Hong Kong Isolates Virus

[JimKlein]

Here's a news story about a breakthrough in the virus. Virus

[AZwolfman]

This is good news. Thanks for the story, Jim.

[tonado]

http://www.msnbc.com/news/885653.asp

 

Clue may point to cause of illness

MSNBC staff and wire reports

 

 

Researchers in Germany and Hong Kong reported Wednesday that at least some victims of a fast-moving disease emanating from Asia appear to be infected by a strain of virus similar to those that cause mumps, measles and some animal diseases. As scientists raced to identify the cause of the illness, the U.S. government said it is investigating 40 suspected cases of the disease in the United States.

 

SCIENTISTS AT THE Institute for Medical Virology at Frankfurt University said samples from two people who contracted severe acute respiratory syndrome, or SARS, resemble a paramyxovirus, the family of microbes that causes measles, mumps and canine distemper. There is no treatment for that virus group.

Doctors in Hong Kong also reached the same conclusion. Professor John Tam at the Prince of Wales Hospital said the finding indicated that current treatments given to patients -- a combination of anti-viral drugs and steroids -- had been the right choice. But he added more tests needed to be done.

 

The World Health Organization, which is coordinating the disease investigation, said it is taking the paramyxovirus theory seriously, but officials say it's too early to draw conclusions.

 

"It's in two specimens and it's not been confirmed anywhere else," said Dr. David Heymann, WHO's communicable diseases chief. "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."

 

SUSPECTED CASES IN U.S.

Word of progress in determining the cause of the disease came as Health and Human Services Secretary Tommy Thompson said authorities are checking to see if the mystery illness is spreading within the United States.

 

Thompson told senators Wednesday morning the government is investigating 40 U.S. reports of the illness and is looking carefully at eleven of those.

 

One of the U.S. cases under investigation is that of a 32-year-old California man, who is hospitalized in Denver with flu-like symptoms and who recently returned from a month-long trip to Hong Kong and Indonesia, the Colorado Department of Public Health and Environment reported Tuesday.

 

A statement by the department said the man, who was not identified, was listed in fair condition.

 

 

Also Wednesday, the disease apparently claimed another victim -- a French doctor at a hospital in Vietnam. An American boy living in Ho Chi Minh City also was reported to be suffering from the mystery ailment, which is known as "atypical pneumonia."

 

The WHO has listed nine deaths from SARS, but that number could be as high as 11 if the French doctor and a Chinese professor who died early this month in Hong Kong were included in the tally.

 

The finding by the researchers in Frankfurt and Hong Kong is the first potential clue to emerge in the three weeks since the illness came to the attention of health experts. But the lead scientist in Frankfurt also urged caution over his group's findings.

 

Dr. Wolfgang Preiser, a consultant virologist at Frankfurt University Hospital, said the preliminary conclusion that that the cause of SARS is a paramyxovirus is based on observations from an electron microscope. Other more rigorous work, such as genetic testing, has not been done.

 

FINDING CALLED PRELIMINARY

"It could possibly, potentially be the agent responsible for SARS, but we don't know at this stage," Preiser said. "The size fits a paramyxovirus. The structure, as far as we can make out, fits."

 

The paramyxovirus family includes hundreds of different viruses of varying degrees of danger to people. Besides measles and mumps, there is respiratory syncytial virus -- a common cause of croup in children -- and parainfluenza viruses, which are not influenza but cause flu-like symptoms.

 

Samples were being sent Wednesday to a specialist lab in Rotterdam, Netherlands, which has previously identified new paramyxoviruses. Other labs also were seeking to confirm the finding, the WHO's Heymann said.

 

The disease, first described as a new form of pneumonia, has sickened 219 people worldwide in the past few weeks. Five of the deaths were in China and occurred during an outbreak months ago.

 

Most of the illnesses have been health workers in Singapore, Hong Kong and Vietnam. A few probable cases have turned up in England, Taiwan and Slovenia. Unconfirmed cases were being investigated in many other places, including the United States, where authorities say they are investigating nine possible cases.

