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Vol. VI, No. 07~ EINet News Briefs ~ March 26 , 2003

****A free service of the APEC Emerging Infections Network*****

The EINet listserv was created to foster discussion, networking, and collaboration in the area of emerging infectious diseases (EID's) among academicians, scientists, and policy makers in the Asia–Pacific region. We strongly encourage you to share their perspectives and experiences, as your participation directly contributes to the richness of the "electronic discussions" that occur. To respond to the listserv, use the reply function.

In this edition:
  1. Infectious disease information
  2. How to join the EINet email list

Below is a semi–monthly summary of Asia–Pacific emerging infectious diseases.



Moderator: News wire stories suggest that the virus, tentatively identified as a Coronavirus, may be more contagious than presented in bulletins from authoritative sources last week. Given the school closures in Hong Kong and Singapore and quarantines in Ontario, Canada, we urgently suggest that APEC member countrieswith strong travel ties to affected countries review the information on this epidemic situation. Additional technical information is available at the WHO (http://www.who.int/csr/don/2003_03_26/en/), CDC (http://www.cdc.gov/ncidod/sars/) and Hong Kong Health Department (http://www.info.gov.hk/dh/ap.htm) Health Canada (http://www.hc–sc.gc.ca/pphb–dgspsp/sars–sras/index.html) websites.

With probable droplet person–to–person transmission advising the public with messages about hand washing, remaining at home when coughing and sneezing and other measures is more important than ever to avoid spread within our communities.

As always EINET is pleased to accept comments from the many authoritative members on our network about the accuracy of these reports, or other information carried through this network.

Below are three news wire accounts:

Reuters: Hong Kong
Associated Press: Beijing
Canadian Press: Ontario

March 26, 2003
34 Deaths in China Attributed to Mystery Illness
By REUTERS Filed at 9:58 a.m. ET

HONG KONG (Reuters) – China dramatically raised the death toll from a mystery virus on Wednesday and reported its first deaths in the capital, as Singapore closed schools to fight a pneumonia outbreak that has killed more than 50 people worldwide.

Singapore, which has quarantined 861 people with flu–like symptoms and reported on Wednesday its first two deaths from severe acute respiratory syndrome (SARS), said all schools would be closed until April 6.

A top Hong Kong official issued a chilling warning to the city's seven million people, saying the killer disease was spreading among the public.

"We can see the trend of the figure climbing. People from all walks of life have been infected,'' Hong Kong Deputy Director of Health Leung Pak–yin told a news conference. ``If you are on the plane and an infected person is sitting either behind or in front of you and he coughs, you can get infected.''

Eleven people have died from the illness in Hong Kong since the outbreak began in February. Leung said infections had risen to 319 from 290 on Tuesday, with 316 suffering severe pneumonia.

Hong Kong officials had said the illness was mostly confined to hospital staff and relatives of infected patients.

China said on Wednesday 34 people had died and about 800 had been infected by a mystery pneumonia, up from a previously reported five deaths and 305 infections.

In Beijing, health officials said three people had died of the disease and five more had been infected but said the illness was not spreading in the city of 14 million. Health officials had previously denied any deaths in the capital.


World Health Organization officials believe SARS, spreading swiftly across the world, is linked to a disease outbreak in China's southern province of Guangdong that began in November, but they have yet to prove a link. Guangdong borders Hong Kong.

Symptoms of the disease, which is believed to be spread through droplets by sneezing and coughing, include high fever, chills, coughing, cold and breathing difficulty. Many victims quickly develop severe pneumonia. Out of every 100 infected people, three to five die from the disease, experts say.

Guangdong officials said 31 people had died of atypical pneumonia in Guangzhou and six other cities in the province by the end of February. A total of 792 had been infected.

Beijing has put its hospitals on alert and laid out a plan to prevent the disease from spreading in the city.

SARS has spread to Hong Kong, Vietnam, Singapore, Canada and Germany, infecting more than 500. Suspected cases have been reported in the United States, Japan, Britain and Australia.

Four people have died in Vietnam, three in Canada and two in Singapore. More than 70 people have been infected in Singapore.

Worried parents in Hong Kong and Singapore kept children home from school or packed them off to class wearing surgical masks.

``Don't worry about how you look. You should feel lucky you have this to protect you,'' one Hong Kong mother told her son as he fidgeted under his mask.


The Singapore government went further on Wednesday evening. It said it would halt classes for the city state's 500,000 children to try to alleviate parent concern, despite saying in a statement there were no medical reasons to close schools.

The Hong Kong government has ruled out suspending classes, although nearly 100 schools have chosen to shut down. Two more school children fell ill on Wednesday, bringing the total to 9.

Hong Kong's Central Library and a branch of the Bank of East Asia in the city were shut for disinfection after a worker in each place was suspected to have caught the disease.

Hong Kong is trying to track down 78 foreigners who stayed on the same hotel floor as an infected mainland Chinese doctor suspected of starting the Hong Kong outbreak in February.

