SARS Severe Acute Respiratory Syndrome

1
SARS(Severe Acute Respiratory Syndrome)

• By Fatmeh Berro
• Sadika Ali
• Anita Hafeez

2
Presentation Outline

• Introduction
• Statistics
• Identification of SARS
• Prevention of SARS
• Treatment of SARS
• Epidemiology of SARS
• SARS Research
• Transmission of SARS
• Future of SARS
• Conclusion

3
Introduction

• SARS
• -latest to gain global attention
• Definition
• -rare form of pneumonia that is resistant to
  antibodies

4
Statistics

• November 2002 SARS first appeared in China,
  Guangdong province (NPR, 2003)
• SARS spread to nearly 32 countries resulting in
  8439 reported cases of which 812 were fatal.

5
Identification

• Symptoms
• High fever Temperature gt 100.4 F
• Dry cough
• Shortness of breath
• Headache
• Muscular stiffness
• Loss of appetite
• Confusion

6
Laboratory case definition

• Suspect Case
• -High fever
• -coughing
• -Contact with infected person
• -Travel to area with SARS transmission

7
Laboratory case definition

• Probable Case
• -is a suspect case with
• - pneumonia on chest X-ray
• - positive for SARS-CoV
• - autopsy findings consistent with RDS

8
Viral Origin in animals

• SARS Corona Virus (Zhang, 2003) is the origin
  detected in monkeys (Anonymous, 2003)
  
  
• SARS Corona Virus may have affected birds and
  mammals (BBC, Aug 2003)

9
Viral Origin in animals

• Black rats in Hong Kong.
• (BBC, Aug 2003)
• Slaughter of wild species in China
• (WHO, June 2003)

10
Causes of SARS

• Pollution
• Age
• Contact with SARS patient
• Nosocomial transmission

11
Viral Genome

• SARS-CoV is a new virus
• -not a mutant virus
• Sequence has
• -Typical RNA boundaries for corona viruses
• -29,727 nucleotides in length
• (health/centers/allergy/710.html)

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Laboratory tests for SARS

• Methods to detect SARS-CoV
• indirect fluorescent antibody or enzyme-linked
  immunosorbent assay reverse transcriptase (ELISA)
• polymerase chain reaction (RT-PCR) test
• Viral culture and isolation
• (health/centers/allergy/710.html)

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Prevention of SARS

• Quarantine
• Applies to people who have been exposed and may
  be infected but are not yet ill.
• Beginning March 18, exposed persons were
  quarantined for 10-14 days Level A. (Lee et
  al., 2003)
• But after June 10, the time was changed to 10
  days in accordance with the incubation period.

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Prevention of SARS

• 2. Isolation
• Applies to people who have SARS.
• Allows for the focused delivery of specialized
  health care to people who are ill.
• It is voluntary, however, many levels of
  government could enforce isolation CDC, 2003.

15
Prevention of SARS

• During the February-July outbreak, patients in
  the U.S were isolated for 10 days.
• Other measures were also taken
• Special SARS hospitals throughout the country
• Instituting fever-screening clinics and
  performing it on all persons entering public
  buildings.

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Prevention of SARS

• 4. A Safer collection Method
• Collect specimens from patients saliva by
  rinsing the mouth with water.
• Health care workers can reduce their chances of
  catching SARS because they do not have to get
  close to the patient Hogg, 2003.

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Prevention of SARS

• 5. Influenza Vaccine
• Influenza is likely to raise suspicion of SARS
  during flu season because of similar symptoms.
• Influenza can infect 10-20 of the total
  population.
• Thus a widespread vaccine program allows workers
  to distinguish between SARS and influenza
  Schlagenhauf, 2003.

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Prevention of SARS

• 6. Masks
• Effective in preventing people with SARS from
  spreading the disease Warner, 2003
• Filter out relatively large particles of moist
  material that are coughed up or sneezed.

19
Treatment of SARS

• There is currently no effective treatment or
  vaccine for SARS.
• This has led to the use of high-dose intravenous
  and oral Ribavirin.
• Ribavirin is a purine nucleoside analogue.
• It prevents replication of RNA and DNA viruses.

20
Treatment of SARS

• It inhibits the enzyme inosine monophosphate
  dehydrogenase, which is required for the
  synthesis of guanosine triphosphate.
• This product in turn will concentrate in the
  erythrocytes and leaches out slowly with a half
  life of 40 days.

21
Treatment of SARS

• Risk Factors
• Severe lung disease
• Nausea
• Headaches
• Rashes
• Researchers do not recommend ribavirin during
  pregnancy and lactation.

