USA —BSE (mad cow disease) update
The USDA reached the conclusion that the BSE–positive cow indeed originated from a dairy farm in Alberta, Canada. The DNA evidence is based on a comparison of DNA from the brain of the positive cow with the DNA from the semen of her sire, as determined by records on the farm in Alberta. Additional DNA test results involved the yearling heifer calf on the index farm, which was born from this positive cow. Breeding records on that calf confirm that she was born from the positive cow, bearing the same tag number found on the positive cow at slaughter, which is also the same tag number found on the record on the dairy farm in Alberta, Canada. The USDA believes that the evidence is strong, as their conclusion is based on this new DNA information, documentation obtained from officials in Canada and from the owner of the dairy farm in Mabton, Washington, and through import records.

On 6 Jan 2004, USDA euthanized the entire bull calf herd from Sunnyside, Washington. Approximately 450 animals were euthanized according to American Veterinary Medical Association humane guidelines. USDA officials secured the animal carcasses overnight and disposed of the carcasses by landfill on 7 Jan 2004. None of the carcasses entered the human food supply chain or were rendered.

In regard to the ongoing investigation, USDA has located another animal that came into the United States with the index cow. This animal is also part of the dairy herd located in Mattawa, Washington, that is under a Washington State hold order. USDA now has 12 of the 82 cattle listed on the Canadian health certificate definitely accounted for, and tracebacks of the animals that entered the United States continues.

Japan wants all imported US beef to be tested for mad cow disease as the minimum condition for lifting a ban, and Japanese firms may be asked to foot some of the cost, a report said. The agriculture and health ministries will also demand disposal of dangerous parts such as the brain and spinal cord of all animals before reopening to US beef imports, the Asahi Shimbun said.

Japan, the largest export market for US beef, was among the first of more than 30 countries to ban imports after the discovery of the first US case of mad cow disease last month. The United States only tests 20,000 cows per year for the brain-wasting disease, but Japanese agriculture ministry officials believe the added cost of checks on Japan-bound beef is needed to ensure safety and maintain supply, the paper said. Japan imported 333,272 tons of US beef and beef products in 2002, accounting for about 1/3 of the country's beef market. On Thursday, Japan sent a five-member fact-finding mission to the United States and Canada ahead of deliberations on whether to lift its ban.
(Promed 1/9/04 , 1/6/04 )

China—China and WHO confirm SARS case in Guangdong Province 5 Jan 2004
Results from laboratory tests have led the Ministry of Health of China and the WHO to upgrade the suspected SARS case in southern China to a laboratory-confirmed case. The latest results were obtained from virus neutralization antibody tests carried out by two laboratories in Hong Kong, that are part of the WHO international laboratory reference network, as well as by a laboratory under the Chinese Centre for Disease Control and Prevention in Beijing. The virus neutralization tests from all three laboratories indicate that the male patient, a 32-year-old television producer in Guangzhou, Guangdong Province, has recently been exposed to a SARS coronavirus. Because of initially inconclusive tests, WHO had recommended to the Ministry of Health of China that it send samples for testing to laboratories within the WHO international laboratory reference network.

WHO said it is important to stress that although this case has now been classified as a SARS case, this does not indicate there is an immediate public-health threat in southern China. It is safe to travel to all areas of China. SARS can be controlled and contained if there is a system that allows early detection and isolation of cases and timely contact tracing. The Guangdong provincial health authorities are clearly committed to developing such a system, and major steps have been taken to achieve this.

The Guangdong provincial authorities have so far identified 81 contacts of the patient, of whom 25 were classified as close contacts, 39 as casual contacts, and 17 as healthcare workers. All 25 close contacts and 39 casual contacts have been released from quarantine and are said to be well. The healthcare workers will be kept under observation until 14 days have passed since their last contact with the patient. At this stage all the healthcare workers are well.

A joint Ministry of Health of China and WHO team visited Guangdong Province last week as part of the ongoing investigation into the case. They concluded that the situation in Guangzhou appears to be under control at the present time. But at the same time WHO has also urged the Ministry of Health of China and Guangdong provincial health authorities to further strengthen the surveillance system and widen the scope of the investigation in the coming days and weeks. There is a need to ensure that the practices seen in Guangzhou are consistent throughout Guangdong Province, and indeed all other provinces and autonomous regions in China as well. At the invitation of the Ministry of Health of China, more WHO international experts will be heading to Guangdong Province this week to assist in the investigation in this case, including trying to find the possible source of the infection.
(Promed 1/5/04 )

China—Rats and civits hunted in SARS episode
The confiscation and slaughter of civets continued in Guangdong Province, where officials trying to prevent a new outbreak of SARS also unveiled plans for a "patriotic campaign" to eradicate rats. The activity comes as Chinese officials are moving aggressively to avoid another SARS outbreak. The confiscation of civets began in earnest on Tuesday, and state media reported that workers were drowning the animals in disinfectant. The WHO has cautioned that such a slaughter must be carried out carefully to avoid the risk of causing more infections or contamination.

