severe acute respiratory syndrome (sars)€¦ · surveillance network partners in asia mekong basin...

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WHO COMMUNICABLE DISEASES • SARS, 15 June 2003 1

Severe Acute Respiratory Syndrome (SARS): Severe Acute Respiratory Syndrome (SARS): Global Alert, Global ResponseGlobal Alert, Global Response

World Health Organization, 15 June 2003World Health Organization, 15 June 2003


Electronic Discussion sitesMedia

NGOs

MilitaryLaboratoryNetworks

WHO Collaborating Centres/Laboratories Epidemiology and

Surveil lance Networks

WHO Regional & Country Offices

Countries/National Disease Control

Centres

UNSister Agencies

FORMALFORMAL

GPHIN

Partnership for global alert and response to infectious Partnership for global alert and response to infectious

diseases: network of networksdiseases: network of networks

INFORMALINFORMAL

2


Surveillance network partners in Asia

Mekong Basin Disease Surveillance (MBDS)

Pacific Public Health Surveillance Network (PPHSN)

ASEAN

APEC

SEAMIC

SEANET

EIDIOR

FluNet


Global Public Health Intelligence Network, CanadaGlobal Public Health Intelligence Network, Canada

3


FluNetFluNet: Global surveil lance of human influenza: : Global surveil lance of human influenza:

Participating laboratories, 2003Participating laboratories, 2003

1 laboratory > 1 laboratory national network


Reports of respiratory infection, WHO global Reports of respiratory infection, WHO global

surveil lance networks, 2002surveil lance networks, 2002––20032003

l 27 November– Guangdong Province, China: N o n-off ic ial report of outbreak of

respiratory i l lness wi th government recommending isolat ion of anyone

wi th symptoms (GPHIN)

l 11 February– Guangdong Province, China: report to WHO off ice Bei j ing of outbreak

o f a typ ica l pneumonia (WHO)

l 14 February– Guangdong Province, China: Off ic ial conf irmation of an outbreak of

atyp ica l pneumonia wi th 305 cases and 5 deaths (China)

l 19 February– Hong Kong, SAR China: Official report of 33- year male and 9 year o ld

son in Hong Kong wi th Avian inf luenza (H5N1), source l inked to Fuj ian

Province, China (Hong Kong, FluNet)

4


Intensified surveil lance for pulmonary infections, WHO Intensified surveil lance for pulmonary infections, WHO

20032003

l 26 February– Hanoi, Viet Nam: Official report of 48-year-o ld bus iness man wi th h igh

fever (> 38 ºC), atypical pneumonia and respiratory fai lure with history of

previous t ravel to China and Hong Kong

l 5 March– Hanoi, Viet Nam: Off ic ia l report of 7 medical staf f f rom French Hospital

reported wi th atypical pneumonia

l Early March– Hong Kong, SAR China Off ic ia l report of 77 medical staf f f rom Hospi tal

reported wi th atypical pneumonia` , WHO teams a r r i ve Hong Kong and

Hanoi , and wi th governments advise on invest igat ion and conta inment

activit ies


Global Alert:Global Alert:

Severe Acute Respiratory Syndrome (SARS)Severe Acute Respiratory Syndrome (SARS)

l 12 March: First global alert

– descr ib ing atypical pneumonia in V ie t Nam and Hong Kong

l 14 March

– Four persons Ontar io, three persons in Singapore, wi th severe atyp ica l

pneumonia f i t t ing descr ipt ion of 12 March a ler t repor ted to WHO

l 15 March

– Medical doctor wi th atypical pneumonia f i t t ing descr ipt ion of 12 March

reported by Ministry of Health, Singapore on return f l ight f rom New York

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Global Alert, 15 March 2003Global Alert, 15 March 2003

