Skip to comments.SARS UPDATE: New Info on SARS for Health Care Providers on Free Republic
Posted on 03/19/2003 11:59:14 PM PST by bonesmccoy
SEVERE ACUTE RESPIRATORY SYNDROME - WORLDWIDE (09) ************************************************** A ProMED-mail post ProMED-mail is a program of the International Society for Infectious Diseases
This report contains information on virology studies on patients with SARS from:  Hong Kong, SAR  Germany  Singapore and  WHO's update on virology
******  Date: Wed, 19 Mar 2003 19:16:42 +0800 From: "John Tam"
Severe acute respiratory syndrome - worldwide --------------------------------------------- We are able to confirm that the patient whose NPA [nasophayngeal aspirate] was found to contain paramyxovirus is a health care worker with SARS who was exposed to the index patient in the medical ward associated with the outbreak at the Prince of Wales Hospital in Hong Kong. Degenerated primer sets for paramyxoviruses were used in a RT-PCR [real-time polymerase chain reaction] in the patient's NPA. Multiple bands from the PCR product were sequenced. A sequence was found to be compatible to paramyxoviruses.
Subsequent application of this RT-PCR in specimens collected from three other health care workers who were exposed in the same medical ward and presenting symptoms of SARS showed similar bands. Sequencing of these PCR products are in progress.
-- John Tam PhD Paul Chan MB BS MSc MRCPath Department of Microbiology Faculty of Medicine The Chinese University of Hong Kong Prince of Wales Hospital Shatin, Hong Kong SAR CHINA
******  Date: Wed, 19 Mar 2003 17:09:36 +0100 From: HW Doerr
Suspected SARS - Germany ex Singapore via New York -------------------------------------------------- In addition to finding paramyxovirus-like particles in throat swabs and sputum specimens from the doctor from Singapore and his mother-in-law currently treated in the isolation unit in Frankfurt am Main, Germany, similar structures have now been identified in the plasma of the mother-in-law.
Although further testing to confirm the finding of what could potentially constitute a novel paramyxovirus (as the presence of known human-pathogenic paramyxoviruses was largely ruled out by using a multitude of other tests) is urgently needed and under way in several laboratories, the detection of such particles in the blood might indicate active viremia and thus underline a potentially causative role for the agent.
H Rabenau, W Preiser, HW Doerr Institute for Medical Virology Frankfurt am Main
-- Prof Dr HW Doerr Institut für Medizinische Virologie Klinikum der Johann Wolfgang Goethe-Universität Paul-Ehrlich-Str. 40 60596 Frankfurt am Main Germany
******  Date: 19 Mar 2003 From: "Henry L Niman, PhD" Source: Singapore Ministry of Health Press Release
Preliminary investigations by the Pathology Department at the Singapore General Hospital and the Defence Medical Research Institute have identified the likely infective agent to belong to the paramyxovirus family. This corroborates early investigation results by overseas centers in Germany and Hong Kong.
-- Henry L Niman, PhD Department of Bioengineering Shriners' Burn Center 51 Blossom Street, Room 422 Boston, MA 02114 USA
******  Date: 19 Mar 2003 From: Marianne Hopp Source: WHO CSR
Preliminary findings suggest a viral cause ------------------------------------------ Research teams at two laboratories, in Germany and Hong Kong Special Administrative Region of China, have detected particles of a virus from the Paramyxoviridae family in samples taken from patients with severe acute respiratory syndrome (SARS).
This is the first major step forward in efforts to pinpoint the causative agent. Previous tests conducted in a number of top laboratories failed to detect the presence of any known bacteria or viruses, including the influenza viruses, recognized as causes of pneumonia or respiratory symptoms, or known to be widespread in the most affected geographical areas.
The failure of all previous efforts to detect the presence of bacteria and viruses known to cause respiratory disease strongly suggests that the causative agent may be a novel pathogen.