 

On Saturday, the WHO issued a worldwide travel alert and warned that the highly contagious disease posed "a worldwide threat." Airports and hospitals around the world immediately went on high alert for carriers of the mysterious illness.

 

Although the CDC is keeping "an open mind" about bioterrorism, CDC Director Julie Gerberding said the mystery illness appears to be naturally occurring.

 

RACE TO FIND CAUSE

Scientists around the world have been working to trace the deadly disease to dozens of different bacteria and viruses, but had found no strong clues on what it was. Many suspected it was something they have not seen before.

 

Most infections are in populous Hong Kong, where 123 people are ill and two are reported to have died. Vietnam has reported 57 cases and one death, while Singapore has 23 sick people. Two patients also died in Canada.

 

The WHO reported a new case Wednesday in Vietnam, that of an American boy, believed to be 11 years old, who had traveled to the northern resort town of Sapa on a school trip before falling sick. No details on the boy's condition were immediately available.

 

U.S. Ambassador Raymond Burghardt told a meeting of diplomats that the boy, who lives in Ho Chi Minh City, had also been in Hanoi but had no known link to any health care workers or other victims.

 

Doctors in Germany said they were treating three people with the illness, including a 32-year-old doctor from Singapore and his pregnant wife. The physician had treated some of the first pneumonia cases in the island republic.

 

WHO EXPERTS TO CHINA

WHO experts are expected to arrive in China soon to determine if the pneumonia is linked with the outbreak of respiratory disease that began in southern China in November.

 

Medical experts said Monday that people should not panic because the illness is not as aggressive as most forms of influenza.

 

WHO officials said Tuesday they were investigating suspicious cases in Britain, France, Israel, Slovenia and Australia, all of which previously had no reports of the illness.

 

The incubation period for SARS appears to be three to seven days. It often begins with a high fever and other flu-like symptoms, such as headache and sore throat. Victims typically develop coughs, pneumonia, shortness of breath and other breathing difficulties. Death results from respiratory failure.

 

Health experts said they were encouraged by indications that the disease seemed to weaken as it passed from person to person. The Chinese said 7 percent of patients there required breathing tubes, but most eventually got better, especially if they were not also stricken with a bacterial infection.

 

 

 

The Associated Press and Reuters contributed to this report.

[Mick]

Thanks for posting the article Tony. I saw a report about it on the HK news last night. 140 cases now reported there.

[tonado]

CDC cites 11 U.S. cases of mystery illness; Hong Kong hotel spread raises questions

 

By Daniel Yee, Associated Press, 3/19/2003 18:54

ATLANTA (AP) Health officials said Wednesday that 11 suspected cases of a mysterious flu-like illness have emerged in the United States, while on the other side of the world, medical investigators continue to puzzle over how the illness spread in a Hong Kong hotel.

 

Centers for Disease Control and Prevention chief Dr. Julie Gerberding said the suspected U.S. cases are people who recently traveled to Asia and later developed fever and respiratory problems, matching definitions for the mystery illness, called ''severe acute respiratory syndrome'' or SARS.

 

The illness, for which there is no treatment, has caused 14 deaths, including five who died months earlier in an outbreak in China.

 

The worldwide number of cases, including the 11 suspect U.S. cases, now totals 264, according to the World Health Organization. Most of those cases are in Hong King, Vietnam and Singapore. The WHO said Wednesday that they continue to receive reports about some patients recovering from the illness, which causes high fever and severe breathing problems.

 

''There's a lot we still don't know about this problem,'' said Gerberding, who added that the CDC is still examining new samples that recently arrived from overseas.

 

''It's very preliminary to say any individual is a case of SARS,'' she said. ''It is going to take some days to know for sure.''

 

She declined to say where the U.S. cases are, but health officials in New Mexico and California said they each had one case on the list.

 

In New Mexico a patient from Albuquerque, who recently returned from Hong Kong, was in a hospital's respiratory isolation unit, state health officials said Wednesday.