1) Atypical pneumonia with rapid progression to

respiratory failure

2) Health workers appeared to be at greatest risk

3) Unidentified cause, presumed to be an infectious

agent

4) Antibiotics and antivirals did not appear effective

5) Spreading internationally within Asia and to Europe

and

WHO COMMUNICABLE DISEASES • SARS, 15 June 2003 1 0

l 15 March: Second global alert• Case def ini t ion provided

• Name (SARS) announced

• Advice given to internat ional t ravel lers to ra ise awareness

l 26 MarchEvidence accumulat ing that persons wi th SARS cont inued to t ravel

f rom areas wi th local t ransmission, and that adjacent passengers were

at smal l , but non-quant i f ied r isk

l 27 MarchGuidance provided to a i r l ines and areas wi th local t ransmission to

screen passengers leaving in order to decrease r isk of internat i onal

t ravel by persons wi th SARS

Global Alert: Global Alert:


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Global Alert: Global Alert:


l 1 April:

Evidence accumulat ing f rom exported cases that three cr i ter ia

were potent ia l ly increasing internat ional spread:

– magni tude of outbreak and number of new cases each

day

– pattern of local t ransmission

– exportat ion of probable cases

l 2 April to present:

Guidance prov ided to general publ ic to postpone non-essent ia l

t ravel to areas with local t ransmission that met above cr i ter ia


SARS: cumulative number of probable casesSARS: cumulative number of probable cases worldwideworldwide as of 12 as of 12

June 2003 June 2003 –– Total: 8 445 cases, 790 deathsTotal: 8 445 cases, 790 deaths

C h i n a ( 5 3 2 8 )

S i n g a p o r e ( 2 0 6 )

H o n g K o n g ( 1 7 5 5 )

V i e t N a m ( 6 3 )

E u r o p e :

1 0 c o u n t r i e s ( 3 8 )

T h a i l a n d ( 9 )

B r a z i l ( 3 )

M a l a y s i a

(5 )

S o u t h A f r i c a

(1 )

C a n a d a ( 2 3 8 )

U S A ( 7 0 )

Outbreaks before 15 March global alert

C o l o m b i a ( 1 )

K u w a i t

(1 )

S o u t h A f r i c a

(1 )

K o r e a R e p .

(3 )M a c a o

(1 )

P h i l i p p i n e s ( 1 4 )

I n d o n e s i a ( 2 )

Mongolia (9)

India (3)

A u s t r a l i a ( 5 )

N e w Z e a l a n d ( 1 )

T a i w a n

( 6 8 8 )

Outbreaks after 15 March global alert

Mongolia (9)

Russian Fed. (1)

7


Probable cases of SARS by date of onset,Probable cases of SARS by date of onset,

Hanoi:Hanoi: n = 62 n = 62

1 February 1 February –– 12 June 200312 June 2003

0

1

2

3

4

5

6

7

8

9

10

1 Feb. 11 Feb. 21 Feb. 3 March 13 March23 March 2 April 12 April 22 April 2 May 12 June

Nu

mb

er

of

ca

se

s



Singapore:Singapore: n = 206n = 206


Source : M in i s t r y o f

H e a l t h , S i n g a p o r e ,

W H O

0

2

4

6

8

10

12

14

1 Feb. 13 Feb. 25 Feb. 9 Mar. 21 Mar. 2 Apr. 14 Apr. 26 Apr.8 May 20 May 29 May

Nu

mb

er

of

ca

se

s

12 Jun.

8



Canada:Canada: n = 227* n = 227*


Nu

mb

er

of

ca

se

s

0

1

2

3

4

5

6

7

8

9

1 0

1 Feb . 13 Feb . 25 Feb . 9 M a r . 2 1 -M a r . 2 A p r . 1 4 A p r . 2 6 A p r . 8 M a y 2 0 M a y 1 Jun . 12 Jun .

* A s o f 1 2 J u n e 2 0 0 3 , 11 additional probable cases o f S A R S h a v e

b e e n r e p o r t e d f r o m C a n a d a

f o r w h o m n o d a t e s o f o n s e t

a re ava i lab le .

