Global, U.S. Health Alerts Go Out for Mystery Respiratory Illness

WHO issues emergency travel advisory, CDC alerts state and local health officials as list of nations reporting respiratory syndrome cases continues to increase.

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SATURDAY, March 15, 2003 (HealthDayNews) -- World Health Organization officials issued an emergency global travel advisory Saturday and the U.S. Centers for Disease Control and Prevention issued its own health alert as the number of nations hit by a mysterious respiratory illness continued to climb.

The illness, now being called Severe Acute Respiratory Syndrome (SARS) and described as an "atypical pneumonia," has killed at least eight people, including an American businessman in Hong Kong and a mother and son in Toronto, Canada.

It has left most of the others, many of them hospital workers, with severe breathing difficulties, according to news reports. The latest case appears to involve a Singapore surgeon who was hospitalized in Germany Saturday after flying out of New York City the night before.

The WHO advisory, sent to all airlines, warned that the illness, which apparently is impervious to antibiotics and antiviral drugs, was becoming "a worldwide health threat."

"Until we can get a grip on it, I don't see how it will slow down," WHO spokesman Dick Thompson said at the agency's headquarters in Geneva. "People are not responding to antibiotics or antivirals; it's a highly contagious disease, and it's moving around by jet. It's bad."

The CDC moved into emergency mode to alert health authorities at state and local levels Saturday.

"The emergence of two clusters of this illness on the North American continent indicates the potential for travelers who have been in the affected areas of Southeast Asia to have been exposed to this serious syndrome," CDC director Dr. Julie L. Gerberding said in a statement issued in Atlanta. "Therefore, we are instituting measures aimed at identifying potential cases among travelers returning to the United States and protecting the people with whom they may come into contact."

Among other things, the agency is now investigating any illness among travelers who may have passed through the United States after having potential exposure to the virus. It is also preparing health alert cards to give to travelers returning from southeast Asia.

And, while no formal travel restrictions are in place, travelers may wish to postpone nonessential trips to the countries at risk, Gerberding said at a news conference.

In addition to Canada and Hong Kong, and possibly Germany, cases of SARS have been reported in mainland China itself along with Indonesia, the Philippines, Singapore, Thailand and Vietnam. WHO officials said the agency had received reports just in the last week of more than 150 suspected new cases.

In Germany, officials would not release the condition of the surgeon, who was taken off a New York-to-Singapore flight during a stopover in Germany and is being quarantined in a Frankfurt hospital. His wife and another doctor traveling with him also were hospitalized, the Associated Press reports.

The surgeon had treated one of the earliest cases in Singapore, and had then flown to a medical meeting in New York City, according to Thompson.

He may have gone to a hospital in New York -- the agency did not know which one -- before flying back via Frankfurt. Before boarding the Singapore Airlines flight, he called a colleague in Singapore to describe his symptoms, and the colleague notified WHO officials, The New York Times reports.

[However, a New York City Health Department statement issued late Saturday said that the surgeon was in stable condition in Germany. In an interview with the city health officials, the statement said, the doctor told them that he had flown in on Wednesday, left on Friday, had had minimal contact with people in New York City and had attended the medical conference for only a few hours.]

Another 155 passengers who deplaned in Frankfurt were being temporarily held in quarantine at the airport, WHO officials said. The 85 remaining passengers and the plane's 20-member crew continued on but were to be quarantined on their arrival in Singapore, health officials said.

In Canada, meanwhile, Toronto's municipal health agency announced Friday that Kwan Sui-chu had died on March 5 soon after returning from Hong Kong. Her son, Chi Kwai Tse, died on Thursday, and four other family members have been hospitalized, the agency said.

A spokeswoman for Toronto Public Health said the agency was aware of two other cases in Canada, both in Vancouver and involving people who had also traveled recently to Hong Kong.

The agency issued an appeal to Canadians to seek medical help if they had been in contact with the Kwan family and were experiencing such symptoms as the sudden onset of a high fever, muscle aches or other flu-like symptoms.

The one other reported fatality was that of the American businessman, who was based in Shangai. The man, who has not yet been identified, died of the illness in Hong Kong on March 6. But he apparently infected at least 37 hospital workers in Hanoi, where he had been treated before being moved to Hong Kong. Two of the patients were listed in serious condition, according to AP.

Hanoi has reported at least 42 cases of the illness, Hong Kong has 43, Singapore at least 16. Tapei reported three people hospitalized with flu-like symptoms. Guangdong province, which adjoins Hong Kong in China, reported 305 cases by mid-February, including five deaths.

A team of CDC epidemiologists arrived in Hanoi Saturday to gather samples and try to determine what's causing the outbreak. A separate team of French doctors was expected to bring medicine and respirators.

WHO officials, who earlier this week issued their first global health alert in 10 years on the outbreaks, urged all countries to help. Scientists do not know whether SARS is a virus or even an infectious agent, they said. As a result, the research is focusing on the possibility that the illness is a previously unknown infectious agent.

The WHO travel advisory, while not calling for restrictions on travel, urged that travelers who may have come in contact with someone infected should watch for such symptoms as high fever, coughing and shortness of breath. People who suspect they may have the illness should seek medical attention and should not travel until they recover, the AP reported.

SOURCES: March 15, 2003, Centers for Disease Control and Prevention, news release; March 15, 2003, New York City Department of Health and Mental Hygiene, news release; The New York Times; The Associated Press

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