Firm conclusions about the identity of the causative agent are premature. All teams have stressed that these are preliminary results only. Further studies are needed before it can be concluded, with confidence, that the causative agent has been identified.
Collaborative efforts continue. All research teams are participants in the international multicentre SARS research project, linking together 11 leading laboratories, that was set up on Monday 17 Mar 2003. Coordinated research is expected to expedite definitive identification of the causative agent.
The detection of paramyxovirus particles in samples from infected patients is the first lead to a possible cause of SARS and will be extremely important in focusing ongoing research. Definitive identification of the causative agent will help physicians move from the current "hit-or-miss" approach to treatment to a more precise selection of drugs with a greater prospect of cure. Knowledge of the causative agent will also speed development of a diagnostic test and thus give physicians and national health authorities a powerful tool for the identification of cases. It will also reassure the many "worried well" now presenting at health facilities, and reduce the number of false alarms.
Update on countries and cases As of Wednesday 19 Mar 2003, a cumulative total of 264 suspected or probable cases and 9 deaths have been reported from 10 countries (Canada, China, Germany Singapore, Slovenia, Spain, Thailand, the United Kingdom, the United States of America, and Viet Nam). Hong Kong SAR, Hanoi (Viet Nam), and Singapore continue to be the most affected areas. Full details are provided in tabular form.
Awareness of the disease is now very high throughout the world. Surveillance is proving to be sensitive, with suspected cases rapidly detected, reported to national authorities and WHO, and investigated according to the standard case definition.
The Paramyxoviridae family Viruses in the Paramyxoviridae family include many common, well-known agents associated with respiratory infections, such as respiratory syncytial virus, and childhood illnesses, including the viruses that cause mumps and measles. Some of these viruses are widespread, particularly during the winter season. Screening of specimens could therefore be expected to detect particles of these common viruses. At this point, it cannot be ruled out entirely that tests for the SARS agent are detecting such "background" viruses rather than the true causative agent.
The Paramyxoviridae family also includes two recently recognized pathogens, Hendra virus and Nipah virus. These related viruses are unusual in the family in that they can infect and cause potentially fatal disease in a number of animal hosts, including humans. Most other viruses in the family tend to infect a single animal species only.
Nipah virus first began to cause deaths in humans in Peninsular Malaysia in 1998 in persons in close contact with pigs. The outbreak caused 265 cases of human encephalitis, including 105 deaths. Two separate outbreaks of Hendra virus, associated with severe respiratory disease in horses, caused two human deaths in Australia in 1994 and 1995. No human-to-human transmission was documented in either outbreak. No treatment was available for cases caused by either of these two viruses. Human-to-human transmission did not occur.
[ProMED-mail thanks Drs Tam and Chan for submitting this first hand report on their preliminary findings of RT-PCR findings consistent with a paramyxovirus from 4 patients with SARS in Hong Kong SAR. This is the first confirmation of viral RNA from multiple patients and is very promising. (An excellent review article on RT-PCR is available online: Mackay IM, Arden KE, Nitsche A. Real time PCR in virology. Nucleic Acids Research 2002; 30(6): 1292-1305 ).
We also thank Dr Doerr and colleagues for submitting their first hand report of the electron microscopy identification of paramyxovirus particles from plasma in one of the cases of SARS undergoing hospital treatment in Germany. As their report states this may be indicative of a viremia (circulation of the virus in the blood stream consistent with an acute infection with the virus).
In addition, we have also included information from the Singapore Ministry of Health website mentioning that a paramyxovirus has been preliminarily identified from patient(s?) in Singapore. While specifics on the testing used in Singapore are not available in the MOH press release, this is now the third location to preliminarily identify paramyxovirus from specimens taken from SARS patients.