S o u r c e : H e a l t h C a n a d a



Taiwan:Taiwan: n = 688n = 688


Nu

mb

er

of

ca

se

s

0

5

10

15

20

25

30

1 Feb. 13 Feb. 25 Feb. 9 Mar. 21 Mar. 2 Apr. 14 Apr. 26 Apr. 8 May 20 May 1 Jun. 12 Jun.

9



Beijing:Beijing: n = 2,522n = 2,522

0

50

100

150

200

250

300

350

30-Mar-03 13-Apr-03 27-Apr-03 11-May-03 25-May-03 8-Jun-03

date of report

num

ber

of c

ases


156 c lose

contactsof HCW

and pat ients

I n d e x c a s e f r o m

G u a n g d o n g

I n d e x c a s e f r o m

G u a n g d o n g

H o s p i t a l 2H o n g K o n g

4 H C W +2


4 H C W +2


3 H C W


3 H C W


9 9 H C W


9 9 H C W

C a n a d a1 2 H C W +

4

C a n a d a1 2 H C W +

4

Hotel MHong Kong

I r e l a n dI r e l a n d

U S AU S A

N e w Y o r kN e w Y o r k

S i n g a p o r e3 4 H C W +

37

S i n g a p o r e3 4 H C W +

37

V i e t N a m3 7 H C W +

?

V i e t N a m3 7 H C W +

?

B a n g k o kH C W

B a n g k o kH C W

4 otherH o n g K o n g

h o s p i t a l s28 HCW

4 otherH o n g K o n g

h o s p i t a l s28 HCW



B

I

K

F G

E

D

C

J

H

A

SARS: chain of t ransmiss ion among guests SARS: chain of t ransmiss ion among guests

at Hotel at Hotel MetropoleMetropole, Hong Kong, 21 February, Hong Kong, 21 February

G e r m a n yH C W +

2

G e r m a n yH C W +

2

As of 26 March,

249 cases have

been traced to

the A case

S o u r c e :

W H O / C D C

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Airport screening and health information, Hong Kong, Airport screening and health information, Hong Kong,

SARS, 2003SARS, 2003



Hong Kong:Hong Kong: n = 1 753, as of 9 June 2003n = 1 753, as of 9 June 2003

Nu

mb

er

of

ca

se

s

01 Feb. 13 Feb. 25 Feb. 9 Mar. 21 Mar. 2 Apr. 14 Apr. 26 Apr. 8 May 20 May 1 Jun. 9 Jun.

0

20

40

60

80

100

120

11


SARS and the economy:SARS and the economy:

impact on global travel, Hong Kongimpact on global travel, Hong Kong


SARS and the economy:SARS and the economy:

impact on global travel, Singaporeimpact on global travel, Singapore

12


The cost of SARS: Initial estimates, Asian Development The cost of SARS: Initial estimates, Asian Development

BankBank


1) Atypical pneumonia with rapid progression to respiratory fai lure:

– Case fatal i ty rate by age group:

– 85% ful l recovery

– Incubation period: 3 –1 0 d a y s

2) Health workers appeared to be at greatest r isk

– Heal th workers remain pr imary r isk group in second generat ion

– Others at r isk inc lude fami ly members of index cases and heal th workers,

and their contacts

– Major i ty of t ransmiss ion has been c lose personal contact ; in Hong Kong

envi ronmental factors caused local ized transmiss ion

< 1 % < 2 4 y e a r s o l d

6 % 2 5 – 4 4 y e a r s o l d

1 5 % 4 5 – 6 4 y e a r s o l d

> 5 0 % > 65 yea rs o ld

SARS: SARS: what more we know what more we know 3 months later3 months later

13



3) Unident i f ied cause, presumed to be an infect ious agents

– Aetiological agent: Coronavi rus, hypothesized to be of animal or ig in

– PCR and var ious ant ibody tests developed and be ing used in

epidemiological studies, but PCR lacks suff ic ient sensi t iv i ty as

diagnost ic tool

4) Antibiotics and antivirals did not appear effect ive

– Studies under way to def in i t ively provide informat ion on ef fect i veness

o f antivirals a lone or in combinat ion wi th s tero ids, and on use of

hyper immune serum in persons wi th severe d isease

– Case detect ion, isolat ion, infect ion control and contact t racing are

ef fect ive means of contain ing outbreaks

– Meet ing 30 Apr i l at NIH to examine pr ior i t ies in drugs and vaccine

developments



5) Spreading international ly within Asia and to Europe and

North America

– Only 1 major outbreak occurred af ter 15 March despi te in i t ia l

exported cases to a total of 32 countr ies

– Symptomat ic persons wi th SARS no longer t ravel l ing internat ionally

– Internat ional spread occurr ing the in smal l number of persons who

are in incubat ion per iod

– Since 15 March, 27 persons on 4 of 32 internat ional f l ights carry ing

symptomat ic persons wi th SARS appear to have been in fected (1

f l ight a lone on 15 March has accounted for 22 of these 27 cases),

and these occurred before 23 March

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SARS: SARS:

