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U.S. Issues Travel Warning on Respiratory Illness

22 suspected cases being probed in 12 U.S. states

SATURDAY, March 22, 2003 (HealthDayNews) -- The U.S. State Department is advising Americans not to travel to Vietnam because of the global respiratory illness that appeaars to have infected at least 650 people and caused 15 deaths.

The government warning, issued Saturday, follows word that U.S. health officials are tracking 22 suspected cases of severe acute respiratory syndrome (SARS) in 12 U.S. states.

State Department spokesman Lou Fintor said an American who traveled in northern Vietnam was recently diagnosed with SARS, the Associated Press reports.

Official government travel has also been halted to Vietnam, which has one of the higher case tolls among the 11 countries that have probable or confirmed SARS cases.

Hong Kong, which has the highest toll, raised its victim count to more than 200 on Saturday.

And from Beijing Saturday came unofficial reports of two deaths in China's capital and 20 people infected in Shanghai.

Chinese doctors said that there were cases in Beijing at least 10 days ago and that Shanghai hospitals had some at least a month ago, the Washington Post reports. Shanghai was the base for an American businessman who died last week of SARS in Hong Kong after infecting hospital workers in Hanoi where he had been treated.

China had been reluctant until this week to give out information on a similar epidemic of respiratory illness in its southern province of Guangdong, which had infected at least 300 people and killed 5.

On Friday, however, world health officials said China had asked for help and was issuing visas to incoming officials at the airport.

A five-member team of health investigators will head to Beijing on Sunday to investigate the Guangdong outbreak.

The increased American case count, which almost doubled within the space of two days, was announced Friday by the U.S. Centers for Disease Control and Prevention.

At a news conference on Friday, Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention, also said the CDC was investigating the possibility that two of the U.S. patients transmitted the disease locally to other people within the country. If confirmed, these would represent the first time the disease had spread from person to person in the States.

"We have identified situations where a case in a traveler may have involved transmission to others in the U.S.," Gerberding said. "In one cluster, an individual who traveled to Asia may have been a source of infection in two health-care workers, and one person who traveled to Asia may have been a source of infection in family members."

Gerberding declined to say where those U.S. cases are. But the San Francisco Chronicle reports that six Californians, including three residents of the Bay Area, had fallen ill with suspicious symptoms after a trip to China.

Apparently state health officials are also deciding whether to count two sick individuals living in the same household as the travelers.

In addition to California, the CDC tally of states with suspected cases is: Hawaii, Maine, Massachusetts, New Jersey, New Mexico, New York, North Carolina, Rhode Island, Utah, Virginia, and Wisconsin.

All the patients in the United States are being classified as "cases under investigation." Officials are hoping that finding a pathogen will help identify people with SARS more accurately.

Earlier this week, labs in Germany, Hong Kong and Singapore found viruses from the paramyxoviridae family in samples taken from SARS patients. And scientists now say they may have a test for diagnosing the SARS. World health officials predict it could be available to key laboratories within a few days if proved reliable.

U.S. health officials, however, were skeptical. Gerberding said that the CDC was relying on case definitions and investigation to determine which patients have the disease.

Meanwhile, the CDC is not fully ruling out the possibility of terrorism.

"The spread to health-care workers and close family members is consistent with naturally occurring pathogens," Gerberding said. "All indications right now are that this is a naturally occurring infectious disease, but we are not ruling out any possibilities until we find the source."

Health officials are also stepping up their efforts to intercept and educate people entering or returning to the United States.

More than 35,000 health alerts have been issued to incoming travelers, with another 10,000 being distributed to arriving air passengers every day. Information cards are also being distributed to cruise lines. And U.S. health officials have intercepted five planes or boats with passengers that recently traveled to infected areas, Gerberding said.

One troubling sign, she said, is that many of the deaths have occurred in healthy and relatively young individuals.

"This tell us that this is a disease that can be virulent and life-threatening, even among those who are otherwise immunologically healthy," Gerberding said. "It is certainly contagious and certainly a virulent pathogen capable of causing severe disease, but we are hearing reports of recovery."

In fact, a Singapore doctor and his wife and mother-in-law who were on their way home from a visit to New York City when they were quarantined in Frankfurt, Germany, are recovering, doctors there said.

The doctor had reportedly treated some of the SARS patients in Singapore before his trip to a medical conference at the Crowne Plaza Hotel in New York.

News reports said it was unclear whether medications are helping the family recover or whether they would have gotten better anyway.

More information

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

SOURCES: March 21, 2003, news conference with Julie Gerberding, M.D., director, U.S. Centers for Disease Control and Prevention; San Francisco Chronicle; Associated Press; Washington Post
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