22
Treatment of SARS

• Recombinant Interferons
• Study done on two strains of SARS. Strains are
  taken from patients in Hong Kong and others in
  Frankfurt University Clinical Center.
• Used Alpha, Beta, and Gamma interferons.
• Beta interferon was effective against both
  strains of SARS.

23
Treatment of SARS

• Other types of interferons, Alpha and Gamma, were
  less effective.
• These findings could help doctors treat patients
  with the disease.
• But further research is needed says Professor
  Robert Reed.Just because a drug kills the virus
  in a test tube does not mean it will kill the
  virus in patients.

24
Treatment of SARS

• Glycyrrhizin
• Significantly reduces the ability of the virus to
  replicate itself.
• Scientists do not understand exactly how the drug
  combats SARS.
• Manufactured from the roots of the liquorices
  plant.
• Used to treat hepatitis C and HIV infection.

25
Treatment of SARS

• The enzyme called corona virus main proteinase,
  helps the virus replicate inside cells Anand,
  2003.
• Scientists are now experimenting with a drug that
  could lock on to the enzyme and stop it from
  working BBC News, 2003.
• They believe that some drugs already in existence
  should do the trick but they would have to be
  modified.

26
Epidemiology of SARS

• 1. China
• It has been hit the hardest by SARS
• First Discovered in the southern province of
  Guangdong in mid November 2002
• Nearly half the cases in china have been in
  Beijing.

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Epidemiology of SARS

• In May, cases in china began decreasing steadily.
• In late May (WHO) lifted the travel warning it
  had put on Guangdong.
• In June, china was dropped from its list of
  infected areas.

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Epidemiology of SARS

• Hong Kong
• Outbreak began in Mid-February.
• Caused by a traveling doctor from Guangdong.
• All Hong Kongs Schools were closed.
• Economy was hit hard because of decreased
  tourism.

29
Epidemiology of SARS

• In late May, the infection rate dropped.
• On June 23, the territory along with the rest of
  china was removed form WHOs list.

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Epidemiology of SARS

• Taiwan
• First case of SARS reported on March 18.
• 90 of cases were related to hospital situations.
• On July 5, Taiwan was was the last country to be
  removed from the WHOs list.

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Epidemiology of SARS

• Canada
• Worst hit country outside of Asia.
• Virus entered when a traveler returned home from
  Hong Kong.
• Quarantine measures were used.
• On July 2, the country was declared SARS-free

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Epidemiology of SARS

• Singapore
• Best country to handle the SARS virus.
• Used thermal-imaging of air passengers to detect
  those with high temperature.
• Ill patients were isolated in a single hospital.
• School students were given digital thermometers
  for daily temperature checks.

33
Epidemiology of SARS

• Vietnam
• Model case in the fight against SARS.
• Disease killed 5 people and infected 63.
• Isolated suspected SARS patients and sealed off
  affected hospitals.
• Tourism was heavily affected because of decreased
  airline use.

34
Epidemiology of SARS

• Malaysia
• Five reported cases of SARS, including two
  deaths.
• Imposed a travel ban tourist from infected
  countries were refused entry.
• The economy was hit hard, prompting an interest
  rate cut.

35
Epidemiology of SARS

• Thailand
• Security measures included
• Visitors must wear masks.
• Returning Thais must quarantine themselves for 14
  days.
• Tourist arrivals dropped by 40.8.

36
SARS Global hotspots

• SARS Worldwide
• World 812
• Mainland China 348
• Hong Kong 298
• Taiwan 84
• Singapore 32
• Canada 38

37
SARS Research

• Disease has been contained in less than four
  month
• Materials produced by SARS-CoV
• -nucleic acids proteins causing viral
  replication

38
Transmission of SARS

• Methods
• Close personal contact with infected person
• Contact with infected body fluids infectious
  droplets
• Most probable time of transmission
• second week of illness

39
Transmission

• Most likely to be affected
• Age young adults
• Old adults
• Occupation
• -HCWs
• -Doctors, nurses.
• -Nosocomial transmission

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Transmission

• Global Travel
• Within 10 days of onset of symptoms to an area
  with SARS infections
• Healthcare facilities
• Hospital acquired illness

41
Future of SARS

• First global conference (June 17, 2003)
• Requirements for control of disease
• Intervention safe, simple, affordable
• Easy to use diagnostic tools
• Clinical trials on SARS vaccine
• Chain of human to human transmission must be
  broken

42
Conclusion

• A lot has been known about the mysterious SARS
  disease.
• Since the discovery of the genome, data has been
  shared among researchers worldwide.
• More research is needed for the public treatment
  of SARS.
• However, it could take years before a drug enters
  the marketplace.

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Thank you

• We hope that you have gained more knowledge on
  this new infectious human disease
• Questions?