what we are learningwhat we are learning

l In the wor ld today an infect ious disease in one country is a threat to all:

infect ious diseases do not respect internat ional borders

l In format ion and t ravel guidance can contain the internat ional spread of an

infect ious disease

l Experts in laboratory, ep idemio logy and pat ient care can work together for

the publ ic heal th good despi te heavy pressure to publ ish academically

l Emerging in fect ious d isease outbreaks of ten have an unnecessary

negat ive economic impact on tour ism, t ravel and t rade

l In fect ious d isease outbreaks reveal weaknesses in publ ic heal th

infrastructure

l Emerging infect ions can be conta ined wi th h igh level government

commitment and internat ional col laborat ion i f necessary


SARS: what Hong Kong has contributed to the SARS: what Hong Kong has contributed to the

global effortglobal effort

l R e p o r t i n g : o p e n a n d t r a n s p a r e n t r e p o r t i n g o f H 5 N 1 o n 1 9 F e b r u a r y t h a t l e d

t o i n t e n s i f i e d g l o b a l s u r v e i l l a n c e f o r r e s p i r a t o r y d i s e a s e

l R e p o r t i n g : o p e n a n d t r a n s p a r e n t r e p o r t i n g i n e a r l y M a r c h o f h e a l t h w o r k e r

i n f e c t i o n , l e a d i n g t o g l o b a l a l e r t o n 1 2 M a r c h

l I n f o r m a t i o n : n e w c a s e s a n d d e a t h s r e p o r t e d r e g u l a r l y t o W H O

l S c i e n c e : c o r o n a v i r u s f i r s t i s o l a t e d a n d i d e n t i f i e d , e a r l y P C R a n d a n t i b o d y

t e s t s d e v e l o p e d , e n v i r o n m e n t a l f a c t o r s i n v o l v e d i n t r a n s m i s s i o n ident i f i ed ,

s t u d i e s o n a n i m a l r e s e r v o i r i n c o l l a b o r a t i o n w i t h G u a n d o n g s c i e n t i s t s

c o n d u c t e d

l O u t b r e a k C o n t r o l : p r o m p t r e a c t i o n o n c e o u t b r e a k h a d b e e n i d e n ti f ied , w i th

e f f e c t i v e c a s e i d e n t i f i c a t i o n , c o n t a c t t r a c i n g , i s o l a t i o n / i n f e c ti o n c o n t r o l ,

s u r v e i l l a n c e a n d q u a r a n t i n e d e s p i t e e n v i r o n m e n t a l t r a n s m i s s i o n a t A m o y

G a r d e n s

l P a t i e n t m a n a g e m e n t : c o n t r o l l e d s t u d i e s o n a n t i v r i a l d r u g s a l o n e a n d i n

c o m b i n a t i o n w i t h s t e r o i d s , c o n v a l e s c e n t s e r u m f o r t r e a t m e n t

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SARS: what Hong Kong will contribute to the SARS: what Hong Kong will contribute to the

global effort over coming monthsglobal effort over coming months

l Continued case identi f icat ion through survei l lance:

– necessary to determine whether infect ion is endemic and seasonal , or whether i t has disappeared from human populat ions

l Continued collaboration with China, part icularly GuangdongProvince in studies to identify animal reservoir and r isk facto rs for t ransmission to humans

– necessary to manage the r isk and prevent future outbreaks

l Continued part icipat ion in major WHO networks of global survei l lance for inf luenza and other infect ious diseases

– identi fy next major emergence of new inf luenza strain or other infect ion of internat ional importance

severe acute respiratory syndrome (sars)€¦ · surveillance network partners in asia mekong basin...

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