
travel advisory, which increased global awareness of this new disease, made
travellers and health staff alert to symptoms, and initiated prompt
reporting of cases.

The SARS outbreak in Hong Kong SAR has developed an unusual pattern of
transmission. This pattern is different from what is being seen in the vast
majority of other SARS outbreaks, and is not yet fully understood. The
number of cases is continuing to increase significantly, and there is
evidence that the disease has spread beyond the initial focus in hospitals.

These developments raise questions related to other routes of transmission,
in addition to well-documented face-to-face exposure to droplets released
when an infected person coughs or sneezes. Epidemiologists are considering
whether SARS is being transmitted in Hong Kong by some environmental means
for which no satisfactory explanation has been found. Particular concern
centres on a large cluster of cases linked to residential buildings in the
Amoy Garden housing estate in the Kowloon [mainland] district of Hong Kong.

Historical perspective
---------------
This is the first time in the history of WHO that such travel advice has
been issued for specific geographical areas because of an outbreak of an
infectious disease.

Since 1958, WHO has issued weekly lists of areas infected with
quarantinable diseases so that national authorities can decide whether to
apply public health measures to arriving travellers. During the last years
of the smallpox eradication campaign cases spread internationally by land.
Controls at borders between neighbouring countries were relied on to
prevent international spread. No global recommendations were necessary.

--
ProMED-mail


[Our continuing thanks and gratitude to Marianne Hopp for
her role as WHO notifications rapporteur.

The major increase in reported cases in the past 24 hours (from 1804 cases
and 62 deaths to 2223 cases and 78 deaths) is primarily attributable to the
361 cases and 9 deaths reported to have occurred in Guangdong China during
the period 1-31 Mar 2003, and represent a one month incidence and not a 24
hour incidence increase. The 24 hour increase in cases is 58, of which
there were 23 in Hong Kong, another 23 were in [mainland] China.

Other areas with increases in reported cases include Canada with 5,
Singapore with 3, & United States with 3. Neither
Viet Nam nor Taiwan have reported new cases in the past 24 hours.

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