Once a viral agent has been identified and confirmed from multiple patients, in multiple geographic locations and specific tests for the virus have been developed, more of the suspected cases of SARS can be tested to see if they have evidence of recent infection with the identified virus. This "step-wise" process is important to confirm that the agent is in fact the agent responsible for SARS. - Mod.MPP]
[Evidence is accumulating that the etiologic agent of SARS is a paramyxovirus. The report from Germany suggests that known paramyxovirus pathogens of humans have been excluded. The report from Hong Kong is rather vague and difficult to evaluate in the absence of precise information on the nature of the PCR-primers employed or the identity of the product sequenced. The limited evidence available at present suggests that the putative agent of SARS is a novel paramyxovirus rather than a known paramyxovirus exhibiting atypical pathogenicity. A variety of novel paramyxoviruses have been characterized in recent years, some of which have been listed in my comment to "PRO/EDR> Severe acute respiratory syndrome - worldwide (06) 20030318.0677. - Mod.CP].
[see also: Severe acute respiratory syndrome - worldwide (08) 20030318.0679 Severe acute respiratory syndrome - worldwide (07) 20030318.0678 Severe acute respiratory syndrome - worldwide (06) 20030318.0677 Severe acute respiratory syndrome - Worldwide (05) 20030317.0669 Severe acute respiratory syndrome - Worldwide (04):comment 20030317.0664 Severe acute respiratory syndrome - Worldwide: alert (03) 20030316.0660 Severe acute respiratory syndrome - Worldwide (02):alert 20030315.0649 Severe Acute Respiratory Syndrome - Worldwide 20030315.0637 Acute respiratory syndrome - Canada (Ontario) 20030314.0631 Acute respiratory syndrome - East Asia 20030314.0630 Acute respiratory syndrome - China (HK), VietNam (03) 20030313.0624 Acute respiratory syndrome - China (HK), VietNam (02) 20030313.0623 Acute respiratory syndrome - China (HK), VietNam 20030312.0602 Undiagnosed illness - Vietnam (Hanoi): RFI 20030311.0595 Influenza, H5N1 human case - China (Hong Kong) (05) 20030228.0500 Pneumonia - China (Guangdong) (07) 20030221.0452 Pneumonia - China (Guangdong) (06) 20030220.0447 Pneumonia - China (Guangdong) (05) 20030220.0446 Pneumonia - China (Guangdong) (04) 20030219.0427 Pneumonia - China (Guangdong) (03) 20030214.0390 Pneumonia - China (Guangdong) (02) 20030211.0369 Pneumonia - China (Guangdong): RFI 20030210.0357]
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Sorry to quibble here, but there seems to be an error here. "RT-PCR", in my experience, means "reverse transcriptase" polymerase chain reaction, not "real-time" PCR. So the virus is RNA-based, rather than DNA-based.
|Avulavirus||Newcastle disease virus|
|[Pneumovirinae]||Pneumovirus||Human respiratory syncytial virus|
|Rhabdoviridae||Vesiculovirus||Vesicular stomatitis Indiana virus|
|Ephemerovirus||Bovine ephemeral fever virus|
|Cytorhabdovirus||Lettuce necrotic yellows virus|
|Nucleorhabdovirus||Potato yellow dwarf virus|
|Novirhabdovirus||Infectious hematopoietic necrosis virus|
|Mononegavirales||Filoviridae||"Marburg-like viruses"||Marburg virus|
|"Ebola-like viruses"||Zaire Ebola virus|
|Bornaviridae||Bornavirus||Borna disease virus|
|Orthomyxoviridae||Influenzavirus A||Influenza A virus|
|Influenzavirus B||Influenza B virus|
|Influenzavirus C||Influenza C virus|
|Isavirus||Infectious salmon anemia virus|
|Phlebovirus||Rift Valley fever virus|
|Tospovirus||Tomato spotted wilt virus|
|Arenaviridae||Arenavirus||Lymphocytic choriomeningitis virus|
|Ophiovirus||Citrus psorosis virus|
|Tenuivirus||Rice stripe virus|
|Deltavirus||Hepatitis delta virus|