Guangdong officials have estimated that they plan to confiscate and kill about 10,000 animals by Saturday. The exact number put to death so far is not known, but the official New China News Agency reported that on Tuesday more than 1,500 government workers in Guangdong had inspected 67 animal markets, 797 restaurants and 137 wildlife markets. They reportedly seized 171 civets. In addition, 2,030 civets from 41 breeding farms were quarantined in Guangdong.

The 32-year-old man from Guangdong, who became mainland China's first SARS case of this winter, was released from the hospital. Earlier, he had told the Chinese media that he had never eaten civet, and that his only contact with wild game was with a mouse. He apparently threw a mouse out a window at some point before he became ill. The disclosure that the SARS patient had come into contact with a rodent apparently prompted officials in Guangzhou to turn their attention to rats. The Guangzhou Daily reported that residents would be encouraged to put out rat poison from 10-13 Jan 2004 as part of a "patriotic campaign" to exterminate vermin.

The SARS case that was confirmed on 5 Jan 2004 was discharged from the hospital today. All of the known contacts under observation have been fever free and the final contact was released from observation today.
(Promed 1/8/04 )

China (South)—New suspect SARS case reported
On January 8, 2004, the Chinese Ministry of Health (MOH) and the WHO reported a suspect case of severe acute respiratory syndrome (SARS) in a 20-year-old woman who works in a restaurant in Guangdong Province, China. According to a Chinese MOH surveillance report and the WHO notice, the woman reported feeling discomfort on December 25 and had onset of fever on December 26. She was admitted to a hospital in Guangzhou city on December 31 and was transferred to an isolation room for treatment. On January 7, a panel of Chinese medical experts made a diagnosis of suspected SARS, and the patient was transferred to another hospital in Guangzhou city. She is reportedly in stable condition and has remained afebrile for the past 7 days. All 48 identified close contacts and 52 other contacts have shown no signs of illness to date. Additional epidemiologic investigations and laboratory studies are under way.

This is the second recent report of SARS in Guangdong Province. On January 5, the Chinese MOH and WHO announced that laboratory test results had confirmed evidence of SARS coronavirus in a 32-year-old man in Guangdong, China. He remains in good condition, has been discharged from the hospital, and all 81 identified contacts are reported to be well. No link has been established at present between the confirmed case and the new suspect SARS case, and the source of exposure for both cases is unclear. Chinese government authorities have initiated several measures to minimize contact between humans and animals thought to carry SARS CoV, including the culling of masked palm civits and related wild-animal species. The culling is expected to be completed within the next few days.

The Philippine Department of Health announced on January 7 that laboratory testing of a suspect SARS patient in Manila was negative for SARS-CoV, and the patient's illness has been reclassified as bacterial pneumonia. None of the patient's 46 contacts have shown signs of SARS-like illness.
(WHO, CDC 1/8/04 )

China ( Guangdong )—Investigative team arrives in Guangdong
A joint team of WHO and Chinese experts has arrived today in Guangdong to investigate possible sources of infection for the confirmed SARS case. Over the coming days, parallel investigations will look at possible human-to-human, animal-to-human, and environmental sources of transmission. Animal experts will also examine conditions surrounding the culling of masked palm civets and other wildlife species, and make recommendations for research that could shed light on the origins of the SARS coronavirus. Further research is urgently needed to determine sources of human exposure, including the possible involvement of specific animal species.

An investigation by a previous joint team of experts, conducted in Guangdong from 20 December to 2 January 2004, found a very high level of awareness of the symptoms of SARS among health care workers and pharmacists, and a very high level of preparedness to introduce appropriate public health measures. Good levels of infection control were in place at all four facilities where the confirmed case was examined or treated. Local and national authorities were rapidly alerted, and the tracing of 81 contacts was completed within two days.
(WHO, CDC 1/8/04 )

Mad Cow Disease: New and updated information on Bovine Spongiform Encephalopathy (BSE) and variant Creutzfeldt-Jakob Disease (vCJD) are available at: http://www.cdc.gov/ncidod/diseases/cjd/cjd.htm

SARS: Updated ( Jan 8 2003 ) CDC guidance can be viewed at: http://www.cdc.gov/ncidod/sars/updatedguidance.htm

News and updated SARS information are available at: http://www.who.int/csr/sars/en/index.html