- Hello Jeff: We still don't know the identity of the
SARA causitive agent. We do know, as exhibited by George W. Bush's signing
of an Executive Order to quarantine suspected cases of SARS, that the medical
community hasn't a clue about the disease.
-
- Health Canada has proclaimed that people who believe
they have SARS must NOT report to hospitals, but stay home without treatment.
-
- Connecting the dots, I believe that George W. and many
of the scientists working on identifying SARS agent KNOW the virus is lab
altered, lab manipulated.
-
- The virus will infect and projecting expoentially we
can determine within one month that we can expect as many as 6,000+ cases
worldwide. We are, already, up to almost 3,000 worldwide. I also believe
that many cases are going to go unrecognized or undiagnosed. When the death
toll begins to mount, I cannot help but wonder how funeral parlors, and
forensic pathologists will manage victims? Will cremation be mandatory?
-
- I did find it interesting that Loudon County, Virginia
has a hospital that can offer BSL 4 isolation to their patients. Of course,
Loudon County is home to the "Bell labs of biotech" namely Howard
Hughes Medical Institute and many other biotech companies, including Ken
Alibek's. Perhaps, hospitals had been equipped with BSL 4 features because
it was feared a pathogen might escape one of the labs.
-
- The SARS patient from Loudon County was treated and cared
for in the hospital's isolation room attended by staff using BSL 4 equipment.
It is a shame that cities like, New York, Los Angeles, Chicago etal do
not have hospitals with a BSL 4 capability.
-
- Although, the Promed article tries to rationalize the
appearance of SARS and equate it with a 10 year emergence of various influenza
viruses from Asia, I find it difficult to believe that the agent causing
SARS is just a natural emergence from Asia. The genome tells another story.
-
- I do forsee a great economic downturn should the virus
spread rapidly through major US cities, like New York City. IF the death
toll and cases rise dramaticallly and people are not admitted to hospital
or given any care, we can be sure civil unrest will overtake cities like
New York and the highways "out of town" will be bogged down with
fleeing residents.
-
- I do hope that people who exhibit signs of the illness
will voluntarily "take themselves out of circulation" and stay
home until it can be determined they are SARS-free. We can prevent spreading
the illness by some common sense measures. Frequent handwashing and wiping
them frequently with alchol wipe will help. Avoid touching your face, especially
eyes, nose, and mouth. Again, if someone begins to have cold or flulike
symptoms, call your doctor and follow your doctor's instructions.
-
- Patricia Doyle
-
- [1] Date: 4 Apr 2003 From: ProMED-mail <promed@promedmail.org>
Source: OIE press release [edited] http://www.oie.int/eng/press/en_last.htm
-
- Atypical pneumonia: Severe acute respiratory syndrome
(SARS) ------------------------ A human epidemic of atypical pneumonia
called severe acute respiratory syndrome (SARS) is currently raging across
the globe and particularly in South-East Asia.
-
- The causative agent has not yet been identified. It appears
to be a Paramyxovirus, a Coronavirus, or a mixture. The World Health Organization
(WHO) has hypothesised that the causative virus(es) may be of animal origin,
from domestic or wild animals located in Guangdong Province (in South China).
-
- This is why the World Organisation for Animal Health
(OIE) has contacted the Chinese Veterinary Authorities to obtain information
on the animal health situation in China over the past 6 months and, in
particular, in Guangdong Province.
-
- The OIE has also approached its Reference Laboratories
and Experts specialising in Paramyxovirus and Coronavirus diseases.
-
- As soon as it is available, the OIE, in close collaboration
with the WHO, will communicate the scientific information needed to confirm
or invalidate the animal origin of SARS and to evaluate, if necessary,
the risks incurred by the international community.
-
- -- ProMED-mail <promed@promedmail.org>
-
- [We look forward to hearing the results of the OIE investigation.
- Mod.MPP]
-
- ****** [2] Date: Fri 4 Apr 2003 From: Steve Berger <mberger@post.tau.ac.il>
-
-
- SARS - Deja vu ? ---------------- As SARS enters its
fifth month, a number of questions remain unanswered. Why Asia? Why now?
Why young adults? To these I would add a fourth question (Why the panic?)
and an hypothesis.
-
- Every 10 years or so, a pandemic spreads out from China
and surrounding countries. The 'Asian flu' of 1957 claimed 98 000 lives
worldwide, and the 'Hong Kong flu' of 1968 an additional 45 000 lives.
Although the world community was rightly concerned, I do not recall a collapse
of air travel, imposition of quarantine, or daily front-page headlines.
To date, SARS has claimed 79 lives, and the etiological agent appears to
be far less contagious than Influenza A virus.
-
- Current evidence suggests that new strains of Influenza
A virus evolve as recombinants when they pass between swine and ducks,
a process favored by close species proximity on Asian farms. Thus, I was
surprised to learn in a recent ProMed-mail posting that coronaviruses also
exist in poultry and swine, as well as cattle, cats, dogs, and rodents
(see: Coronavirus, Chicken, New - Brazil 20030403.0816). I do not know
whether coronaviruses are capable of recombination in the manner of influenza
viruses, but such a mechanism would partially explain the origin of SARS.
