Severe Acute Respiratory Syndrome (SARS)

1
Severe Acute Respiratory Syndrome (SARS)

• Introduction

2
Hong Kong situation (on 23 May 2003)

• No. of cases1724
• No. of death 260
• male female 4.55.5

3
Age distribution

• 0-14 5
• 15-24 10
• 25-34 24
• 35-44 21
• 45-54 15
• 55-64 7
• 65-74 8
• 75 or above 10

4
Occupations

• Information collected from 90.3 of cases
• 61 working population
• 39 non-working population

5
Working Group

• Health Care Workers 23.9
• Food Handlers 1.9
• Domestic Helpers 1.9
• School Staff 1.5
• Disciplinary Force 0.6
• Others 31.3
• (e.g. drivers, clerical and administrative
  personnel)

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Non-working Group

• Retired 12.9
• Housewives 10.1
• Students 8.7
• Pre-school Children 0.6
• Visitors/Tourists 0.3
• Others 6.6
• (e.g. unemployed)

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Incidence of SARS cases by residential areas

• Kwun Tong 11.8 per 10 000
• Tai Po 6.2
• Sha Tin 4.1
• Other 15 districts 0.5-2.4

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Clinical Presentation

• Fever is the commonest reported symptom
• Other symptoms chills, malaise, cough, headache
  and muscle ache
• of elderly having fever is lower
• Only 61 have respiratory symptoms, 32 have GI
  symptoms

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General Symptoms

• Fever 93.3
• Chills 58
• Malaise 55.9
• Headache 42.6
• Muscle Ache 41.8
• Rigors 35.9
• Loss of appetite 28

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Respiratory Symptoms

• Cough 45.8
• Sore throat 18.3
• Shortness of breath 15.3
• Running nose 12.4

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GI Symptoms

• Diarrhoea 17.5
• Vomiting 11.5
• Nausea 11.3
• Abdominal pain 10.2

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Combination of symptoms

• Fever and chills 55.8
• Fever and malaise 53.1
• Fever and cough 42.8

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Symptoms of different age groups

• 0-14 Fever and cough
• 15-64 Fever with general symptoms
• 65 and above only 10 to 36 having fever
• with one other symptom

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Home Confinement

• Household contacts
• confirmed or suspected cases
• maximum of 10 days
• for monitoring and referral for treatment

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• As at 22 May
• 1219 persons had been affected
• 49 were still under confinement
• 33 had been confirmed to have SARS

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Border Checks

• Health Declaration Post
• airport, ports and border points
• incoming travellers to complete a health
  declaration

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Temperature checks

• All passengers arriving, departing and transit
  passengers
• at the HK International Airport
• temperature checks

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• Other control points
• arriving passengers subjected to screening
• all departing passengers from Ferry Terminals and
  Hung Hom Station are required to undergo
  temperature checks
• So far, 2 passengers had been confirmed to have
  SARS

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Other Measures

• Setting up of Designated Medical Centres (DMC)
• monitor contacts other than household contacts
• daily reports and monitoring

• Schools
• recent return to school
• daily temperature checks
• Close school for cleaning once suspected case
  identified

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General Health Education

• Daily press release for dissemination of
  information
• SARS symptoms
• Hand hygiene, personal and environmental hygiene
• Cleaning campaigns

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Thank You
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Background Information

• Nov 02, reports of cases in Guandong, China
• Mar 02, professor visited Hong Kong to attend
  banquet
• Outbreaks of infection in local hospitals and
  overseas

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Case Definition

• WHO
• Probable cases
• Suspected cases
• other considerations

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Cases worldwide

• No. of cases
• No. of deaths

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The responsible agent

• SARS related corona virus
• co-infection with other agents
• new recent findings

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Mode of transmission

• Droplets infection
• close contacts
• Amoy garden reports
• superspreaders

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Virus behaviour

• Survival
• incubation period

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Treatment methods

• Inpatient treatment
• ribarivirin
• steroids
• combination

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Treatment methods

• Inpatient treatment
• ribarivirin
• steroids
• combination

• Vaccine
• no effective vaccine available
• need time for development
• 1 to 5 years

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WHO recommendations

• Case detection and treatment
• Contact tracing and isolation
• Prevention of export of cases by health checks at
  borders
• Education of public
• symptoms of SARS
• hand hygiene, personal and environmental hygiene

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WHO information

• Updates in website
• affected areas with recent local transmission
• travel advice to affected areas