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U.S. Monitoring 14 in Respiratory Illness Alert

CDC officials say four cases are 'under scrutiny'

MONDAY, March 17, 2003 (HealthDayNews) -- Health officials are following 14 people in the United States who may have symptoms of the deadly respiratory illness that is tracking the globe.

Ten of the U.S. cases are "almost certainly not" the syndrome (called Severe Acute Respiratory Syndrome, or SARS), according to Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention, while the other four are "under a little bit more scrutiny."

"We're not highly suspicious of any of the cases, but we want to be absolutely certain that we're not missing the first cases, so we are giving them a careful follow-up," Gerberding said at a news conference Monday. "It will not be surprising to us if we identify cases in the U.S., but we have not identified any cases yet."

She refused to say where in the country any of the cases were.

The current tally of victims is at least 167 infected and nine dead in at least eight countries. Most of the victims are in Asia, but there have also been cases, and deaths, in Canada. In addition, a doctor from Singapore is currently under quarantine in Germany after attending a medical meeting in New York City last week. One woman who acquired the illness from family members in Canada was sick while in Atlanta, but did not pass the infection on, officials said.

Although laboratories across the globe are working on the problem, officials still do not know what is causing the mysterious malady and whether it is a virus, a bacteria or some other unknown pathogen.

"To date, we have not been able to identify any agent that could be linked to the outbreak and none has been identified as such," Health and Human Services Secretary Tommy Thompson said at the news conference Monday.

"We have not ruled out anything. We simply do not have sufficient information to draw firm conclusions," Gerberding added. "We are looking at bacteria, viruses, atypical bacteria. We are checking for absolutely everything."

She also said it is unlikely the illness would be influenza because labs in Hong Kong, which doubled its official tally of victims on Monday to 95, have not been able to diagnose influenza.

Thus far, transmission does not seem to have occurred through casual contact. In Hong Kong, for instance, news reports say the majority of the cases involve only one hospital, and those stricken are medical workers and family or friends of someone who was infected.

"The disease so far has been limited to people who have had very close contact with the cases. Most are health-care personnel who have been in direct contact with the patient or body fluids, or household contacts," Gerberding said. Cases appear to be limited to people who live in or have traveled to certain parts of Asia.

This pattern suggests the infectious organism, whatever it is, is spread by droplets, which are usually only infectious when they're fresh. "The epidemiologic pattern we understand so far is consistent with face-to-face transmission," Gerberding said.

Because the possibility of infection via droplets can be substantially reduced by the use of face shields, gowns and gloves, "we are using infectious control that goes beyond that just to be absolutely certain," Gerberding said. "We're not 100 percent sure that this isn't an airborne component. So, at least in close quarters, [those who deal with anyone suspected of being infected] need masks."

In New York City, meanwhile, the use of gloves has been mandated for housekeeping crews at the Crowne Plaza Hotel, the site of the infectious disease conference the Singaporean doctor attended.

The general manager of the hotel said hotel officials are working closely with city health officials and aren't concerned about any health dangers.

"At this point in time, we do not feel there is any threat to anyone in the hotel," Ann Peterson said.

However, she added, the hotel employees have been retrained in procedures that were introduced in the wake of the AIDS epidemic and anthrax scares. In particular, the workers are advised to wear gloves when in rooms and especially when stripping beds.

In addition, she said, guests checking in are being advised of developments in a welcome letter, which also includes a fact sheet. Guests who are already staying at the hotel have also been given letters. Overall, the responses have been good, Peterson said.

"Guests have been reacting very, very well because of the amount of information that we have put out," she added.

New York City health officials also did not indicate any cause for alarm over the doctor's visit.

"He had minimal contact with other people during the two days he was in New York City, and attended the conference for a few hours," the New York City Department of Health and Mental Hygiene said in a statement.

Physicians who attended the same conference at the Crowne Plaza also seemed unfazed.

"I personally am not concerned that he would have given it to others at the meeting," said Dr. Robert P. Perrillo, head of the section of gastroenterology and hepatology at the Ochsner Clinic Foundation in New Orleans. He delivered presentations on hepatitis on Friday.

"I would have been concerned if I was rooming with the guy," he added.

The Singaporean doctor, who has not been identified but is quarantined in a Frankfurt hospital, apparently attended only one conference session on Thursday evening.

On Friday, Perrillo said, he received a letter from the city's health department informing participants of what was going on and saying the doctor had had a rash and a fever.

"He might not have been thinking straight," Perrillo said in response to a question of why the doctor would get on a plane that night. The doctor was flying home to Singapore, with his wife and mother-in-law, when he was met by health officials during the Frankfurt stopover.

Dr. Alan L. Bisno, vice chairman of the department of medicine at the University of Miami School of Medicine and another conference presenter, didn't even know anything had happened until he read it in the newspapers.

Bisno said that he did not overlap with the Singaporean doctor and that he was not at all worried about the possibility of infections.

"I don't think most of the people were aware that this had even happened until the handout," he said.

More information

The CDC and the World Health Organization have updates and information on SARS.

SOURCES: March 17, 2003, news conference with Julie Gerberding, M.D., director, U.S. Centers for Disease Control and Prevention, and Tommy Thompson, Secretary of Health and Human Services; Ann Peterson, general manager, Crowne Plaza Hotel, New York City; Alan L. Bison, M.D., professor and vice chairman, department of medicine, University of Miami School of Medicine, Miami; Robert P. Perrillo, M.D., head, section of gastroenterology and hepatology, Ochsner Clinic Foundation, New Orleans; March 15, 2003, New York City Department of Health and Mental Hygiene, news release
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