-
- 3 years ago, a 'new' human infection was described in
the Netherlands. It soon became evident that Human metapneumovirus [HMP]
was neither new nor exotic, and seems to have affected most humans in every
country investigated, going back decades. The clinical features of this
infection mimic those of Human respiratory syncytial virus, and infant
deaths are not uncommon. Indeed, it may well be that more people die of
HMP than from SARS each year. These facts only became evident when serological
tests were developed. I suspect that use of serological and other tests
for SARS developed over the next few weeks will reveal: (1) a high degree
of sero-positivity in the 'healthy' community of Asia, if not other countries;
and (2) the existence of an animal (Porcine? Avian?) reservoir.
-
- During the H1N1 pandemic of 1977, there were suggestions
that elderly persons had a lower rate of complications than would be expected.
It was theorized that persons who had survived the prior H1N1 pandemic
of 1918 had retained partial immunity into old age. If, as noted above,
background immunity exists from a SARS outbreak several decades ago, relatively
low disease rates among the elderly during the current epidemic would not
be surprising. The fact that few children are affected is also not surprising,
when we recall that viral diseases (measles, varicella, poliomyelitis,
mumps) are often more overt and severe among adults.
-
- -- Steve Berger Tel Aviv Medical Center, Israel <mberger@post.tau.ac.il>
-
- [Steve Berger has posed some interesting questions and
made some relevant comments. My response is limited to consideration of
the genetic characteristics of coronaviruses. High frequency recombination
is a characteristic property of coronaviruses, and is probably restricted
to closely related coronaviruses. An example is Feline infectious peritonitis
virus, a coronavirus that exists as 2 serotypes and causes peritonitis,
pneumonia, meningoencephalitis, and other immunopathologic complications
in cats. Serotype 2 of feline infectious peritonitis virus appears to be
a recombinant virus incorporating genetic information from a canine coronavirus,
which causes diarrhea in dogs. The serotype 2 virus, in addition to causing
peritonitis, etc., in cats can -- unlike serotype 1 -- infect pups (but
does not cause acute disease).
-
- That said, it is not necessary to hypothesize origin
of the putative SARS-associated coronavirus by recombination with an animal
or avian coronavirus. There are many coronaviruses in the natural environment
that could become pathogenic in humans as a result of progressive mutation,
or perhaps have existed undetected.
-
- The origin of pandemic influenza A viruses by "recombination"
is an entirely different process and can occur between dissimilar viruses.
The genome of influenza viruses exists as a complement of sub-units which
can be interchanged when genetically distinct viruses replicate in a common
(or intermediate) host, generating progeny with non-parental combinations
of genes (and potentially expressing novel combinations of antigens and
causing an explosive pandemic). Consequently there could be abundant opportunity
for exchange of sub-units between human and avian viruses where humans,
domesticated mammals, and birds live in close proximity. This is a gross
oversimplification, of course, but the origin of pandemic strains of influenza
A virus in east Asia in the past should not be used as an argument favouring
the origin of the SARS agent by recombination between a human virus and
an animal virus.
-
- At this stage we simply do not know. Nor is it certain
that the coronavirus (and/or the human metapneumovirus) present in SARS
patients is the pathogenic agent. As Steve Berger points out, coronaviruses
and pneumoviruses are ubiquitous in the human population. Caution is required
in advancing hypotheses at this stage until more data become available.
- Mod.CP]
-
- ***** [3] Date: 5 Apr 2003 From: ProMED-mail <promed@promedmail.org>
Source: CDC press briefing 4 Apr 2003 [excerpted and edited] <http://www.cdc.gov/od/oc/media/transcripts/t030404.htm>
-
-
- Update on the ongoing laboratory investigation: --------------------------------------
CDC is part of an international collaborating network of laboratories led
by WHO. There are 12 laboratories and 10 companies participating in this
network.
-
- Evidence for a previously unrecognized Coronavirus has
been found now in at least 10 laboratories, including the laboratories
here at CDC. The preponderance of the evidence continues to mount and continues
to favor an etiologic role or this previously unrecognized Coronavirus
in the cause of SARS.
-
- So far, in looking at specimens from the suspect cases
in the United States, we now have evidence of infection with this agent
in a total of 4 people, and we are working with the state health departments
in the states where these people reside, so that they are provided with
the information and they, in turn, will provide the clinicians and the
patients with the information.
-
- We have cultured this Coronavirus from a total of 4 patients.
We have electron microscopic evidence from 2 patients of this virus. We
have PCR (Polymerase Chain Reaction) results -- , the amplification technique
-- where we find evidence of Coronaviral nucleic acid in 11 patients.