 

Los Angeles County's public health officer said a man with SARS symptoms was recovering after being hospitalized Saturday. He fell ill March 11 after returning from a visit to Vietnam, Hong Kong and part of China.

 

Although more cases could be identified in the United States, people who haven't recently traveled to affected areas in Asia shouldn't worry, Gerberding said.

 

''We don't want people who haven't traveled to this region to be concerned about this problem, at least at this point in time,'' she said.

 

Health and Human Services Secretary Tommy Thompson cited the mysterious bug in announcing the government's plan to spend $100 million toward vaccines that would fight off new strains of flu.

 

He said the new disease reminds everyone of ''the potential danger posed by emerging infectious diseases.''

 

So far, the mystery bug has not been identified as a new flu strain. Instead, health investigators are focusing on a family of viruses called paramyxovirus. First German, then Hong Kong doctors reported finding it in case specimens there. WHO said its labs will study other samples to see if the same virus is present.

 

''There is now a clue about what might be causing this,'' said Dr. David Heymann, WHO communicable diseases chief. ''This clue will make it easier to diagnose patients.''

 

But Gerberding and other experts cautioned that it's still too soon to be sure this is the culprit behind the mystery illness.

 

''The laboratories that have identified this virus are very good laboratories,'' Gerberding said. ''But we don't at this point know what it means.''

 

The virus was found in patients' nasal passages, she said, and ''it hasn't yet been identified from any tissues or lung material or other specimens that would directly implicate it as the cause of the infection.''

 

Paramyxovirus is from a virus group that includes common childhood illnesses, such as mumps and measles.

 

''My suspicion is it may be a new virus within that family,'' said Dr. Larry Anderson, a CDC virus expert.

 

Investigators said Wednesday that seven of the people infected, including one who died, all stayed on or visited the same floor of Hong Kong's Metropole Hotel before the outbreak prompted a global alert. The discovery may be significant, because until now officials have said close personal contact is necessary to catch the illness.

 

''It would suggest that it spread through the air-conditioning system, but you can't rule out person-to-person contact, since you don't know if they were even in the same room together,'' said Ronald Atlas, president of the American Society of Microbiology. ''But everything says it is airborne.''

 

Gerberding noted that none of the hotel staff became ill. She said that investigating how the guests interacted will offer additional clues to the degree of contagion and how it's spread.

 

For now, all health officials know is that at least two of the guests visited each other in the hotel; contact among the others is being investigated.

[tonado]

http://www.nytimes.com/2003/03/20/health/20INFE.html

 

March 20, 2003

W.H.O. Reports Gains Against Respiratory Outbreak

By LAWRENCE K. ALTMAN with MARK LANDLER

 

 

Officials at the World Health Organization expressed increased optimism yesterday that scientists had found a virus that could be the cause of a mysterious respiratory ailment, adding that if the research continued at its surprising speed, a test to detect cases could soon be developed.

 

Such a test would be a major step in controlling the outbreak, which has killed at least nine people and sickened hundreds more. An accurate test could detect individuals who might be healthy carriers of the virus and those who have mild cases. The test could also help guide doctors to move from the current hit-or-miss treatment approach to more precise selection of drugs that might help patients recover.

 

But much more work needs to be done to be sure that the suspect virus is the true cause of the ailment that W.H.O. calls SARS, for severe acute respiratory syndrome. The agency has declared the condition a "worldwide health threat."

 

Yesterday, W.H.O. increased the cumulative number of cases to 264, including all nine deaths since Feb. 1. The previous total, on Tuesday, was 219 cases, including four deaths at that time. In addition, Chinese health officials have said that an outbreak before February sickened 305 people in Guangdong province, leaving five dead.

 

The cases reported by W.H.O. occurred in Britain, Canada, Germany, Hong Kong, Singapore, Slovenia, Spain, Taiwan, Thailand, the United States and Vietnam. Most cases involve hospital workers or individuals who have had close household contact with someone who is infected, and many are recovering after nursing care but without specific drug treatment.