The hotel guests –– from mainland China, Britain, the United States, Singapore, Canada, Australia, Malaysia, Japan, the Philippines, Netherlands, Germany and Taiwan –– stayed on the ninth floor of the Metropole Hotel between February 21㪮.

The Chinese doctor is believed to have infected at least seven strangers –– probably in the hotel lift or lift lobby ––who then spread the virus in Hong Kong, Singapore, Vietnam and Canada. The doctor and two of those he infected have died.

Hong Kong is looking for 245 passengers on board two Air China flights –– CA 112 from Hong Kong to Beijing on March 15, and CA 115 from Beijing to Hong Kong on March 19 –– after nine tourists from Hong Kong on those two flights fell ill.

The nine were likely to have caught the disease during the March 15 flight from an infected Chinese passenger, who was returning to Beijing after visiting a sick relative in Hong Kong.


World Health Organization links China illness outbreak to others
Associated Press Writer
BEIJING (AP) – The World Health Organization for the first time has linked a pneumonia outbreak in China to a mystery flu–like illness that has hit other countries on three continents. The global death toll from the combined outbreaks climbed to 52 on Wednesday.

Chinese authorities said the disease has killed at least 34 people in China since November – 31 in the south and three in Beijing. Hundreds have been infected. Previously, they said only five had died in southern Guangdong province. World health officials later said the symptoms of the Chinese illness are consistent with those for severe acute respiratory syndrome, or SARS, which has sickened nearly 500 people and killed 18 elsewhere – 10 in Hong Kong, four in Vietnam, three in Canada and one in Singapore.

A second person suspected of having the disease died in Singapore late Wednesday, officials said, and all schools were ordered shut as a health precaution. More than 700 people in the city–state have been ordered to stay home under quarantine or face fines.

"Everything we've seen so far indicates it's the same disease," said Dr. Meirion Evans, a member of a WHO team that has studied the cases in southern China, but not yet those in Beijing.

"We're getting a more complete picture," Evans told The Associated Press. "It's certainly been one of the objectives of the mission to clarify whether the outbreak in China was the same disease as what's been seen outside of China.

"It's not good news for the patients, but it's helpful in our understanding of the disease."

The WHO has called on Beijing to be more cooperative. Taiwan also urged China on Wednesday to be more forthcoming.

"Because the mainland is not sharing information, the source of the contagion has not been clear and the period of risk for the outbreak has been lengthened," said a report from Taiwan's Mainland Affairs Council, which handles the island's relations with rival China. "This hasn't helped us protect ourselves from an

Singapore's closure of schools, from day care centers to junior colleges, will keep a half–million students temporarily out of class.

"On purely medical grounds, there are currently no strong reasons for closing all schools," said Teo Chee Hean, Singapore's education minister.

"However, principals and general practitioners have reported that parents continue to be concerned about the risk to their children in schools."

In Hong Kong, where numerous citizens are going about town in masks, media reported that about 60 schools have been closed as a precaution.

The Hong Kong Education and Manpower Bureau would confirm only five closures – after eight students were infected by sick relatives or health care workers – but officials acknowledged some schools were closing at their own initiative.

Health officials said Tuesday they had quarantined about two dozen possible carriers of SARS in Canada after the number of probable cases in Ontario jumped from 10 to 18. The disease is believed to have spread to Singapore, Vietnam and Canada by people who caught it while spending time last month on the ninth floor of the Metropole Hotel in Hong Kong, where an infected mainland Chinese medical professor was a guest.

The South China Morning Post in Hong Kong reported early Wednesday that the professor had been treating atypical pneumonia patients in the mainland before he came to Hong Kong. The professor died here in early March. Chinese officials said previously that 305 people were sickened in the atypical pneumonia outbreak.
But a spokeswoman for the Guangzhou city government, who identifiederself only by the surname Ye, said Wednesday that 792 cases of atypical pneumonia were reported in the province by the end of February, with 680 in the capital Guangzhou.

Ye said 31 people in Guangdong had died by the end of February. Three others died in Beijing this month, the city said Wednesday. Hoping to avoid any SARS cases in the Philippines, officials in Manila on Wednesday urged travelers from countries hit by the disease to stay at home for a week in voluntary quarantine. Foreign Secretary Blas Ople also cautioned Filipinos to limit travel to countries with known cases of SARS. Tens of thousands of Filipinos work in Hong Kong and Singapore, many as domestic helpers. Philippine officials also convinced the parents of a Filipina maid, Adela Dalingay, who is believed to have died of SARS this week in Hong Kong, to have her remains cremated to avoid difficulties of transporting the body home, Ople said. No official cause of her death has been given.

