March 16, 2003
Rare Health Alert Is Issued by W.H.O. for Mystery Illness
By LAWRENCE K. ALTMAN and KEITH BRADSHER
As a mysterious respiratory illness spread to more countries, the World Health Organization today issued a rare health alert, declaring the ailment "a worldwide health threat" and urged all countries to help in seeking its cause and control.
The agency said that in the last week it had received reports of more than 150 new suspected cases of the illness, now known as Severe Acute Respiratory Syndrome, or SARS. The syndrome has caused at least six deaths and not one of the survivors has fully recovered. It apparently does not respond to antiviral and antibiotic drugs.
The cause has not been identified. Scientists do not know whether it is a virus or even an infectious agent. Although health officials have suspected avian influenza, which has infected a small number of people sporadically in Hong Kong since 1997, laboratory tests have not detected that rare strain, known as influenza A(H5N1). As a result, laboratory scientists are focusing on the possibility of a previously unknown infectious agent.
Reported cases have come from Canada and six countries in Asia — Hong Kong and elsewhere in China, Indonesia, the Philippines, Singapore, Thailand and Vietnam, the health organization said.
There have been no reports of the illness in the United States. But today, an ill passenger and two companions who traveled from New York City were removed from a flight after it arrived in Frankfurt and put in isolation in a German hospital.
The passenger is a surgeon from Singapore who treated one of the earliest cases there, and who flew to a medical meeting in New York City, said Dick Thompson, a spokesman for W.H.O. The surgeon may have gone to a hospital in New York — the agency is not certain which one — before flying back to Singapore via Frankfurt with his wife and another doctor. Before boarding the flight, the surgeon called a colleague in Singapore to describe his symptoms, and the colleague notified the World Health Organization.
In an emergency advisory issued today, the World Health Organization, an arm of the United Nations based in Geneva, said that "there is presently no indication to restrict travel to any destination."
But it urged all travelers to be aware of the main symptoms and signs. In addition to the breathing problems, the illness can cause a dry cough and other flulike symptoms that apparently develop about four to five days after exposure. They usually start with a sudden onset of high fever and go on to include muscle aches, headache, sore throat and shortness of breath.
Standard lab tests often show low numbers of white blood cells and platelets, which help blood to clot.
W.H.O. said that any passenger or airline crew member who developed such symptoms should immediately seek medical attention and ensure that information about their recent travel is passed on to the health care staff. "Any traveler who develops these symptoms is advised not to undertake further travel until they have recovered," the agency said.
If a passenger became ill on a flight, the agency asked airlines to alert the airport of destination and to refer any ill passengers to airport health officials.
"There are currently no indications to restrict the onward travel of well passengers, but all passengers and crew should be advised to seek medical attention if they develop" symptoms, the agency said.
In another rare step, the United States Centers for Disease Control and Prevention activated its emergency operations center in Atlanta, including sophisticated communications technology, to enhance its ability to coordinate information from other countries and to investigate any suspect cases in this country.
C.D.C. has used the operations center only twice before, for the mosquito-borne West Nile fever epidemic last year and the anthrax attacks in 2001. The last time it issued a global health alert was in 1993, to enhance measures to control tuberculosis. W.H.O. officials said they could not recall the last time an emergency global travel advisory was issued.
C.D.C. is investigating the travel histories of the passengers who are now in a German hospital as well as one of the eight cases suspected to be the new syndrome in Toronto and Vancouver that Canadian health officials reported on Friday.
W.H.O. officials said they at first thought the surgeon who fell ill was on a flight to London, but learned from a pharmaceutical company that paid for his trip that he was flying to Frankfurt instead. Two hours before landing, W.H.O. notified German health officials, who had the plane moved to a separate runway where the surgeon, his wife and colleague disembarked and were taken to a nearby hospital. German health officials advised the other passengers to monitor their health and gave them a telephone number to call if they developed any symptoms. Officials did not release any information on his condition.
Mr. Thompson said the cases in Toronto involved a family who returned home after flying to Hong Kong. A woman, Kwan Sui-chu, died shortly after her return. Five other family members who had not been to Hong Kong have since become ill; four are still in the hospital while the fifth, Mrs. Kwan's son, Chi Kwai Tse, died on March 13, according to Toronto Public Health officials.
Toronto health officials said they were aware of two other cases in Vancouver, British Columbia, both involving people who had recently traveled to Hong Kong.
C.D.C. officials are aiding in the investigation because Mrs. Kwan's daughter, who is being treated in an intensive care unit in Toronto, had flown to Atlanta recently, Mr. Thompson said.
So far, laboratory scientists have not been able to identify a known or novel infectious agent, said Dr. David L. Heymann, a W.H.O. official.
Japanese officials said their tests showed that the influenza virus was not the cause of the illness. But Dr. Heymann said that samples from more victims need to be tested, because it can take weeks for the immune system to produce influenza antibodies, the proteins that are formed to fight invading microbes.
"We have not ruled out influenza definitively," Dr. Heymann said.
Tests of victims' samples have found no evidence of mycoplasma or similar microbes that are the usual causes of atypical pneumonia. Additional tests have shown no evidence of Ebola or any of the other viruses that cause hemorrhagic fevers, hanta virus and bacteria.
In Hong Kong, an American businessman died on Thursday after passing through Hong Kong and falling ill in Hanoi, where 30 doctors and other medical personnel have fallen ill at the hospital where the businessman was initially treated before being sent back to Hong Kong.
Today, Hong Kong's secretary for health and welfare, Dr. Yeoh Eng-kiong, denied that the Chinese territory was experiencing a serious public health problem. Dr. Yeoh said that the outbreak in Hong Kong remained almost entirely confined to hospital workers and had not spread to the general community.http://www.nytimes.com