 

For several days, Dr. Julie L. Gerberding, the director of the Centers for Disease Control and Prevention in Atlanta, has said her agency was investigating a number of suspect cases. But the 11 cases reported from the United States made this the first time this country has been on W.H.O.'s list of nations where the disease has been identified.

 

Dr. Gerberding said the number of cases would vary daily as the epidemiological and clinical investigation proceeded. She said her agency was using a broad definition purposely to cast a wide net for cases to avoid missing any true ones.

 

The definition includes people who have traveled to an area with documented transmission of SARS within 10 days of becoming ill or having had contact with an individual suspected of having SARS.

 

Signs and symptoms include a fever of 100.4 degrees Fahrenheit and respiratory symptoms including cough, shortness of breath, difficulty breathing or chest X-rays showing pneumonia or acute respiratory distress syndrome.

 

But using such a broad definition, particularly in a season when respiratory illnesses are common means that the 11 cases may fall by the wayside as the investigation progresses, Dr. Gerberding said.

 

C.D.C. has received more than 40 calls concerning suspect cases since Monday, she said.

 

In Hong Kong, the health department said the first group of patients there had stayed in a hotel in Kowloon last month. That group included three visitors from Singapore, two from from Canada, one from mainland China and a seventh from Hong Kong. At least two of the patients visited each other in the hotel. Health officials are trying to reconstruct the interactions of the other five guests.

 

On Tuesday, scientists from laboratories in Hong Kong and Germany reported having found particles that seem to belong to a large family of viruses, paramyxoviridae, in three patients with suspect SARS cases. The family includes the viruses that cause croup, respiratory disease, measles, mumps, rubella and a number of diseases in animals, including Newcastle disease, which is lethal to chickens; canine distemper virus and rinderpest, which affects cattle and other animals.

 

In recent years, scientists have added the Hendra virus, which infects horses, and the Nipah virus, which infects pigs, to the list of paramyxoviridae that can infect humans.

 

The key to detecting the viral particles in the three SARS patients appears to have been the use of electron microscopes, a powerful instrument not used in many virology laboratories.

 

Dr. Larissa Kolesnikova, a Russian microbiologist who is working at the Institute for Virology in Marburg, Germany, said yesterday that she had used specimens from a Singapore doctor who attended a medical meeting in New York City last week and his mother-in-law. They were taken off a plane on a scheduled stop in Frankfurt on their return flight home.

 

Dr. Kolesnikova said she had peered into an electron microscope at the doctor's specimens for three hours on Saturday, then came back and identified the particles on Sunday morning. Meanwhile, scientists at the Chinese University in Hong Kong were identifying similar particles, also using an electron microscope. "With the confirmation from Hong Kong, we are more confident" that the virus might be the cause of the outbreak, said Dr. Hans-Dietrech Klenk, the director of the Marburg institute.

 

However, Dr. Klenk and W.H.O. officials emphasized that much more work was needed to be sure the virus was the true cause of the outbreak.

 

A team headed by Dr. John Tam, a microbiologist in Hong Kong, used the electron microscope findings to determine the nucleic acid sequence of the virus's molecular structure, said Dr. Klaus Stöhl , a virologist and epidemiologist who is leading the health organization's scientific team investigating the illness.

 

The Chinese scientist also used a technique known as PCR, for polymerase chain reaction, to get strong hints that the suspect virus had infected three patients in Hong Kong.

 

Dr. Tam has agreed to share the information on a secure Web site so that other laboratories in the W.H.O. network can try to confirm and advance the findings in cell cultures and animals in the laboratory.

 

If a paramyxoviridae virus is confirmed as the cause of SARS, the World Health Agency would consider recommending the antiviral ribavirin as a treatment, said Dr. David L. Heymann, a W.H.O. official.

 

Given the problems infectious diseases often cause in the military, American officials said the Department of Defense was keeping an eye on the movement of this disease.

 

"You can be sure that the D.O.D. is well up to date on the status of this outbreak and investigation, and they are doing what is necessary to protect the troops," Dr. Gerberding said.