-
- Looking at the antibody tests, of which we have 2 --an
IFA [immunofluorescent antibody] test and Allose test -- there is evidence
for infection in a total of 5 patients. And from the standpoint of histopathology,
looking through the microscope at tissue from deceased patients, we have
seen evidence of an entity that the pathologist call diffuse alveolar damage,
which is the pathologic correlate for the clinical syndrome of Acute Respiratory
Distress Syndrome, which has appeared in patients with severe forms of
SARS.
-
- We have seen that evidence in a total of 4 specimens.
Don't try to add those numbers up and get a grand total because some patients,
in some cases, have more than one positive result.
-
- [In response to a question on whether there were samples
that tested negative for coronavirus]:
-
- There are negative results. I don't have numbers. For
example though, when you think about antibody tests, what you really need,
[in order] to be able to interpret those and to say that something's negative,
is 2 serum specimens collected 2 or 3 weeks apart. So any negative that
we have now for the most part represents a single serum that's negative.
So we're not in the position to say that evaluation is complete. Part of
our effort now, working with the states, is to get paired serum specimens
from patients so they can be tested.
-
- [In response to a question re: the information that some
of the earlier cases had eaten wild game]:
-
- [Dr. Hughes had not heard the reports about the wild
game consumption.] But, we don't know the source, the original source of
this previously unrecognized virus. There are a number of Coronaviruses
that do infect animals, though. So it may well be that there is an animal
origin for this, and it's the sequencing of the full virus that will tell
us this. So I'm interested actually to follow up and see what sort of wild
game this is and what the evidence might be.
-
- [In response to the question if they have run the tests
on controls] : In terms of PCR, yes, we have negative controls that we
run, both for the PCR and for the serologic tests that we have done, and
it looks like these tests are performing quite well, but it is early in
their use.
-
- There are several diagnostic tests that look promising.
There is the ELISA test for antibody, there's the Indirect Fluorescent
Antibody -- or IFA -- test, again, for antibody, and then there's a PCR
assay [for viruse] that look like they have potential to be useful.
-
- We will be collecting and testing as many specimens as
we can acquire from suspect cases, from health care workers exposed to
them, from household contacts, and from healthy controls over time to further
validate them.
-
- We are going to be trying very soon to transfer some
of these tests to state public health laboratories through the Laboratory
Response Network so we can get the diagnostics, such as they are at the
moment, closer to where the illnesses are occurring. So that's a high priority
-
- [In response to the question on reports ot the isolation
of Chlamydia]: The outbreak in Guangdong Province initially was reported
based on some lab evidence that I don't know the details of, to be caused
by _Chlamydia and [sic] pneumoniae_. My impression is that they had relatively
few positive results for that. We certainly put _Chlamydia and [sic] pneumoniae_
on our long list of differential diagnostic possibilities when we first
heard about the situation in Vietnam, Hong Kong and Canada. We, in our
laboratories, looked for evidence of _Chlamydia and [sic] pneumoniae_ infection
in suspect cases, and so far have not found it.
-
- -- ProMED-mail <promed@promedmail.org>
-
- [The new information provided in this briefing from CDC
is consistent with the hypothesis that a novel (or perhaps previously unrecognized)
human coronavirus is the etiologic agent of SARS, either alone or in combination
with another agent still to be identified. The supporting evidence is far
from conclusive, however. If at the CDC only specimens from suspected cases
in the United States have been examined so far, an undetermined proportion
of whom may not be SARS patients, this would be a limitation.
-
- The RT-PCR amplification of coronavirus sequences produced
11 positive results and was the most sensitive diagnostic procedure employed,
but even with this technique an unspecified number of negative results
was obtained. The most encouraging result is successful propagation of
virus from 2 of the suspected SARS cases. This will allow the entire genome
of the virus to be sequenced and its phylogenetic position in the family
_Coronaviridae_ to be established. It will be possible then to deduce whether
this virus is a new human pathogen derived by recombination with an animal
coronavirus, or whether it has evolved by progressive mutation from either
of the 2 known human coronaviruses, which are associated with upper respiratory
tract infections, or from one of the known animal coronaviruses. It is
curious that a virus, which has such devastating pathological potential
in some people, is present in these specimens in such low abundance.
-
- Specific antibodies were detected in five patients by
ELISA and/or IFA tests, but samples suitable for demonstrating seroconversion
appear to have been lacking. The response to the question on controls is
confusing. It should be a priority to extend these diagnostic procedures
to a matched series of non-SARS patients to exclude the possibility that
this novel human coronavirus is no more than a ubiquitous resident in the
human respiratory tract. Several respiratory viruses, such as the common
cold-associated coronaviruses and human respiratory syncytial virus, are
distributed world-wide and affect individuals of all ages. At the moment
the single fact that best identifies this virus as the etiologic agent
of SARS is its apparent low nucleotide sequence homology with other coronaviruses.
- Mod.CP]
-
-
- Patricia A. Doyle, PhD Please visit my "Emerging
Diseases" message board at: http://www.clickitnews.com/emergingdiseases/index.shtml
Zhan le Devlesa tai sastimasa Go with God and in Good Health
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