Free Republic
Browse · Search
Topics · Post Article

Skip to comments.

SARS UPDATE: New Info on SARS for Health Care Providers on Free Republic
Pro-MED | 3-19-03 | ProMed

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: [1] Hong Kong, SAR [2] Germany [3] Singapore and [4] WHO's update on virology

****** [1] 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

****** [2] 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

****** [3] 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

****** [4] 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

[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]


*##########################################################* ProMED-mail makes every effort to verify the reports that are posted, but the accuracy and completeness of the information, and of any statements or opinions based thereon, are not guaranteed. The reader assumes all risks in using information posted or archived by ProMED-mail. ISID and its associated service providers shall not be held responsible for errors or omissions or held liable for any damages incurred as a result of use or reliance upon posted or archived material. ************************************************************ Visit ProMED-mail's web site at . Send all items for posting to: (NOT to an individual moderator). If you do not give your full name and affiliation, it may not be posted. Send commands to subscribe/unsubscribe, get archives, help, etc. to: For assistance from a human being send mail to: ############################################################ ############################################################

TOPICS: Anthrax Scare; Breaking News; Culture/Society; Foreign Affairs; Front Page News; News/Current Events; Technical; War on Terror
KEYWORDS: atypicalpneumonia; niman; sars
The research continues...
1 posted on 03/19/2003 11:59:14 PM PST by bonesmccoy
[ Post Reply | Private Reply | View Replies]

To: bonesmccoy
Degenerated primer sets for paramyxoviruses were used in a RT-PCR [real-time polymerase chain reaction] in the patient's NPA.

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.

2 posted on 03/20/2003 1:57:46 AM PST by exDemMom (W in '04)
[ Post Reply | Private Reply | To 1 | View Replies]

To: bonesmccoy
Now just think of how much faster we might have gotten to the bottom of this had all those microbiologists not met such untimely deaths last year.

heh. (not being paranoid!)

3 posted on 03/20/2003 3:00:52 AM PST by ecru ((i'm bland, like the color))
[ Post Reply | Private Reply | To 1 | View Replies]

To: ecru
Or if the Chinese had bothered to mention it sooner.
4 posted on 03/20/2003 4:24:41 AM PST by CathyRyan
[ Post Reply | Private Reply | To 3 | View Replies]

To: exDemMom
Mysterious illness shows in Carolinas
Symptoms: Fever, respiratory problems
Staff Writer

N.C. health officials have identified two possible cases -- the first in the Carolinas -- of the mysterious flu-like illness that recently appeared in people living in or traveling to Asia.

The N.C. cases from Wake and Orange counties are among 11 suspected cases that emerged in the United States since the first reports of illness from China only days ago...

...The illness, for which there is no treatment, has caused 14 deaths, including five who died months ago in an outbreak in China.

The worldwide number of cases, including the 11 suspected U.S. cases, now totals 264, according to the World Health Organization.

Most of those ill have been health-care workers in Singapore, Hong King and Vietnam. Though so far concentrated in East Asia, cases have cropped up as far away as Germany and Canada, spread by sick patients traveling along airline routes.

There were scattered reports on Wednesday of new suspected cases in Europe, all in patients who had traveled from Southeast Asia. Four people suspected of having the illness are hospitalized in France. A few probable cases have also turned up in England, Taiwan and Slovenia.

"This shows the situation is not under control yet, and we remain on maximum sanitary alert," the French health minister, Jean-Francois Mattei, said in Parliament.

The WHO said Wednesday it continues to receive reports about some patients recovering from the illness, which causes severe fever and breathing problems.

In North Carolina, both patients are receiving medical care and are in good condition, state health officials said. Citing patient confidentiality, they would not release the patients' names or ages.

Both exhibited symptoms of the syndrome and had traveled to or from Asian countries in the last 10 days. Close contacts and fellow travelers of the two people are being notified, and laboratory specimens have been sent to the Centers for Disease Control and Prevention for testing.

The syndrome can be deadly, so rapid identification and treatment is important, said State Health Director Leah Devlin. More...
5 posted on 03/20/2003 7:08:16 AM PST by TaxRelief (You mean people keep little jars of diseases in their garages?)
[ Post Reply | Private Reply | To 2 | View Replies]

To: bonesmccoy
6 posted on 03/20/2003 7:11:57 AM PST by EdReform (Support Free Republic -
[ Post Reply | Private Reply | To 1 | View Replies]

To: bonesmccoy
So, what measures are hospitals taking to protect healthcare workers and their families? Are N95 masks proving to be effective? Now that there might be cases in North Carolina, this healthcare worker could possibly be coming face to face with SARS sooner than I'd care to think.
7 posted on 03/20/2003 9:49:53 AM PST by k omalley
[ Post Reply | Private Reply | To 1 | View Replies]

To: bonesmccoy; exDemMom; CathyRyan
Genus table with detailed links at NIH

The negative-sense ssRNA Viruses




Type Species

Mononegavirales Paramyxoviridae
Sendai virus
    Morbillivirus Measles virus
    Rubulavirus Mumps virus
    Henipavirus Hendra virus
    Avulavirus Newcastle disease virus
         [Pneumovirinae] Pneumovirus Human respiratory syncytial virus
    Metapneumovirus Avian pneumovirus
  Rhabdoviridae Vesiculovirus Vesicular stomatitis Indiana virus
    Lyssavirus Rabies 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
    Thogotovirus Thogoto virus
    Isavirus Infectious salmon anemia virus
  Bunyaviridae Orthobunyavirus Bunyamwera virus
    Hantavirus Hantaan virus
    Nairovirus Dugbe 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

8 posted on 03/20/2003 9:59:20 AM PST by TaxRelief (You mean people keep little jars of diseases in their garages?)
[ Post Reply | Private Reply | To 1 | View Replies]

To: bonesmccoy
I dunno. Sounds a lot like the ASIAN FLU!
9 posted on 04/02/2003 2:25:38 PM PST by HapaxLegamenon
[ Post Reply | Private Reply | To 1 | View Replies]

To: HapaxLegamenon
asian flu???



couldn't be!!!

This is "SARS".

/sarc off

10 posted on 04/02/2003 6:27:20 PM PST by bonesmccoy (Defeat the terrorists... Vaccinate!)
[ Post Reply | Private Reply | To 9 | View Replies]

Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.

Free Republic
Browse · Search
Topics · Post Article

FreeRepublic, LLC, PO BOX 9771, FRESNO, CA 93794 is powered by software copyright 2000-2008 John Robinson