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11 in U.S. Now Possible SARS Cases

CDC widens health alert on deadly illness

WEDNESDAY, March 19, 2003 (HealthDayNews) -- U.S. health officials Wednesday broadened to 11 the number of suspected respiratory-illness cases in the country. At the same, they widened their travel health alerts to include cruise and commercial shipping lines that have been to eastern Asia.

"The 11 people have a travel history, fever, and respiratory symptoms, which are part of the case definition," Dr. Julie Gerberding, the director of the U.S. Centers for Disease Control and Prevention, told a news conference.

While she would not say where the cases were or whether any individuals have been isolated, she did say all 11 are on what is being called "an active evaluation list." Some may turn out not to have this illness, she added.

Gerberding had announced on Monday that 14 people may possibly have signs of the illness, severe acute respiratory syndrome (SARS). The number had been revised downward Tuesday to nine.

Wednesday's increased count, with its indication of a common thread, would appear to move the United States a step closer to its first cases of an illness that has struck in eight countries, with suspected cases in five more.

"There is a lot we still don't know. The investigation is still under way," Gerberding said.

What is now known, she added, is causing an expansion of "our safety net for travelers."

Health alerts are now being issued to anyone who has entered the United States directly or indirectly from the Hong Kong area of eastern Asia, which includes travel by plane, cruise line, or commercial shipping vessel.

A CDC alert had been initially sent to state and local health officials over the weekend, and health officials then began issuing health cards to those entering the country by plane from the Hong Kong region, which has the highest casualty count at this point.

Gerberding also addressed reports that three laboratories have found a common virus in specimen samples taken from some of those now hospitalized with SARS.

The laboratories, in Germany and Hong Kong, identified particles of the paramyxovirus, which is a family of viruses that cause measles, mumps, and respiratory diseases.

"The labs are very good labs, excellent labs. We put a lot of credibility in their reports, but we don't know what it means," Gerberding said.

But she and other health officials cautioned that it was way too early to draw definitive conclusions about the virus finding.

"Seeing something in a nasal swab is not the same thing as finding a causal relationship," Gerberding said.

"It's not been confirmed anywhere else," said Dr. David Heymann, communicable diseases chief for the World Health Organization (WHO), told the Associated Press. "It's really premature to put out something like this, because it will automatically make everybody who's dealing with patients try to alter their therapies, and it may be altering them in the wrong way if this is not confirmed."

And Dr. Hans-Wilheim Dörr, director of the Institute of Medical Virology in Frankfurt, told The New York Times the discovery of the virus "could just be a coincidence, because this is the flu season."

Members of the paramyxovirus family commonly cause infection during the influenza season, so their presence would not be surprising, the paper reported.

The official number of SARS victims stood at 264 on Wednesday, according to a WHO tally. Hong Kong's 150 cases top the list. Vietnam has 56, while Singapore has 31.

The number of fatalities, however, rose to 15 Wednesday with the death of a French doctor in Vietnam who had treated one of the earliest victims, an American businessman who died there March 6. A nurse who also tended the American at the Hanoi French Hospital died on Sunday.

The official fatality list includes a mother and son in Canada, and five deaths in Hong Kong. Five other deaths, along with 300 illnesses, in an earlier outbreak in mainland China are not yet included on the WHO tally.

Two of the specimens in which the virus was found were taken from a Singapore surgeon and his mother-in-law, both of whom remain hospitalized in Frankfurt with confirmed cases of SARS.

The surgeon had attended an infectious disease conference at the Crowne Plaza Hotel in New York City last week before he, his wife, and his mother-in-law boarded a Singapore Airlines plane headed to Singapore. All three were quarantined during the stopover in Frankfurt.

While New York City officials had said the doctor's visit did not appear to put anyone else in danger, housekeeping crews at the hotel were ordered to use gloves when cleaning rooms and stripping beds.

At the Wednesday press conference, Gerberding said, "Folks who stayed at that hotel should be very reassured," because so far the window of infection time seems to have been too wide. However, she didn't rule out the possibility that they could become infected.

Officials in Hong Kong, meanwhile, are scrutinizing a hotel of their own. In what could be an intriguing clue, Gerberding noted the Hong Kong health department is reporting that seven people in its initial cases apparently stayed on the same floor of a hotel -- wire reports identified it as the Metropole -- in Kowloon in February.

"It is an epidemiological clue," she said, "and there may have been some common exposure." Two of those guests visited each other, but Gerberding said she didn't know how many times.

More information

The U.S. Centers for Disease Control and Prevention and the World Health Organization have updates and information on SARS.

SOURCES: March 19, 2003, teleconference with Julie Gerberding, M.D., director, U.S. Centers for Disease Control and Prevention, Atlanta; Associated Press; The New York Times
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