Ontario warns of 'health emergency' Health minister says SARS must be stopped

ONTARIO — Protective face masks flew off supply store shelves today as panicked Torontonians sought to shield themselves against a deadly SARS outbreak that prompted Ontario to declare a "health emergency." Police wearing surgical face masks descended on the east–end hospital where two people died of the pneumonia–like disease, putting yellow police tape around the perimeter and blocking the entrances with their cruisers, Citytv reported today.

A police spokesperson said police were providing protection for a helicopter about to land at Scarborough Grace Hospital and would not immediately confirm that the measures taken were linked to SARS.

"This is a temporary stop–gap measure until this helicopter comes in," said Sgt. Jim Muscat.

"Because there is no launch pad for a helicopter we are putting a perimeter on the hospital so this helicopter could facilitate a safe landing."

The dramatic scene unfolded hours after Health Minister Tony Clement announced he had activated an action group under Ontario's emergency powers legislation to try to stop the spread of SARS, or severe acute respiratory syndrome.

Dozens of households have already been quarantined and a school and a hospital emergency room has been closed.

"We're taking this very seriously," Clement said.

"By characterizing it as a health emergency, we are giving ourselves the powers that we need and the information that we need at the most appropriate time to ensure that we can contain this disease as soon as possible."

A command centre will be set up and staffed 24 hours a day to co–ordinate all information from hospitals and health workers on SARS, also known as atypical pneumonia.

The government has already designated the illness a reportable, communicable and virulent disease under the Health Protection and Promotion Act, which lets officials quarantine people against their will.

About 25 Toronto residents showing symptoms of SARS, many of them health care workers, have been quarantined, some in hospital isolation rooms. Their family members have been told to stay home for at least 10 days. They must wear facemasks while interacting with other family members, sleep in separate rooms and are forbidden to leave their home or hospital room.

Public health officials warn the total quarantine count could be in the hundreds.

The outbreak has dominated the front pages of local newspapers, sending some Torontonians straight to a surgical supply store first thing this morning.

"Before we even opened there were three people at the door and I think they cleaned us out at that point," said Jim Garde, general manager of Starkman's Home Healthcare.

"It's gone crazy, we're trying to keep up with it right now. ... It seems that about every second person that's coming in is buying a box of these masks."

Garde's store provides masks wholesale to several pharmacies, as well as to Toronto's ambulance service, public health office and police force. But many of the customers he's seen in recent days have been regular citizens, fearful they could soon fall ill.

It's made for huge sales for a business that generally sells one case of masks per month.

"We've picked up 30 cases this morning, we've got another 125 cases tomorrow," said Garde.

Health officials urged the public not to panic, pointing out that only people who have been in close contact – within about one metre, over a period of some time – with a person sick with SARS have become infected.

Clement said he held a rare evening meeting with Ontario's chief medical officer Tuesday to discuss taking extraordinary measures to deal with the pneumonia–like illness.

"(The) Health (Ministry) has an emergency situation, it recognizes that," he said. "We felt that because there were new suspect cases that this was warranted."

On Tuesday, eight more probable cases emerged in Ontario, marking a substantial jump in suspected cases in Canada. There are now 19 probable cases; 18 in Toronto and one in Vancouver. Three people in Toronto have died.

Clement said the ministry action group would make it easier to track the disease's spread.

"It provides a central depository of this kind of information so that we can act as swiftly as possible," he said.

Fears over the spread of SARS closed an east–end school until Monday after three kindergarten students fell ill with undiagnosed fever. The board stressed the fevers were not consistent with SARS symptoms and that the closure of the elementary school was a precaution.

Other schools have sent notes home urging parents to watch for symptoms such as dry coughs and soaring temperatures and to keep sick children home.

The closed school is a short walk from Scarborough Grace Hospital, which shut its emergency room earlier this week after treating three people who died from the disease.

Clement noted that SARS posed a distinct threat from the West Nile virus, which is not as easily spread.

"(SARS) is a potentially airborne disease," Clement said. "The degree of spread could be quite exponential if nothing is done."

West Nile is spread by mosquitoes that have bitten an infected bird, not through person–to–person contact, such as coughing, sneezing or drinking from a shared cup.

The SARS outbreak started in China, where it sickened hundreds. It was carried to Toronto by Sui–chu Kwan who was returning from Hong Kong. Kwan died of the disease March 5.

Health Canada has urged Canadians planning trips to the most affected parts of Southeast Asia to defer travel for the time being. Those areas are Hanoi, Vietnam, Hong Kong, Guangdong province in China and Singapore.

Grover Hayashi of Elite Orient Tours said about 20 people have cancelled flights with his company in recent days, likely because of the Health Canada warning and anxiety over the war with Iraq.


The APEC EINet listserv was established to enhance collaboration among academicians and public health professionals in the area of emerging infections surveillance and control. Subscribers are encouraged to share their material with colleagues in the Asia–Pacific Rim. To subscribe (or unsubscribe), contact apec–ein@u.washington.edu. Further information about the APEC Emerging Infections Network is available at http://www.apec.org/infectious.


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